Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School

10 ARTICLES PUBLISHED IN JoVE

Neuroscience

Electrode Positioning and Montage in Transcranial Direct Current Stimulation

Alexandre F. DaSilva¹, Magdalena Sarah Volz^2,3, Marom Bikson⁴, Felipe Fregni²

¹Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Material Sciences, School of Dentistry, University of Michigan , ²Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, ³Charité, University Medicine Berlin, ⁴Department of Biomedical Engineering, The City College of New York

Transcranial direct current stimulation (tDCS) is an established technique to modulate cortical excitability^1,2. It has been used as an investigative tool in neuroscience due to its effects on cortical plasticity, easy operation, and safe profile. One area that tDCS has been showing encouraging results is pain alleviation ^3-5.

Medicine

Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation (HD-tDCS)

Mauricio F. Villamar^1,2, Magdalena Sarah Volz^1,3, Marom Bikson⁴, Abhishek Datta^1,4, Alexandre F. DaSilva^*5, Felipe Fregni^*1

¹Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, ²School of Medicine, Pontifical Catholic University of Ecuador, ³Charité University Medicine Berlin, ⁴The City College of The City University of New York, ⁵Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences, School of Dentistry, University of Michigan

High-definition transcranial direct current stimulation (HD-tDCS), with its 4x1-ring montage, is a noninvasive brain stimulation technique that combines both the neuromodulatory effects of conventional tDCS with increased focality. This article provides a systematic demonstration of the use of 4x1 HD-tDCS, and the considerations needed for safe and effective stimulation.

Behavior

Simultaneous EEG Monitoring During Transcranial Direct Current Stimulation

Pedro Schestatsky^1,2,3, Leon Morales-Quezada^3,4, Felipe Fregni³

¹Programa de Pós-Graduação em Ciências Médica, Universidade Federal do Rio Grande do Sul, ²Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES), ³Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, ⁴De Montfort University

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has shown initial therapeutic effects in several neurological conditions. The main mechanism underlying these therapeutic effects is the modulation of cortical excitability. Therefore, online monitoring of cortical excitability would help guide stimulation parameters and optimize its therapeutic effects. In the present article we review the use of a novel device that combines simultaneous tDCS and EEG monitoring in real time.

Medicine

A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation (tDCS) in Multiple Sclerosis (MS)

Margaret Kasschau^1,2, Kathleen Sherman^1,2, Lamia Haider², Ariana Frontario^1,2, Michael Shaw^1,2, Abhishek Datta³, Marom Bikson⁴, Leigh Charvet^1,2

¹Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center, ²Department of Neurology, Stony Brook Medicine, ³Soterix Medical, Inc, ⁴Department of Biomedical Engineering, The City College of New York

The goal of this pilot study is to describe a protocol for the remotely-supervised delivery of transcranial direct current stimulation (tDCS) so that the procedure maintains standards of in-clinic practice, including safety, reproducibility, and tolerability. The feasibility of this protocol was tested in participants with multiple sclerosis (MS).

Neuroscience

Remotely Supervised Transcranial Direct Current Stimulation: An Update on Safety and Tolerability

Michael T. Shaw¹, Margaret Kasschau², Bryan Dobbs¹, Natalie Pawlak¹, William Pau¹, Kathleen Sherman¹, Marom Bikson³, Abhishek Datta⁴, Leigh E. Charvet¹

¹New York University, Langone Medical Center, ²Stony Brook Medicine, ³City College of New York, ⁴Soterix Medical

This manuscript provides an updated remote supervision protocol that enables participation in transcranial direct current stimulation (tDCS) clinical trials while receiving treatment sessions from home. The protocol has been successfully piloted in both patients with multiple sclerosis and Parkinson's disease.

Medicine

Home-Based Transcranial Direct Current Stimulation Device Development: An Updated Protocol Used at Home in Healthy Subjects and Fibromyalgia Patients

Fabiana Carvalho^1,2, Aline Patrícia Brietzke^1,2, Assunta Gasparin^1,2, Franciele Pereira dos Santos^2,3, Rafael Vercelino⁴, Rafael Firmino Ballester^2,3, Paulo Roberto Stefani Sanches⁵, Danton Pereira da Silva Jr⁵, Iraci L. S. Torres^1,6, Felipe Fregni^7,8, Wolnei Caumo^1,2,9,10

¹Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), ²Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), ³School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), ⁴Faculdade de Desenvolvimento do Rio Grande do Sul (FADERGS), Health and Wellness School Laureate International Universities, ⁵Biomedical Engineering Department, Hospital de Clínicas de Porto Alegre (HCPA), ⁶Pharmacology Department, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), ⁷Department of Physical Medicine and Rehabilitation, Harvard Medical School, ⁸Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, ⁹Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), ¹⁰Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)

This study provides an updated home-based tDCS protocol that enables subjects to receive the beneficial effects of tDCS at home with an easy to use device with settings to control the use and dosage, enhancing the feasibility for long-term use at home.

Neuroscience

The Combined Use of Transcranial Direct Current Stimulation and Robotic Therapy for the Upper Limb

Marcus Yu Bin Pai¹, Thais Tavares Terranova¹, Marcel Simis¹, Felipe Fregni², Linamara Rizzo Battistella¹

¹Department of Physical Medicine and Rehabilitation, Instituto de Reabilitação Lucy Montoro, ²Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School

The combined use of transcranial direct current stimulation and robotic therapy as an add-on for conventional rehabilitation therapy may result in improved therapeutic outcomes due to modulation of brain plasticity. In this article, we describe the combined methods used in our institute for improving motor performance after stroke.

Neuroscience

Real-time Video Projection in an MRI for Characterization of Neural Correlates Associated with Mirror Therapy for Phantom Limb Pain

Faddi G. Saleh Velez^1,2, Camila B. Pinto^1,3, Emma S. Bailin⁴, Marionna Münger¹, Andrew Ellison⁵, Beatriz T. Costa¹, David Crandell⁶, Nadia Bolognini^7,8, Lotfi B. Merabet⁴, Felipe Fregni¹

¹Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, ²University of Chicago Medical Center, Department of Neurology, University of Chicago, ³Department of Neuroscience and Behavior, Psychology Institute, University of Sao Paulo, ⁴The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, ⁵Center for Biomedical Imaging, Department of Anatomy and Neurobiology, Boston University School of Medicine, ⁶Spaulding Rehabilitation Hospital, Harvard Medical School, ⁷Department of Psychology & Milan Center for Neuroscience, University of Milano-Bicocca, ⁸Neuropsychological Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano

We present a novel combined behavioral and neuroimaging protocol employing real-time video projection for the purpose of characterizing the neural correlates associated with mirror therapy within the magnetic resonance imaging scanner environment in leg amputee subjects with phantom limb pain.

Neuroscience

Measuring Contralateral Silent Period Induced by Single-Pulse Transcranial Magnetic Stimulation to Investigate M1 Corticospinal Inhibition

Ingrid Rebello-Sanchez¹, Joao Parente¹, Kevin Pacheco-Barrios^1,2, Anna Marduy¹, Danielle Carolina Pimenta¹, Daniel Lima¹, Eric Slawka¹, Alejandra Cardenas-Rojas¹, Gleysson Rodrigues Rosa¹, Kamran Nazim³, Abhishek Datta^3,4, Felipe Fregni¹

¹Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, ²Universidad de Investigación para la Generación y Síntesis de Evidencia en Salud, Universidad San Ignacio de Loyola, ³Research and Development, Soterix Medical, ⁴City College of New York

Contralateral silent period (cSP) assessment is a promising biomarker to index cortical excitability and treatment response. We demonstrate a protocol to assess cSP intended for studying M1 corticospinal inhibition of upper and lower limbs.

Neuroscience

Understanding the Effects of Non-Invasive Transauricular Vagus Nerve Stimulation on EEG and HRV

Anna Carolyna Gianlorenco^1,2, Kevin Pacheco-Barrios^1,3, Lucas Camargo¹, Elly Pichardo¹, Hyuk Choi^4,5, Jae-Jun Song^5,6, Felipe Fregni¹

¹Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, ²Physical Therapy Department, Federal University of Sao Carlos, ³Vicerrectorado de Investigación, Universidad de Investigación para la Generación y Síntesis de Evidencia en Salud, Universidad San Ignacio de Loyola, ⁴Department of Medical Sciences, Graduate School of Medicine, Korea University, ⁵Neurive Co., Ltd., ⁶Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center

This protocol provides information on how to apply transcutaneous auricular vagus nerve stimulation (taVNS) in a clinical trial, including potential biomarkers such as EEG metrics and heart rate variability (HRV) to measure the effect of this treatment on the autonomic nervous system.