DaSilva自动对焦收到CTSA高科技资金的赠与，美国密歇根大学的资金支持，以完成这项检讨。 Volz MS是从Charité基金会授予的奖学金资助。

1。材料<ol><li>检查如果你有所有需要的材料（ 表1，图1）。 TDCS设备应该是电池驱动，并作为一个常数与一个在miliAmps范围内的最大输出电流刺激的功能。在一些设备，电池可以征收。恒定电压（电压控制）刺激TDCS适当。使用的电源插座，电源设备，是不是方便或适当的正常运转的设备可能会提供没有警告的大电流强度。 </li><li> TDCS使用的电极通常由饱和与电解质（盐液）在穿孔海绵口袋内的金属或导电橡胶电极。另一种可能性是使用橡胶电极与导电凝胶。直接电流长时间通过整个金属电极（刺激的电子转换为通过身体进行离子 8）能产生不受欢迎的电化学产品，如pH值的变化。海绵口袋行为分开，从而缓冲区，皮肤电化学变化。 </li><li>出于这个原因，不应该被放在金属或橡胶电极在皮肤上，在TDCS。同样在刺激用户应警惕海绵脱水和运动。另一项相关的考虑是TDCS电极的耐用性和重用性。我们的经验，尤其是当电极的极性是旋转，并始终保持适当的刺激条件下，橡胶与金属电极可以重新使用。电解液的选择是在下面进一步讨论。经营经验，建议使用平面，穿孔海绵不是太粗，因为他们最好的吸收电解质的传导解决方案，并提供统一的皮肤接触8。 </li><li>是适用于局部麻醉剂的可能性。特别是对于短期持久的刺激，是不可能的斜坡时，它可能会阻止体感知觉和贸发局的刺激所产生的不舒服的感觉。使用局部麻醉剂的局部应用的另一个原因是创造最好的深水和积极TDCS条件之间的可比性，因为没有题目会觉得如果目前的流动或不和最佳致盲的情况将得到保障。这种方法特别是脆弱的，规划时，使用较大的强度，作为致盲可能在这种情况下7。虽然感觉/疼痛和皮肤有刺激性，并不总是相关，过度使用局部麻醉剂可能掩盖作为燃烧等严重的不良影响。 </li></ol>在本指南中，我们说明了设置疼痛管理的最典型的TDCS：使用导电橡胶电极，掌上型穿孔海绵，放在头的，没有局部麻醉。 2。测量<ol><li>确保主题是坐在舒适。 </li><li>面积的刺激，会发现通过测量头皮。通常情况下，“公约”的脑电10/20 系统是使用7。刺激的部位取决于您的实验方法。 </li><li>查找本地化的顶点（ 图2）： 测量距离鼻根枕外隆凸尖和标志中途使用皮肤标记。 鼻根-点之间的额头和鼻子的鼻甲骨的交界处，（ 图 3 ）。 枕外隆凸尖-枕骨最突出的点（ 图3）。 测量前耳穴之间的距离和标志半途而废。马克两个中途点找到顶点。 </li><li><ol><li>要定位初级运动皮层，或货币供应量M1，使用20％的耳廓测量和耳廓线（一侧的顶点）（ 图4）锆通过使用这种测量。这点应符合C3/C4脑电图位置。这种定位方法就足够了传统的大型电极TDCS focality。对于多个协调中心，TDCS，皮质本地化的其他方法可能需要。 </li><li>要查找的背外侧前额叶皮层（DLPFC）9,10：一个实用的方法是5厘米，向前来衡量，从货币供应量M1的位置，或使用10/20的脑电图系统。这应与F3或F4脑电图的位置，在这里看到（图5）。使用的电极传统TDCS时，这种方法确定刺激的部位是足够的。多个协调中心，TDCS，可能需要其他皮质定位的方法，如神经导航。 </li></ol></li></ol> 3。备皮<ol><li>检查任何预先退出刺激，削减，或病变部位的皮肤 - 避免受损的皮肤和颅骨病变，刺激。 </li><li>为了增加导，移动头发远离现场的刺激和清洁皮肤表面的化妆水，污物等删除任何迹象，让其干燥。浓密的头发的科目，使用导电胶可能是必要的。 </li><li>如果使用可重复使用的电极，检查插图的磨损橡胶和海绵。检查插图的磨损橡胶和海绵。如果有任何恶化的迹象，扔脏组件和使用新的电极。 </li></ol> 4。位置电极<ol><li>寻找刺激和皮肤准备的网站后，你应该把各地的头围的弹性或橡胶头带之一。弹性头带应置于枕外隆凸尖，以避免在刺激运动。松紧带应的非导电材料（或他们将作为电极）及非吸收性材料（海绵吸收液，以避免肩带）。 </li><li>海绵的每一方应与盐溶液浸泡。对于一个35厘米2海绵，约6毫升每端解决方案可能就足够了（共12毫升每海绵）。要小心，不要过分浸泡的海绵（不能过分潮湿，应无漏水，但也不会干，有一个良好的电极接触）。避免液体泄漏整个主题。您可以使用注射器，如果需要添加更多的解决方案。 有证据表明，较低浓度的NaCl（15毫米）的电解质溶液，更舒适的感知在与高浓度的NaCl（220 毫米 ）11,12这些解决方案比TDCS。由于去离子水的离子强度比NaCl溶液少得多，有一个显着对面的电极，并通过皮肤进行NaCl溶液相比，目前需要较大的电压。因此，建议的解决方案与使用适度的NaCl浓度，范围在15毫米至140毫米，这些浓度TDCS是更容易被认为舒适的，需要适度降低电压，同时仍然允许很好的传导电流。使用凝胶（改编应用，如脑电图）也被认为 - 没有证实有关的结果，采用穿孔海绵电极时的受益，一个主要的限制是设置清理刺激后增加麻烦。 </li><li>将电缆连接到设备。 请咨询您的刺激操作手册上的刺激应该是对之前或之后的刺激定位电极连接供电。电极使用的所有刺激，不应该被断开或已开始当电流流过连接。确保连线的极性是正确的，TDCS的影响是高度极性特定的（通常情况下，红色表示阳极，黑色或蓝色表示阴极电极，这是该公约，但检查与您的设备）。请注意，TDCS（和更广泛的一般的电刺激）的范围内，“阳极”总是显示相对的正极正向电流流介绍的身体，而“阴极”表示相对负端的正向电流，然后退出身体。 </li><li>插入连接线引脚牢固地插入插座上的导电橡胶插图开幕。 </li><li>滑动导电橡胶嵌入到海绵。电缆的绝缘部分将突出从海绵口袋开幕。确保覆盖整个导电橡胶的插图是由海绵，有没有连接线针的一部分是可见的。 </li><li>弹性头带下方放置一个海绵电极。确保过多的液体是不是从海绵头皮所不欲，在此过程中弹出，因为这会波及整个头皮电流的流动和流体消耗海绵。 </li><li>连接第二弹性头带的弹性头带，根据您要使用的电极蒙太奇（ 见表2） 。可用于其他弹性头带。 </li><li>下放置第二弹性头带的海绵头的第二个电极。确保你放到标记的区域，你想刺激。 </li><li>从一个设备终端，通过一个电极，整个身体，通过第二个电极的路径，回到第二个设备终端，形成了一个电路 - 可以测量其中的总电阻（电极和机体抵抗力的总和）。如果总电阻是高得离谱，这可能表明设置不当电极。如果您的设备测量电阻 - 这将是建议 - 指示字段应显示适当的电极接触。理想的情况下，应力求在5k欧姆的阻抗。有些设备的电压显示整个路径，而不是阻力 - 在这种情况下的电阻，可以简单地用欧姆定律（电阻=显示电压/电流）计算。许多设备继续提供阻力的迹象，在刺激过程中，它提供了一种有用的方法来检测一个潜在的危险情况（如干燥的电极）。在某些情况下，设备会自动终止刺激或减少刺激的强度如果超出了一定的阈值的阻力增大。 </li></ol> 5。开始TDCS <ol><li>在启动程序之前，任何禁忌的屏幕科目（见讨论）。 </li><li>主体应在轻松，舒适，在手术过程中醒来。应避免在TDCS与当前的皮质活动不受控制的干扰。对于刺激的运动皮层区，它已被证明无关的目标区域，以及激活长时间的肌肉收缩运动皮层的大规模密集的认知努力废除13 TDCS的影响。 </li><li>调整对TDCS的刺激，想要刺激，包括强度，时间，如果适用于您的设备，深水条件的设定（ 图 10）设置。需要注意的是一些刺激电极与皮肤之间的接触，以避免电击之前接通。 </li><li>现在启动的TDCS。为了减少任何不利的影响，开始加速当前的电流流过。许多商用设备，包括自动斜坡电流的开启和关闭的功能。有一点应该指出的是，受试者通常继续电流中断后，甚至感觉有些地方感觉。 </li><li>有些科目可能会遇到初步TDCS期间的不适。目前在这种情况下，可适度减少临时期间，例如50％，为主体的调整，然后逐步增加备份到所需的程度。此功能可能依赖于正在使用的设备。 </li><li>大多数受试者在开始的刺激，会感觉到有轻微的瘙痒感，然后在大多数情况下变淡。同样的，迅速变化的刺激电路立即可能引起周围神经射击。这个题目可以看到它与眼睛附近的电极简短视网膜幻视。这些影响可以在很大程度上避免通过提高治疗的开始和结束的当前和下。这也可能偶尔防止头晕或眩晕报道，当电流突然增加或减少。 7 </li><li>电流流过的刺激后，应斜坡关闭， 以及注意对高清晰度TDCS（HD - TDCS）：。电极较小的约2 厘米 2 HD - TDCS和经常使用的电极阵列（两个以上） TDCS引导通过对14个特定的应用程序的大脑电流。这种方法的文件只集中于传统TDCS（使用较大的海绵电极），重要的是要强调的是，HD - TDCS需要特定的电极15，备皮，和刺激的硬件。 不建议申请TDCS使用1-2毫安的海绵电极14,15。 </li></ol> 6。手术后<ol><li>要定期评估经颅直流电刺激，并记录这项技术的一个相当长的时间时期的安全，这是推荐使用的不利影响的调查问卷。 </li><li>这样的问卷调查应包括与TDCS相关的任何可能的不利影响。最常见的副作用是刺痛，瘙痒和烧灼感，头痛和不适感。你可以找到一个这样一个问卷Brunoni 等人的文章中的例子。 （2011年）16。此外，还建议收集像1至5或1到10级规模的不利影响的定量。 </li><li>人们还应该使用这种不利影响问卷后假刺激的情况下，揭示了两者之间的刺激的情况下更好的可比性。有证据表明，深水刺激引起的瘙痒和刺痛积极刺激的感觉可比金额。 </li></ol> 7。代表性的成果： TDCS设备应正确安装，显示，无论是目前在积极TDCS情况是流动的，或设备应显示深水模式运行时假刺激程序（ 图10）。 值得注意的是，甚至表明，电流流经系统的设备，目前实际上可能被分流通过皮肤。为了避免这种影响，这是建议电极之间有足够的距离。根据模拟研究，我们建议，8厘米至少使用5x7cm电极时 17 。 此外，建议咨询计算机头部模型14和神经生理学研究。这些额外的步骤将确保一个特定的蒙太奇皮质兴奋性的显着变化，正在被调查的面积。 正极刺激的代表是一个我ncrease大脑兴奋，而阴极刺激导致减少皮质兴奋。这有力的证据针对初级运动皮层（ 图6）的试验中已经显露。 电极尺寸的变化导致的焦距效果的变化。减少电极直径，可以实现焦距更刺激。这可以证明使用TMS在运动皮层。在另一方面通过增加电极的大小，它可能有一个功能无效电极（ 图8） 。 随着会议持续时间20分钟以上，并连续两天超过多个会话，TDCS的后效应将持续较长时间。这个例子是治疗疼痛综合征。 其中重要的一点是参比电极的位置。如果extracephalic位置选择，研究者应意识到作为参比电极的电流分布，可能会取代感应电流的峰值和修改TDCS的影响。 <img src="/files/ftp_upload/2744/2744fig1.jpg" alt="图1" /> 图1。材料<img src="/files/ftp_upload/2744/2744fig2.jpg" alt="图2" /> 图2：顶点的位置。皮质区的标志，符合10/20系统。 <img src="/files/ftp_upload/2744/2744fig3.jpg" alt="图3" /> 图3：鼻根和枕外隆凸尖位置<img src="/files/ftp_upload/2744/2744fig4.jpg" alt="图4" /> 图4：运动皮层的位置。皮质区的标志，符合10/20系统。 <img src="/files/ftp_upload/2744/2744fig5.jpg" alt="图5" /> 图5：DLPFC位置。 DLPFC =背外侧前额叶皮层。皮质区的标志，符合10/20系统。 <img src="/files/ftp_upload/2744/2744fig6.jpg" alt="图6" /> 图6：在皮质兴奋的变化，由于电流的极性和TDCS蒙太奇。表：贸发局的刺激诱导效应对电机的大小诱发电位（MEP），经颅磁刺激（TMS）的评估。 MEP的刺激后的振幅无刺激的MEP％。请注意，只有对侧运动皮层（M1） - 超轨道（FP2）蒙太奇设置导致的MEP的大小显着增加后，正极和阴极刺激后的MEP波幅下降。环境保护部在蒙太奇其他TDCS的幅度上有没有显着影响。图：电极的存款6（从2000 Nitsche修改）。 <img src="/files/ftp_upload/2744/2744fig7.jpg" alt="图7" /> 图7：电极尺寸<img src="/files/ftp_upload/2744/2744fig8.jpg" alt="图8" /> 图8：降低了电极的大小，导致了TDCS灶性效果。肌肉诱发电位（MEP）的外展小指（ADM）和第一背鳍interosseus肌肉在正极或阴极TDCS（FDI）的幅度大小。使用了35厘米的电极条件，正极和阴极TDCS影响的ADM和外国直接投资的MEP波幅大小类似的程度。在此蒙太奇，双方手部肌肉代表性的地区是位于下方的刺激电极。在一个较小的电极，这是只有在代表性区域的ADM情况下，外国直接投资的皮质代表性的MEP振幅变化的影响是不可再生的（ 见黄柱）18（从2007年Nitsche修改）。 <img src="/files/ftp_upload/2744/2744fig9.jpg" alt="图9" /> 图9：组织取决于电流密度。在不同组织中的电流密度计算。电流密度的大小是依赖于组织的电导率。请注意，约10％的电流密度达到19灰质（瓦格纳，2007年a修改）。 <img src="/files/ftp_upload/2744/2744fig10.jpg" alt="图10" /> 图10：不同的刺激条件：积极与假。一些TDCS设备提供积极和深水条件设置UPS。通常适用于刺激与光信号表示。 <table border="1"><tbody><tr><td> 材料 </td></tr><tr><td> TDCS设备</td></tr><tr><td> 9V电池（2个） </td></tr><tr><td>两个橡胶头频带</td></tr><tr><td>两个导电橡胶电极</td></tr><tr><td>两个海绵电极</td></tr><tr><td>电缆</td></tr><tr><td> NaCl溶液</td></tr><tr><td>测量胶带</td></tr></tbody></table> 表1。 <table border="1"><tbody><tr><td> 阳极电极定位 </td><td> 阴极电极定位 </td><td> 观测 </td><td> 注意事项 </td></tr><tr><td>初级运动皮层（M1） </td><td>跨轨道</td><td>这是最常用的蒙太奇。事实已证明，皮质兴奋的是可以改变的高达40％（ 图6） 。正极，在神经元去极化和神经元兴奋性增加刺激的结果，而阴极刺激有相反的结果。 </td><td>只有一个运动皮层刺激 - 可能是一个双边疼痛综合征问题。超轨道电极混杂影响也需要考虑。 </td></tr><tr><td>初级运动皮层（M1） </td><td>初级运动皮层</td><td> - 有趣的方法时，有一个电机皮层之间的双向半球的不平衡（如中风） - 可使用两个正极刺激电极（见第六行），阴极电极放在例如眶上区。 </td><td>电极可能是太接近每个分流的其他问题。 一个电极面积的减少将增加的分流程度， 沿皮肤19 因此分流不仅可能与电极定位也电极的大小。 该组织的相对性是依赖后，电极位置和大小的总电阻，电流流取决于电极属性19。 </td></tr><tr><td>背外侧前额叶皮层（DLPFC） </td><td>跨轨道</td><td>大部分用于DLPFC刺激- 20抑郁症和慢性疼痛3治疗的积极成果。 </td><td>只有单方面DLPFC刺激的情况可能与此蒙太奇。 </td></tr><tr><td>背外侧前额叶皮层</td><td>背外侧前额叶皮层</td><td> - 有趣的方法时，有一个半球双向失衡。 - 可用于两个正极刺激的情况（见第六行），阴极电极置于例如眶上区。 </td><td>电极可能太近等问题每个分流19。 （请参阅第二行，第四列）。 </td></tr><tr><td>枕</td><td>顶点</td><td>有趣的主动控制慢性疼痛试验或视觉皮层调制。 </td><td>主动控制使用时，参比电极放置在不同的地点内和种间实验方法之间的可比性问题。 </td></tr><tr><td>两个正极电极，例如汽车皮质</td><td>跨轨道</td><td>同时皮质兴奋性的改变</td><td> Transcallosal抑制可能会添加一个混杂因素21 </td></tr><tr><td>一个电极皮质的目标，如初级运动皮层（M1） </td><td>颅内外</td><td>避免混淆的两个电极与大脑中的7极性相反的效果。 </td><td>根据预定的目标，可能不会是最佳的电流分布，因此导致无效刺激22 </td></tr></tbody></table> 表2。电极定位7 注：这可能是不同的电极位置之间的差异可能是由于不同的电场方向的不同神经元的人口激活。

<ol>
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S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cortical+stimulation+of+the+prefrontal+cortex+with+transcranial+direct+current+stimulation+reduces+cue-provoked+smoking+craving:+a+randomized,+sham-controlled+study.">Cortical stimulation of the prefrontal cortex with transcranial direct current stimulation reduces cue-provoked smoking craving: a randomized, sham-controlled study.</a> J Clin Psychiatry. 69 (1), 32-32 (2006).</li></ol>

纽约市立大学拥有专利，对大脑的刺激Marom Bikson是一个发明家。 Marom Bikson是Soterix医疗公司的共同创始人

关键步骤： 进行检查之前，启动程序方面的内容： <ul><li>首先，患者应甄别是否有任何禁忌症为TDCS - 这些禁忌症可能是特定于应用程序。这包括，如存在严重或经常头痛，慢性皮肤疾病，或以前TDCS治疗的不良反应的问题。如果他或她有任何的头部金属或产生了严重的脑损伤，解剖变化，可能会修改当前流动 23,24 。扣押，怀孕和中风史的历史，通常没有严格的禁忌 - 而事实上，可能在一些临床试验入选标准。 </li><li>检查头皮此外科目任何病变，应具体面试和皮肤疾病的存在检查。如果有任何病变，应避免或TDCS的过程，如果合适，保证，不会直接或整个病灶进行刺激。刺激不同的网站可以考虑的。据悉，每天重复TDCS原因，在一些患者的电极 7临床意义的皮肤有刺激性。根据皮肤的完整性，是TDCS诱发病变的证据。例如，它已经显示出广泛的皮肤发红和棕色硬壳皮内变化，由于贸发局为一个为期2周，包括五次会议每星期25的刺激强度为2毫安的不规则圆形。如果TDCS强烈表示或已经进行，这是考虑到可能刺激强度较低，如0.5 - 1.0毫安，但它不能保证，这将防止皮肤过敏或病变。因此，电极下的皮肤状况应检查前后TDCS 7 。 </li><li>电解检查电缆的连接器。如果明显，使用另一对。这是约2个月的使用后，建议先检查电缆。 </li></ul>在主动或假的TDCS总是问是否受仍然感觉舒适，并能够继续程序。 可能的修改： <ul><li>电极定位（ 见表2）有许多品种。 </li><li>有许多品种的电极尺寸为 26（ 图7） 。对于一个给定的的外加电流，电极的大小会影响电流密度18和影响大脑调制（图 8） focality。临床研究表明电极的电流密度较大的26尺寸较小的，但是模拟研究显示，大脑调制电极的大小和面积之间的关系可能更复杂 27 。此外，小电极的影响可能有所不同质差分流，当前在头皮上，和更大的边缘效应相对于整体的电极面积7。有大幅分流小电极尺寸比较大的电极计划 19报告上级。 </li><li>高清晰度TDCS（HD - TDCS）是一种技术，提高了空间focality，但需要特殊的硬件和程序的控制15。 </li><li>随着施加电流的电极蒙太奇（电极位置和大小）确定在大脑中产生，反过来又决定了TDCS的疗效的电场强度。只是电极的电流密度之间的电流强度和电极尺寸的比例确定，已提出正常化临床结果 - 但模拟研究显示，这可能只适用于在有限的范围内，整体电极的蒙太奇设计决定的结果。一般情况下，增加更强的影响蒙太奇结果对于任何给定的电流强度（或电流密度）。重要的是要注意，在皮肤表面的电流密度比大脑中的 19（ 图9），高。 </li><li>电极的位置“回归”（“参考”），通过大脑可能会影响整体的电流流动模式，并由此甚至影响大脑调制下的 22个活跃的电极。因此应考虑两个电极药水。 </li><li>刺激的持续时间取决于实验方法的目的。刺激持续时间的增加，相关的发生和持续时间较长的后效应3,4。但至少有一项研究报告的影响时，刺激持续时间增加的方向逆转，这表明更多的强度并不一定能转化成一个更强大的临床结果。虽然公布的参数TDCS内被认为是安全和耐受性良好，潜在的不受欢迎的副作用增加强度的增加（时间，durati或重复率/数字）。 </li><li>电场方向：由电极的位置和极性定义。阴极刺激，通常会降低大脑皮层兴奋性，而正极的刺激，通常会增加皮质兴奋2,3。 </li><li>安慰剂：深水TDCS上述相同的协议使用。然而，目前将应用于为30秒。这是比其他非侵入性脑刺激方法的TDCS的优势之一。由于所产生的感觉，主动TDCS往往只发生在应用的早期阶段，这种假的方法使病人难以区分应用程序的活动TDCS安慰剂。这最初的和短暂的刺激，是一个可靠的方法， 安慰剂组28。 </li><li>请注意，该技术也可以使用其他颅电疗法， 如 TACS 29 日或TRNS 30日时应用。 </li></ul> 使用在慢性疼痛的TDCS的理由 ： 事实上，治疗多种药理方式为慢性疼痛患者只有轻微缓解，提出了一种可能性，这种令人衰弱的疾病的持久性的原因可能在于内疼痛相关的神经网络的塑料变化。有趣的是，皮质活动的调制可以实现非侵入性的TDCS，如前面所述，已报产生持久的慢性疼痛的治疗效果由于皮层可塑性变化。 在慢性疼痛的临床疗效TDCS： 它已被证明适用于运动皮层的TDCS改变了本地的皮质兴奋性（ 图 6） 6。更确切地说，在正极，阴极刺激神经 ​​元的兴奋性增加，而刺激的结果相反的结果。事实上，对货币供应量M1的应用程序导致正极TDCS一个较大的改善视觉模拟量表（VAS），疼痛比深水TDCS评级。这对疼痛的治疗效果，货币供应量M1的刺激后，虽然是短暂的，在神经性疼痛综合征的患者，如三叉神经痛，中风后疼痛综合征31， 背部疼痛和纤维肌痛32的几组复制。有趣的是，在神经性疼痛，由于脊髓损伤，运动皮层刺激TDCS的临床试验表明疼痛改善和累积的镇痛作用，历时两个星期后的刺激。也有其在纤维肌痛患者33的镇痛作用，仍然是经过三个星期的后续正极的M1 TDCS假的刺激，以及刺激DLPFC 33比较显着的证据。虽然疼痛改善对DLFPC正极TDCS的影响还没有被广泛探讨，结果表明它可用于在34个健康受试者的疼痛阈值来调节。然而，这一大脑区域的刺激，是一个可靠的技术提高工作记忆10，增加记忆任务中的表现在阿尔茨海默病9和显着降低线索挑起的吸烟渴求，例如35;因此它也是可以想象的，这可能是一个有用的策略来调节与慢性疼痛患者的疼痛处理相关的情感情感认知网络。

electrode positioning and montage in transcranial direct current stimulation

经颅直接电流刺激（TDCS）是一种技术，在过去十年中已经深入调查，这种方法提供了一种非侵入性和安全的替代品， 改变皮质兴奋2。一届的TDCS的影响可能会持续几分钟，其效果取决于刺激的极性，如阴极刺激诱导皮质兴奋性下降，和正极的刺激诱导皮质兴奋性的增加，可能会持续超越的持续时间刺激6。这些效应已在认知神经科学探索和多种神经精神疾病在临床上也超过了连续4次会议-尤其是当应用。已吸引了神经科学家和临床医生的注意的一个领域是TDCS疼痛相关的神经网络3,5调制使用。调制疼痛研究的两个主要的皮层区已探索：初级运动皮层和背外侧前额叶皮层 7 。由于电极蒙太奇的关键作用，在本文中，我们显示电极安置TDCS对疼痛的临床试验不同的选择;讨论刺激的每个方法的优点和缺点。

Watch this Scientific Journal Video about Electrode Positioning and Montage in Transcranial Direct Current Stimulation at JoVE.com

Electrode Positioning and Montage in Transcranial Direct Current Stimulation

经颅直接电流刺激（TDCS）是一个既定的技术，调节大脑皮层的兴奋性<sup&gt; 1,2</sup&gt;。它已被用来作为一个在神经科学的调查工具，由于其皮层可塑性强，操作简便，安全的个人资料的影响。一个领域，TDCS已经呈现出令人鼓舞的结果是疼痛缓解<sup&gt; 3-5</sup&gt;。

经颅直接电流刺激电极定位和蒙太奇

Transcranial direct current stimulation (tDCS) is a technique that has been intensively investigated in the past decade as this method offers a ...

electrode-positioning-montage-transcranial-direct-current

Research

JoVE Journal

Neuroscience

261.6K 次观看.  University of Michigan. 经颅直接电流刺激（TDCS）是一个既定的技术，调节大脑皮层的兴奋性 1,2。它已被用来作为一个在神经科学的调查工具，由于其皮层可塑性强，操作简便，安全的个人资料的影响。一个领域，TDCS已经呈现出令人鼓舞的结果是疼痛缓解 3-5。

视频: Electrode Positioning and Montage in Transcranial Direct Current Stimulation

Combining Transcranial Magnetic Stimulation and fMRI to Examine the Default Mode Network

The default mode network is a group of brain regions that are active when an individual is not focused on the outside world and the brain is at "wakeful rest."1,2,3 It is thought the default mode network corresponds to self-referential or "internal mentation".2,3
It has been hypothesized that, in humans, activity within the default mode network is correlated with certain pathologies (for instance, hyper-activation has been linked to schizophrenia 4,5,6 and autism spectrum disorders 7 whilst hypo-activation of the network has been linked to Alzheimer's and other neurodegenerative diseases 8). As such, noninvasive modulation of this network may represent a potential therapeutic intervention for a number of neurological and psychiatric pathologies linked to abnormal network activation. One possible tool to effect this modulation is Transcranial Magnetic Stimulation: a non-invasive neurostimulatory and neuromodulatory technique that can transiently or lastingly modulate cortical excitability (either increasing or decreasing it) via the application of localized magnetic field pulses.9
In order to explore the default mode network's propensity towards and tolerance of modulation, we will be combining TMS (to the left inferior parietal lobe) with functional magnetic resonance imaging (fMRI). Through this article, we will examine the protocol and considerations necessary to successfully combine these two neuroscientific tools.

In this article, we examine the methodology and considerations relevant to the combination of TMS and fMRI to examine the effects of brain stimulation on the default network.

结合经颅磁刺激和功能磁共振成像检查默认模式网络

The default mode network is a group of brain regions that are active when an individual is not focused on the outside world and the brain is at "wakeful ...

科研

神经科学

Direct-current Stimulation and Multi-electrode Array Recording of Seizure-like Activity in Mice Brain Slice Preparation

Cathodal transcranial direct-current stimulation (tDCS) induces suppressive effects on drug-resistant seizures. To perform effective actions, the stimulation parameters (e.g., orientation, field strength, and stimulation duration) need to be examined in mice brain slice preparations. Testing and arranging the orientation of the electrode relative to the position of the mice brain slice are feasible. The present method preserves the thalamocingulate pathway to evaluate the effect of DCS on anterior cingulate cortex seizure-like activities. The results of the multichannel array recordings indicated that cathodal DCS significantly decreased the amplitude of the stimulation-evoked responses and duration of 4-aminopyridine and bicuculline-induced seizure-like activity. This study also found that cathodal DCS applications at 15 min caused long-term depression in the thalamocingulate pathway. The present study investigates the effects of DCS on thalamocingulate synaptic plasticity and acute seizure-like activities. The current procedure can test the optimal stimulation parameters including orientation, field strength, and stimulation duration in an in vitro mouse model. Also, the method can evaluate the effects of DCS on cortical seizure-like activities at both the cellular and network levels.

Studies have shown that cathodal transcranial direct-current stimulation can produce suppressive effects on drug-resistant seizures. In this study, an in vitro experimental setup was devised in which the direct-current stimulation and multielectrode array recording of seizure-like activity were evaluated in mice brain slice preparation. The direct-current stimulation parameters were evaluated.

小鼠脑切片准备扣押样活性的直接电流刺激和多电极阵列记录

Cathodal transcranial direct-current stimulation (tDCS) induces suppressive effects on drug-resistant seizures. To perform effective actions, the ...

Effects of Transcranial Alternating Current Stimulation on the Primary Motor Cortex by Online Combined Approach with Transcranial Magnetic Stimulation

Transcranial Alternating Current Stimulation (tACS) is a neuromodulatory technique able to act through sinusoidal electrical waveforms in a specific frequency and in turn modulate ongoing cortical oscillatory activity. This neurotool allows the establishment of a causal link between endogenous oscillatory activity and behavior. Most of the tACS studies have shown online effects of tACS. However, little is known about the underlying action mechanisms of this technique because of the AC-induced artifacts on Electroencephalography (EEG) signals. Here we show a unique approach to investigate online physiological frequency-specific effects of tACS of the primary motor cortex (M1) by using single pulse Transcranial Magnetic Stimulation (TMS) to probe cortical excitability changes. In our setup, the TMS coil is placed over the tACS electrode while Motor Evoked Potentials (MEPs) are collected to test the effects of the ongoing M1-tACS. So far, this approach has mainly been used to study the visual and motor systems. However, the current tACS-TMS setup can pave the way for future investigations of cognitive functions. Therefore, we provide a step-by-step manual and video guidelines for the procedure.

Transcranial Alternating Current Stimulation (tACS) allows the modulation of cortical excitability in a frequency-specific fashion. Here we show a unique approach which combines online tACS with single pulse Transcranial Magnetic Stimulation (TMS) in order to "probe" cortical excitability by means of Motor Evoked Potentials.

经颅磁刺激在线联合方法对经颅交流电刺激对原发性运动皮层的影响

Transcranial Alternating Current Stimulation (tACS) is a neuromodulatory technique able to act through sinusoidal electrical waveforms in a specific ...

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

The remotely supervised tDCS (RS-tDCS) protocol enables participation from home through guided and monitored self-administration of tDCS treatment while maintaining clinical standards. The current consensus regarding the efficacy of tDCS is that multiple treatment sessions are needed to observe targeted behavioral reductions in symptom burden. However, the requirement for patients to travel to clinic daily for stimulation sessions presents a major obstacle for potential participants, due to work or family obligations or limited ability to travel. This study presents a protocol that directly overcomes these obstacles by eliminating the need to travel to clinic for daily sessions.
This is an updated protocol for remotely supervised self-administration of tDCS for daily treatment sessions paired with a program of computer-based cognitive training for use in clinical trials. Participants only need to attend clinic twice, for a baseline and study-end visit. At baseline, participants are trained and provided with a study stimulation device, and a small laptop computer. Participants then complete the remainder of their stimulation sessions at home while they are monitored via videoconferencing software.
Participants complete computerized cognitive remediation during stimulation sessions, which may serve a therapeutic role or as a &#34;placeholder&#34; for other computer-based activity. Computers are enabled for real-time monitoring and remote control by study staff.
Outcome measures that assess feasibility and tolerance are administered remotely with the aid of visual analogue scales that are presented onscreen. Following completion of all RS-tDCS sessions, participants return to clinic for a study end visit in which all study equipment is returned.
Results support the safety, feasibility, and scalability of the RS-tDCS protocol for use in clinical trials. Across 46 patients, 748 RS-tDCS sessions have been completed. This protocol serves as a model for use in future clinical trials involving tDCS.

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&#39;s disease.

远程监督的经颅直流电刺激: 安全性和耐受的最新进展

The remotely supervised tDCS (RS-tDCS) protocol enables participation from home through guided and monitored self-administration of tDCS treatment while ...

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

Neurologic disorders such as stroke and cerebral palsy are leading causes of long-term disability and can lead to severe incapacity and restriction of daily activities due to lower and upper limb impairments. Intensive physical and occupational therapy are still considered main treatments, but new adjunct therapies to standard rehabilitation that may optimize functional outcomes are being studied.
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that polarizes underlying brain regions through the application of weak direct currents through electrodes on the scalp, modulating cortical excitability. Increased interest in this technique can be attributed to its low cost, ease of use, and effects on human neural plasticity. Recent research has been performed to determine the clinical potential of tDCS in diverse conditions such as depression, Parkinson&#39;s disease, and motor rehabilitation after stroke. tDCS helps enhance brain plasticity and seems to be a promising technique in rehabilitation programs.
A number of robotic devices have been developed to assist in the rehabilitation of upper limb function after stroke. The rehabilitation of motor deficits is often a long process requiring multidisciplinary approaches for a patient to achieve maximum independence. These devices do not intend to replace manual rehabilitation therapy; instead, they were designed as an additional tool to rehabilitation programs, allowing immediate perception of results and tracking of improvements, thus helping patients to stay motivated.
Both tDSC and robot-assisted therapy are promising add-ons to stroke rehabilitation and target the modulation of brain plasticity, with several reports describing their use to be associated with conventional therapy and the improvement of therapeutic outcomes. However, more recently, some small clinical trials have been developed that describe the associated use of tDCS and robot-assisted therapy in stroke rehabilitation. In this article, we describe the combined methods used in our institute for improving motor performance after stroke.

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.

经颅直流电刺激与上肢机器人治疗的联合应用

Neurologic disorders such as stroke and cerebral palsy are leading causes of long-term disability and can lead to severe incapacity and restriction of ...

Transcranial Direct Current Stimulation (tDCS) in Mice

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique proposed as an alternative or complementary treatment for several neuropsychiatric diseases. The biological effects of tDCS are not fully understood, which is in part explained due to the difficulty in obtaining human brain tissue. This protocol describes a tDCS mouse model that uses a chronically implanted electrode allowing the study of the long-lasting biological effects of tDCS. In this experimental model, tDCS changes the cortical gene expression and offers a prominent contribution to the understanding of the rationale for its therapeutic use.

Transcranial Direct Current Stimulation tDCS in Mice

Transcranial direct current stimulation (tDCS) is a therapeutic technique proposed to treat psychiatric diseases. An animal model is essential for understanding the specific biological alterations evoked by tDCS. This protocol describes a tDCS mouse model that uses a chronically implanted electrode.

经颅直流电刺激 (tDCS) 在小鼠中的作用

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique proposed as an alternative or complementary treatment for ...

Stimulation Location Determination using a 3D Digitizer with High-Definition Transcranial Direct Current Stimulation

The abundance of neuroimaging data and rapid development of machine learning has made it possible to investigate brain activation patterns. However, causal evidence of brain area activation leading to a behavior is often left missing. Transcranial direct current stimulation (tDCS), which can temporarily alter brain cortical excitability and activity, is a noninvasive neurophysiological tool used to study causal relationships in the human brain. High-definition transcranial direct current stimulation (HD-tDCS) is a noninvasive brain stimulation (NIBS) technique that produces a more focal current compared to conventional tDCS. Traditionally, the stimulation location has been roughly determined through the 10-20 EEG system, because determining precise stimulation points can be difficult. This protocol uses a 3D digitizer with HD-tDCS to increase accuracy in determination of stimulation points. The method is demonstrated using a 3D digitizer for more accurate localization of stimulation points in the right temporo-parietal junction (rTPJ).

Presented here is a protocol to achieve higher accuracy in determination of stimulation location combining a 3D digitizer with high-definition transcranial direct current stimulation.

使用具有高清晰度颅内直接电流刺激的 3D 数字化仪确定刺激位置

The abundance of neuroimaging data and rapid development of machine learning has made it possible to investigate brain activation patterns. However, ...

In Vivo Intracellular Recording of Type-Identified Rat Spinal Motoneurons During Trans-Spinal Direct Current Stimulation

Intracellular recording of spinal motoneurons in vivo provides a &#8220;gold standard&#8221; for determining the cells&#8217; electrophysiological characteristics in the intact spinal network and holds significant advantages relative to classical in vitro or extracellular recording techniques. An advantage of in vivo intracellular recordings is that this method can be performed on adult animals with a fully mature nervous system, and therefore many observed physiological mechanisms can be translated to practical applications. In this methodological paper, we describe this procedure combined with externally applied constant current stimulation, which mimics polarization processes occurring within spinal neuronal networks. Trans-spinal direct current stimulation (tsDCS) is an innovative method increasingly used as a neuromodulatory intervention in rehabilitation after various neurological injuries as well as in sports. The influence of tsDCS on the nervous system remains poorly understood and the physiological mechanisms behind its actions are largely unknown. The application of the tsDCS simultaneously with intracellular recordings enables us to directly observe changes of motoneuron membrane properties and characteristics of rhythmic firing in response to the polarization of the spinal neuronal network, which is crucial for the understanding of tsDCS actions. Moreover, when the presented protocol includes the identification of the motoneuron with respect to an innervated muscle and its function (flexor versus extensor) as well as the physiological type (fast versus slow) it provides an opportunity to selectively investigate the influence of tsDCS on identified components of spinal circuitry, which seem to be differently affected by polarization. The presented procedure focuses on surgical preparation for intracellular recordings and stimulation with an emphasis on the steps which are necessary to achieve preparation stability and reproducibility of results. The details of the methodology of the anodal or cathodal tsDCS application are discussed while paying attention to practical and safety issues.

This protocol describes in vivo intracellular recording of rat lumbar motoneurons with simultaneous trans-spinal direct current stimulation. The method enables us to measure membrane properties and to record rhythmic firing of motoneurons before, during and after anodal or cathodal polarization of the spinal cord.

在跨脊柱直流刺激期间类型识别大鼠脊柱腺瘤的 Vivo 细胞内记录

Intracellular recording of spinal motoneurons in vivo provides a &#8220;gold standard&#8221; for determining the cells&#8217; electrophysiological ...

Simultaneous Application of Transcranial Direct Current Stimulation during Virtual Reality Exposure

Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that changes the likelihood of neuronal firing through modulation of neural resting membranes. Compared to other techniques, tDCS is relatively safe, cost-effective, and can be administered while individuals are engaged in controlled, specific cognitive processes. This latter point is important as tDCS may predominantly affect intrinsically active neural regions. In an effort to test tDCS as a potential treatment for psychiatric illness, the protocol described here outlines a novel procedure that allows the simultaneous application of tDCS during exposure to trauma-related cues using virtual reality (tDCS+VR) for veterans with posttraumatic stress disorder (NCT03372460). In this double-blind protocol, participants are assigned to either receive 2 mA tDCS, or sham stimulation, for 25 minutes while passively watching three 8-minute standardized virtual reality drives through Iraq or Afghanistan, with virtual reality events increasing in intensity during each drive. Participants undergo six sessions of tDCS+VR over the course of 2-3 weeks, and psychophysiology (skin conductance reactivity) is measured throughout each session. This allows testing for within and between session changes in hyperarousal to virtual reality events and adjunctive effects of tDCS. Stimulation is delivered through a built-in rechargeable battery-driven tDCS device using a 1 (anode) x 1 (cathode) unilateral electrode set-up. Each electrode is placed in a 3 x 3 cm (current density 2.22 A/m2) reusable sponge pocket saturated with 0.9% normal saline. Sponges with electrodes are attached to the participant&#8217;s skull using a rubber headband with the electrodes placed such that they target regions within the ventromedial prefrontal cortex. The virtual reality headset is placed over the tDCS montage in such a way as to avoid electrode interference.

This manuscript outlines a novel protocol to allow the simultaneous application of transcranial direct current stimulation during exposure to warzone trauma-related cues using virtual reality for veterans with posttraumatic stress disorder.

虚拟现实曝光期间颅外直接电流刺激的同步应用

Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that changes the likelihood of neuronal firing through ...

Transcranial Direct Current Stimulation (tDCS) for Memory Enhancement

Memory enhancement is one of the great challenges in cognitive neuroscience and neurorehabilitation. Among various techniques used for memory enhancement, transcranial direct current stimulation (tDCS) is emerging as an especially promising tool for improvement of memory functions in a non-invasive manner. Here, we present a tDCS protocol that can be applied for memory enhancement in healthy-participant studies as well as in aging and dementia research. The protocol uses weak constant anodal current to stimulate cortical targets within cortico-hippocampal functional network engaged in memory processes. The target electrode is placed either on the posterior parietal cortex (PPC) or the dorsolateral prefrontal cortex (DLPFC), while the return electrode is placed extracranially (i.e., on the contralateral cheek). In addition, we outline a more advanced method of oscillatory tDCS, mimicking a natural brain rhythm to promote hippocampus-dependent memory functions, which can be applied in a personalized and non-personalized manner. We present illustrative results of associative and working memory improvement following single tDCS sessions (20 minutes) in which the described electrode montages were used with current intensities between 1.5 mA and 1.8 mA. Finally, we discuss crucial steps in the protocol and methodological decisions that must be made when designing a tDCS study on memory.

Transcranial Direct Current Stimulation tDCS for Memory Enhancement

A protocol for memory enhancement by using transcranial direct current stimulation (tDCS) targeting dorsolateral prefrontal and posterior parietal cortices, as core cortical nodes within hippocampo-cortical network, is presented. The protocol has been well evaluated in healthy-participant studies and is applicable to aging and dementia research as well.

用于增强内存的颅外直接电流刺激 （tDCS）

Memory enhancement is one of the great challenges in cognitive neuroscience and neurorehabilitation. Among various techniques used for memory enhancement, ...