DaSilva AF a reçu le soutien financier du CSTC high-tech subvention, l&#39;Université du Michigan pour effectuer cet examen. Volz MS est financé par une bourse subvention de Stiftung Charité.

<ol>
	<li>Fregni, F., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technology+insight:+noninvasive+brain+stimulation+in+neurology-perspectives+on+the+therapeutic+potential+of+rTMS+and+tDCS.">Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS.</a> Nat Clin Pract Neurol. 3 (7), 383-383 (2007).</li><li>Wagner, T., Valero-Cabre, A., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Noninvasive+human+brain+stimulation.">Noninvasive human brain stimulation.</a> Annu Rev Biomed Eng. 9, 527-527 (2007).</li><li>Fregni, F., Freedman, S., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recent+advances+in+the+treatment+of+chronic+pain+with+non-invasive+brain+stimulation+techniques.">Recent advances in the treatment of chronic pain with non-invasive brain stimulation techniques.</a> Lancet Neurol. 6 (2), 188-188 (2007).</li><li>Lefaucheur, J. P., Antal, A., Ahdab, R., Ciampi de Andra, D., Fregni, F., Khedr, E. M., Nitsche, M., Paulus, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+repetitive+transcranial+magnetic+stimulation+(rTMS)+and+transcranial+direct+current+stimulation+(tDCS)+to+relieve+pain.">The use of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) to relieve pain.</a> Brain Stimul. 1 (4), 337-337 (2008).</li><li>Antal, A., Paulus, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+magnetic+and+direct+current+stimulation+in+the+therapy+of+pain.">Transcranial magnetic and direct current stimulation in the therapy of pain.</a> Schmerz Apr. 24 (2), 161-161 (2010).</li><li>Nitsche, M. A., Paulus, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Excitability+changes+induced+in+the+human+motor+cortex+by+weak+transcranial+direct+current+stimulation.">Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.</a> J Physiol. 527 (Pt 3), 633-633 (2000).</li><li>Nitsche, M. A., Cohen, L. G., Wassermann, E. M., Priori, A., Lang, N., Antal, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation:+state+of+the+art.">Transcranial direct current stimulation: state of the art.</a> Brain Stimul. 11, 642-642 (2008).</li><li>Merrill, D. R., Bikson, M., Jefferys, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrical+stimulation+of+excitable+tissue:+design+of+efficacious+and+safe+protocols.">Electrical stimulation of excitable tissue: design of efficacious and safe protocols.</a> J Neurosci Methods. 141 (2), 171-171 (2005).</li><li>Boggio, P. S., Khoury, L. P., Martins, D. C., Martins, O. E., de Macedo, E. C., Fregni, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temporal+cortex+direct+current+stimulation+enhances+performance+on+a+visual+recognition+memory+task+in+Alzheimer+disease.">Temporal cortex direct current stimulation enhances performance on a visual recognition memory task in Alzheimer disease.</a> J Neurol Neurosurg Psychiatry. 80 (4), 444-444 (2009).</li><li>Fregni, F., Boggio, P. S., Nitsche, M., Bermpohl, F., Antal, A., Feredoes, E., Marcolin, M. A., Rigonatti, S. P., Silva, M. T., Paulus, W., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anodal+transcranial+direct+current+stimulation+of+prefrontal+cortex+enhances+working+memory.">Anodal transcranial direct current stimulation of prefrontal cortex enhances working memory.</a> Exp Brain Res. 166 (1), 23-23 (2005).</li><li>Dundas, J. E., Thickbroom, G. W., Mastaglia, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perception+of+comfort+during+transcranial+DC+stimulation:+effect+of+NaCl+solution+concentration+applied+to+sponge+electrodes.">Perception of comfort during transcranial DC stimulation: effect of NaCl solution concentration applied to sponge electrodes.</a> Clin Neurophysiol. 118 (5), 1166-1166 (2007).</li><li>Minhas, P., Datta, A., Bikson, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cutaneous+perception+during+tDCS:+Role+of+electrode+shape+and+sponge+salinity.">Cutaneous perception during tDCS: Role of electrode shape and sponge salinity.</a> Clin Neurophysiol. 11, (2010).</li><li>Antal, A., Terney, D., Poreisz, C., Paulus, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Towards+unravelling+task-related+modulations+of+neuroplastic+changes+induced+in+the+human+motor+cortex.">Towards unravelling task-related modulations of neuroplastic changes induced in the human motor cortex.</a> Eur J Neurosci. 26 (9), 2687-2687 (2007).</li><li>Datta, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gyri-precise+head+model+of+transcranial+direct+current+stimulation:+improved+spatial+focality+using+a+ring+electrode+versus+conventional+rectangular+pad.">Gyri-precise head model of transcranial direct current stimulation: improved spatial focality using a ring electrode versus conventional rectangular pad.</a> Brain Stimul. 2 (4), 201-201 (2009).</li><li>Minhas, P., Bansal, V., Patel, J., Ho, J. S., Diaz, J., Datta, A., Bikson, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrodes+for+high-definition+transcutaneous+DC+stimulation+for+applications+in+drug+delivery+and+electrotherapy,+including+tDCS.">Electrodes for high-definition transcutaneous DC stimulation for applications in drug delivery and electrotherapy, including tDCS.</a> J Neurosci Methods. 190 (2), (2010).</li><li>Brunoni, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Systematic+Review+on+Reporting+and+Assessment+of+Adverse+Effects+associated+with+Transcranial+Direct+Current+Stimulation.">A Systematic Review on Reporting and Assessment of Adverse Effects associated with Transcranial Direct Current Stimulation.</a> Int J Neuropsychopharmacol. , (2011).</li><li>Wagner, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation:+a+computer-based+human+model+study.">Transcranial direct current stimulation: a computer-based human model study.</a> Neuroimage. 35 (3), 1113-1113 (2007).</li><li>Nitsche, M. A., Doemkes, S., Karaköse, T., Antal, A., Liebetanz, D., Lang, N., Tergau, F., Paulus, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Shaping+the+effects+of+transcranial+direct+current+stimulation+of+the+human+motor+cortex.">Shaping the effects of transcranial direct current stimulation of the human motor cortex.</a> J Neurophysiol. 97 (4), 3109-3109 (2007).</li><li>Wagner, T., Fregni, F., Fecteau, S., Grodzinsky, A., Zahn, M., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation:+a+computer-based+human+model+study.">Transcranial direct current stimulation: a computer-based human model study.</a> Neuroimage. 35 (3), 1113-1113 (2007).</li><li>Boggio, P. S., Rigonatti, S. P., Ribeiro, R. B., Myczkowski, M. L., Nitsche, M. A., Pascual-Leone, A., Fregni, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomized,+double-blind+clinical+trial+on+the+efficacy+of+cortical+direct+current+stimulation+for+the+treatment+of+major+depression.">A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression.</a> Int J Neuropsychopharmacol. 11 (2), 249-249 (2008).</li><li>Williams, J. A., Pascual-Leone, A., Fregni, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interhemispheric+modulation+induced+by+cortical+stimulation+and+motor+training.">Interhemispheric modulation induced by cortical stimulation and motor training.</a> Phys Ther. 90 (3), 398-398 (2010).</li><li>Lang, N., Nitsche, M. A., Rothwel, J. C., Williams, J. A., Lemon, R. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+transcranial+direct+current+stimulation+over+the+human+motor+cortex+on+corticospinal+and+transcallosal+excitability.">Effects of transcranial direct current stimulation over the human motor cortex on corticospinal and transcallosal excitability.</a> Exp Brain Res. 156 (4), 439-439 (2004).</li><li>Bikson, M., Datta, A., Rahman, A., Scaturro, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrode+montages+for+tDCS+and+weak+transcranial+electrical+stimulation:+role+of+"return"+electrode's+position+and+size.">Electrode montages for tDCS and weak transcranial electrical stimulation: role of "return" electrode's position and size.</a> Clin Neurophysiol. 121 (12), (1976).</li><li>Bikson, M., Fregni, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation+in+patients+with+skull+defects+and+skull+plates:+high-resolution+computational+FEM+study+of+factors+altering+cortical+current+flow.">Transcranial direct current stimulation in patients with skull defects and skull plates: high-resolution computational FEM study of factors altering cortical current flow.</a> Neuroimage. 52 (4), 1268-1268 (2010).</li><li>Datta, A., Baker, J. M., Bikson, M., Fridriksson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Individualized+model+predicts+brain+current+flow+during+transcranial+direct-current+stimulation+treatment+in+responsive+stroke+patient.">Individualized model predicts brain current flow during transcranial direct-current stimulation treatment in responsive stroke patient.</a> Brain Stimulation. , (2011).</li><li>Palm, U., Keeser, D., Schiller, C., Fintescu, Z., Nitsche, M., Reisinger, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Padberg+Skin+lesions+after+treatment+with+transcranial+direct+current+stimulation+(tDCS).">Padberg Skin lesions after treatment with transcranial direct current stimulation (tDCS).</a> Brain Stimul. 1 (4), 386-386 (2008).</li><li>Datta, A., Elwassif, M., Bikson, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bio-heat+transfer+model+of+transcranial+DC+stimulation:+comparison+of+conventional+pad+versus+ring+electrode.">Bio-heat transfer model of transcranial DC stimulation: comparison of conventional pad versus ring electrode.</a> Conf Proc IEEE Eng Med Biol Soc. , 670-670 (2009).</li><li>Miranda, P. C., Faria, P., Hallett, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+does+the+ratio+of+injected+current+to+electrode+area+tell+us+about+current+density+in+the+brain+during+tDCS?.">What does the ratio of injected current to electrode area tell us about current density in the brain during tDCS?.</a> Clin Neurophysiol. 120 (6), 1183-1183 (2009).</li><li>Gandiga, P. C., Hummel, F. C., Cohen, L. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+DC+stimulation+(tDCS):+a+tool+for+double-blind+sham-controlled+clinical+studies+in+brain+stimulation.">Transcranial DC stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in brain stimulation.</a> Clin Neurophysiol. 117 (4), 845-845 (2006).</li><li>Antal, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparatively+weak+after-effects+of+transcranial+alternating+current+stimulation+(tACS)+on+cortical+excitability+in+humans.">Comparatively weak after-effects of transcranial alternating current stimulation (tACS) on cortical excitability in humans.</a> Brain Stimul. 1 (2), 97-97 (2008).</li><li>Terney, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increasing+human+brain+excitability+by+transcranial+high-frequency+random+noise+stimulation.">Increasing human brain excitability by transcranial high-frequency random noise stimulation.</a> J Neurosci Methods. 28 (52), 14147-14147 (2008).</li><li>Fregni, F., Boggio, P. S., Mansur, C. G., Wagner, T., Ferreira, M. J., Lima, M. C., Rigonatti, S. P., Marcolin, M. A., Freedman, S. D., Nitsche, M. A., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation+of+the+unaffected+hemisphere+in+stroke+patients.">Transcranial direct current stimulation of the unaffected hemisphere in stroke patients.</a> Neuroreport. 16 (14), 1551-1551 (2005).</li><li>Antal, A., Terney, D., K hnl, S., Paulus, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anodal+transcranial+direct+current+stimulation+of+the+motor+cortex+ameliorates+chronic+pain+and+reduces+short+intracortical+inhibition.">Anodal transcranial direct current stimulation of the motor cortex ameliorates chronic pain and reduces short intracortical inhibition.</a> J Pain Symptom Manage. 39 (5), (2010).</li><li>Fregni, F., Gimenes, R., Valle, A. C., Ferreira, M. J., Rocha, R. R., Natalle, L., Bravo, R., Rigonatti, S. P., Freedman, S. D., Nitsche, M. A., Pascual-Leone, A., Boggio, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomized,+sham-controlled,+proof+of+principle+study+of+transcranial+direct+current+stimulation+for+the+treatment+of+pain+in+fibromyalgia.">A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia.</a> Arthritis Rheum. 54 (12), (2006).</li><li>Boggio, P. S., Zaghi, S., Lopes, M., Fregni, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modulatory+effects+of+anodal+transcranial+direct+current+stimulation+on+perception+and+pain+thresholds+in+healthy+volunteers.">Modulatory effects of anodal transcranial direct current stimulation on perception and pain thresholds in healthy volunteers.</a> Eur J Neurol. 15 (10), 1124-1124 (2008).</li><li>Fregni, F., Liguori, P., Fecteau, S., Nitsche, M. A., Pascual-Leone, A., Boggio, P. 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>

La City University de New York détient des brevets sur la stimulation cérébrale, sur lequel Marom Bikson est un inventeur. Marom Bikson est une co-fondateur de Medical Inc Soterix

Étapes critiques: Les aspects à être contrôlée avant la procédure de départ: <ul><li> Tout d&#39;abord, les patients doivent être testés pour savoir s&#39;il existe des contre-indications pour STCC - ces contre-indications peuvent être d&#39;application spécifique. Cela inclut des questions telles que la présence de céphalées sévères ou fréquentes, les troubles chroniques de la peau, ou de réactions indésirables à un traitement antérieur STCC. Si il ou elle a toute de métal dans la tête ou a eu un traumatisme crânien grave, les changements anatomiques peuvent modifier le flux de courant 23,24. Histoire de la saisie, la grossesse et l&#39;histoire d&#39;un AVC ne sont généralement pas des contre-indications strictes - et en effet, peut-être les critères d&#39;inclusion dans certains essais cliniques. </li><li> Vérifiez la présence de lésions sur le cuir chevelu en plus sujets devraient être spécifiquement interrogés et inspectés pour l&#39;existence de maladies de peau. S&#39;il ya des lésions, la procédure STCC devrait être évitée ou, le cas échéant, s&#39;assurer que la stimulation ne sera pas réalisée directement sur ou à travers la lésion. La stimulation d&#39;un autre site ne peut être envisagée. Il est rapporté que répétées STCC quotidienne provoque une irritation cutanée cliniquement significative sous les électrodes dans certaines 7 patients. Il ya des preuves de lésions induites par STCC selon intégrité de la peau. Par exemple, il a été démontré rougeur étendue et brun changements intracutanée croustillant aux formes rondes irrégulière due à la stimulation TDC à une intensité de 2 mA pour une période de deux semaines, dont cinq séances par semaine 25. Si STCC est fortement indiquée ou doit être réalisée, il est possible de prendre en considération pour stimuler avec une intensité plus faible, comme 0,5 à 1,0 mA, mais il n&#39;est pas garanti que cela va empêcher les irritations de la peau ou des lésions. Ainsi, la condition de la peau sous les électrodes doivent être inspectés avant et après STCC 7. </li><li> Vérifiez les connecteurs des câbles pour l&#39;électrolyse. Utilisez une autre paire si évident. Il est recommandé de vérifier les câbles après environ deux mois d&#39;utilisation. </li></ul> Pendant les deux-active ou factice STCC toujours se demander si l&#39;objet se sent toujours à l&#39;aise et est capable de continuer la procédure. Modifications possibles: <ul><li> Il ya beaucoup de variétés de positionnement des électrodes 7 (tableau 2). </li><li> Il ya beaucoup de variétés de 26 tailles d&#39;électrode (figure 7). Pour une donnée courant appliqué, la taille des électrodes influence la densité de courant 18 et influe sur la focalité du cerveau de modulation (figure 8). Des études cliniques ont suggèrent plus la taille de l&#39;électrode de plus la densité de courant 26, cependant les études de modélisation suggèrent que la relation entre la taille de l&#39;électrode et la zone de modulation du cerveau peut être plus complexe 27. Par ailleurs, les effets de petites électrodes peuvent différer qualitativement en raison de manœuvres différentiel de courant dans le cuir chevelu, et plus les effets relatifs de bord à la zone des électrodes globale 7. Il y avait radicalement des niveaux supérieurs de manœuvre pour les tailles petite électrode rapporté que pour les régimes d&#39;électrode plus grande 19. </li><li> High-Definition STCC (HD-STCC) est une technologie qui améliore focalité spatiale, mais nécessite un matériel spécial et des contrôles procéduraux 15. </li><li> L&#39;électrode (position de l&#39;électrode et la taille) le montage avec le courant appliqué de déterminer l&#39;intensité du champ électrique généré dans le cerveau qui, à son tour, détermine l&#39;efficacité du STCC. L&#39;utilisation de la densité d&#39;électrode simplement actuel, défini par le rapport entre la force du courant et la taille des électrodes, a été proposé de normaliser les résultats cliniques - mais les études de modélisation suggèrent cela ne peut s&#39;appliquer sur une gamme limitée et que l&#39;électrode de conception globale montage détermine le résultat. Généralement, l&#39;augmentation de l&#39;intensité du courant (ou la densité de courant) pour un résultat donné montage dans plus d&#39;effets. Il est important de noter que la densité de courant à la surface de la peau est beaucoup plus élevé que dans le cerveau 19 (figure 9). </li><li> La position du «retour» («de référence») d&#39;électrode peuvent influencer l&#39;écoulement de courant globale à travers le cerveau, et donc même influencer la modulation du cerveau sous les électrodes actives 22. Ainsi, la potion de deux électrodes doit être envisagée. </li><li> La durée de la stimulation dépend de l&#39;objectif de la démarche expérimentale. Une augmentation de la durée de la stimulation est associée à l&#39;apparition et une plus longue durée de séquelles 3,4. Toutefois, au moins une étude a révélé un renversement de sens lorsque la durée des effets de stimulation a été augmenté, ce qui suggère que plus d&#39;intensité ne se traduit pas nécessairement un résultat plus robuste clinique. Bien que l&#39;intérieur de paramètres STCC publié est considéré comme sûr et bien toléré, le potentiel d&#39;effets secondaires indésirables augmente avec l&#39;intensité croissante (le temps, duratisur, ou la répétition de taux / nombre). </li><li> Orientation du champ électrique: défini par les positions des électrodes et de la polarité. La stimulation cathodique diminue généralement excitabilité corticale, alors que la stimulation anodique augmente généralement l&#39;excitabilité corticale 2,3. </li><li> Placebo: Pour factice STCC le même protocole est utilisé ci-dessus. Cependant, le courant sera appliqué pendant 30 secondes. C&#39;est l&#39;un des avantages de la STCC rapport à d&#39;autres méthodes non invasives de stimulation cérébrale. Depuis les sensations découlant résulté de STCC-actifs ont tendance à se produire que dans les premières étapes d&#39;application, cette méthode imposture, il est difficile pour le patient à distinguer le groupe placebo de l&#39;application STCC actif. Cette stimulation initiale et brève est une méthode fiable d&#39;un placebo 28. </li><li> Notez que la technique peut également être appliquée lors de l&#39;utilisation d&#39;autres thérapies transcrânienne électriques tels que les TAC 29 ou 30 RRT. </li></ul> Justification de l&#39;aide STCC dans la douleur chronique: Le fait que plusieurs thérapeutiques pharmacologiques modalités n&#39;apportent qu&#39;un soulagement modeste pour la douleur chronique des patients soulève la possibilité que la cause de la persistance de cette maladie débilitante peut se situer dans les changements de plastique dans la douleur liée réseaux de neurones. Fait intéressant, la modulation de l&#39;activité corticale peut être réalisé de façon non invasive par STCC, comme décrit précédemment, ce qui a été rapporté pour produire durablement des effets thérapeutiques de la douleur chronique due à des changements dans la plasticité corticale. Effet clinique de la douleur chronique STCC: Il a été démontré que STCC appliquée au cortex moteur des changements de l&#39;excitabilité corticale locale (figure 6) 6. Plus précisément, les résultats de stimulation anodique à une augmentation de l&#39;excitabilité neuronale, alors que la stimulation cathodique a des résultats opposés 6. En effet, l&#39;application anodique STCC plus M1 conduit à une plus grande amélioration de l&#39;échelle visuelle analogique (EVA) notes de douleur que STCC imposture. Cet effet thérapeutique sur la douleur suite à une stimulation M1, bien que transitoire, a été reproduite dans plusieurs groupes de patients atteints de syndromes de douleur neuropathique, comme la névralgie du trijumeau, le syndrome de la douleur poststroke 31, les maux de dos et la fibromyalgie 32. Fait intéressant, les essais cliniques dans la douleur neuropathique, en raison de blessures à la moelle épinière, la stimulation du cortex moteur par STCC a montré une amélioration des douleurs et cumulatifs effet analgésique qui a duré deux semaines après la stimulation. Il ya aussi des preuves de son effet analgésique chez les patients fibromyalgiques 33 qui est toujours significative après trois semaines de suivi pour STCC anodique de la M1 par rapport à une stimulation factice, et ainsi que la stimulation du 33 DLPFC. Bien que les effets de la STCC anodique plus DLFPC pour l&#39;amélioration des douleurs n&#39;ont pas été explorées intensivement, il a été démontré qu&#39;il peut être utilisé pour moduler les seuils de douleur chez des sujets sains 34. Néanmoins, la stimulation de cette zone du cerveau est une technique fiable pour améliorer la mémoire de travail 10, en augmentant les performances sur des tâches de mémoire dans la maladie d&#39;Alzheimer et la réduction de 9 cue-provoqué soif de fumer de façon significative 35 par exemple; par conséquent, il est également concevable que cela pourrait être une stratégie utile pour moduler affectivo-émotionnelles réseaux cognitifs associés au traitement des douleurs chez les patients souffrant de douleurs chroniques.

electrode positioning and montage in transcranial direct current stimulation

Stimulation transcrânienne à courant continu (STCC) est une technique qui a été intensivement étudiés dans la dernière décennie que cette méthode offre une alternative non invasive et sûre à changer l&#39;excitabilité corticale 2. Les effets d&#39;une session du STCC peut durer plusieurs minutes, et ses effets dépendent de la polarité de stimulation, comme celui de stimulation cathodique induit une diminution de l&#39;excitabilité corticale, et la stimulation anodique induit une augmentation de l&#39;excitabilité corticale qui peut durer au-delà de la durée de la stimulation 6. Ces effets ont été explorées en neurosciences cognitives et aussi sur le plan clinique dans une variété de troubles neuropsychiatriques - surtout lorsqu&#39;il est appliqué sur plusieurs séances consécutives 4. Un domaine qui a été d&#39;attirer l&#39;attention des neuroscientifiques et les cliniciens est l&#39;utilisation de STCC d&#39;une modulation des douleurs liées à des réseaux de neurones 3,5. Modulation de deux principales aires corticales de recherche sur la douleur a été explorée: le cortex moteur primaire et le cortex préfrontal dorsolatéral 7. En raison du rôle essentiel de l&#39;électrode de montage, dans cet article, nous montrons les différentes alternatives pour le placement des électrodes pour des essais cliniques sur la douleur STCC; discuter des avantages et des inconvénients de chaque méthode de stimulation.

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

Stimulation transcrânienne à courant continu (STCC) est une technique bien établie pour moduler l&#39;excitabilité corticale<sup&gt; 1,2</sup&gt;. Il a été utilisé comme un outil d&#39;investigation en neurosciences à cause de ses effets sur la plasticité corticale, une opération facile, et le profil de sécurité. Un domaine qui a été STCC montrant des résultats encourageants est la réduction de la douleur<sup&gt; 3-5</sup&gt;.

Positionnement des électrodes et de montage de stimulation transcrânienne Direct Current

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 vues.  University of Michigan. Stimulation transcrânienne à courant continu (STCC) est une technique bien établie pour moduler l'excitabilité corticale 1,2. Il a été utilisé comme un outil d'investigation en neurosciences à cause de ses effets sur la plasticité corticale, une opération facile, et le profil de sécurité. Un domaine qui a été STCC montrant des résultats encourageants est la réduction de la douleur 3-5.

Vidéo: 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.

Alliant la stimulation magnétique transcrânienne et l&#39;IRMf pour examiner le réseau en mode par défaut

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 ...

Recherche

Neurosciences

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.

Stimulation à courant continu et multi-réseau d&#39;électrodes d&#39;enregistrement de la capture comme activité chez la souris Cerveau Slice Préparation

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.

Effets de la Stimulation transcrânienne courant alternatif sur le Cortex moteur primaire par en ligne approche combinée avec la Stimulation magnétique transcrânienne

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.

Supervisé à distance directe de Transcranial Stimulation actuelle : Une mise à jour sur l’innocuité et de tolérabilité

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.

L’utilisation combinée de Transcranial Direct Current Stimulation et thérapie robotique pour le membre supérieur

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.

Stimulation transcrânienne courant continu (CDV) chez la souris

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.

Détermination de l'emplacement de la stimulation à l'aide d'un numériseur 3D avec stimulation à courant direct transcrânien haute définition

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.

Enregistrement intracellulaire in vivo des motoneurones spinaux de rat identifiés par type pendant la stimulation trans-spinale à courant direct

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.

Application simultanée de la stimulation transcrânienne à courant continu pendant l’exposition à la réalité virtuelle

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.

Stimulation transcrânienne à courant continu (tDCS) pour l’amélioration de la mémoire

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