Name: effects of transcranial alternating current stimulation on the primary motor cortex by online combined approach with transcranial magnetic stimulation
Uploaded: 2017-09-23T13:00:00
Description: Watch this Scientific Journal Video about Effects of Transcranial Alternating Current Stimulation on the Primary Motor Cortex by Online Combined Approach with Transcranial Magnetic Stimulation at JoVE

Questo studio è stato sostenuto dal russo Science Foundation grant (numero di contratto: 17-11-01273). Ringraziamento speciale Andrey Afanasov e colleghi dal centro polifunzionale di innovazione per televisione Technics (National Research University, Higher School of Economics, Moscow, Russia) per la registrazione video e video editing.

tutte le procedure sono state approvate dal comitato etico locale ricerca della Higher School of Economics (HSE), a Mosca, con il consenso di tutti i partecipanti.
 Nota: i partecipanti non devono presentarsi la storia di dispositivi impiantati in metallo, malattia neurologica o psichiatrica, abuso di droga o alcolismo. TMS è usato secondo le più recenti linee guida sicurezza 20. Soggetti devono essere pienamente informati della natura della ricerca e segno un modul...

<ol>
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F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Entrainment+of+brain+oscillations+by+transcranial+alternating+current+stimulation.">Entrainment of brain oscillations by transcranial alternating current stimulation.</a> Curr. Biol. 24 (3), 333-339 (2014).</li><li>Bergmann, T. O., Karabanov, A., Hartwigsen, G., Thielscher, A., Siebner, H. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combining+non-invasive+transcranial+brain+stimulation+with+neuroimaging+and+electrophysiology:+Current+approaches+and+future+perspectives.">Combining non-invasive transcranial brain stimulation with neuroimaging and electrophysiology: Current approaches and future perspectives.</a> Neuroimage. 140, 4-19 (2016).</li><li>Feher, K. D., Morishima, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concurrent+Electroencephalography+Recording+During+Transcranial+Alternating+Current+Stimulation+(tACS).">Concurrent Electroencephalography Recording During Transcranial Alternating Current Stimulation (tACS).</a> J. Vis. Exp. (107), e53527 (2016).</li><li>Antal, A., et al. <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), 97-105 (2008).</li><li>Struber, D., Rach, S., Neuling, T., Herrmann, C. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=On+the+possible+role+of+stimulation+duration+for+after-effects+of+transcranial+alternating+current+stimulation.">On the possible role of stimulation duration for after-effects of transcranial alternating current stimulation.</a> Front Cell Neurosci. 9, 311 (2015).</li><li>Feurra, M., Paulus, W., Walsh, V., Kanai, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency+specific+modulation+of+human+somatosensory+cortex.">Frequency specific modulation of human somatosensory cortex.</a> Front Psychol. 2, (2011).</li><li>Feurra, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency-dependent+tuning+of+the+human+motor+system+induced+by+transcranial+oscillatory+potentials.">Frequency-dependent tuning of the human motor system induced by transcranial oscillatory potentials.</a> J. Neurosci. 31 (34), 12165-12170 (2011).</li><li>Feurra, M., Paulus, W., Walsh, V., Kanai, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency+specific+modulation+of+human+somatosensory+cortex.">Frequency specific modulation of human somatosensory cortex.</a> Front Psychol. 2, (2011).</li><li>Feurra, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=State-dependent+effects+of+transcranial+oscillatory+currents+on+the+motor+system:+what+you+think+matters.">State-dependent effects of transcranial oscillatory currents on the motor system: what you think matters.</a> J. Neurosci. 33 (44), 17483-17489 (2013).</li><li>Feurra, M., Galli, G., Pavone, E. F., Rossi, A., Rossi, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency-specific+insight+into+short-term+memory+capacity.">Frequency-specific insight into short-term memory capacity.</a> J. Neurophysiol. 116 (1), 153-158 (2016).</li><li>Kanai, R., Paulus, W., Walsh, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+alternating+current+stimulation+(tACS)+modulates+cortical+excitability+as+assessed+by+TMS-induced+phosphene+thresholds.">Transcranial alternating current stimulation (tACS) modulates cortical excitability as assessed by TMS-induced phosphene thresholds.</a> Clin. Neurophysiol. 121 (9), 1551-1554 (2010).</li><li>Polania, R., Moisa, M., Opitz, A., Grueschow, M., Ruff, C. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+precision+of+value-based+choices+depends+causally+on+fronto-parietal+phase+coupling.">The precision of value-based choices depends causally on fronto-parietal phase coupling.</a> Nat. Commun. 6, 8090 (2015).</li><li>Santarnecchi, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency-dependent+enhancement+of+fluid+intelligence+induced+by+transcranial+oscillatory+potentials.">Frequency-dependent enhancement of fluid intelligence induced by transcranial oscillatory potentials.</a> Curr. Biol. 23 (15), 1449-1453 (2013).</li><li>Santarnecchi, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Individual+differences+and+specificity+of+prefrontal+gamma+frequency-tACS+on+fluid+intelligence+capabilities.">Individual differences and specificity of prefrontal gamma frequency-tACS on fluid intelligence capabilities.</a> Cortex. 75, 33-43 (2016).</li><li>Dayan, E., Censor, N., Buch, E. R., Sandrini, M., 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=Noninvasive+brain+stimulation:+from+physiology+to+network+dynamics+and+back.">Noninvasive brain stimulation: from physiology to network dynamics and back.</a> Nat. Neurosci. 16 (7), 838-844 (2013).</li><li>Rossi, S., Hallett, M., Rossini, P. 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=Safety,+ethical+considerations,+and+application+guidelines+for+the+use+of+transcranial+magnetic+stimulation+in+clinical+practice+and+research.">Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research.</a> Clin. Neurophysiol. 120 (12), 2008-2039 (2009).</li><li>Nasseri, P., Nitsche, M. A., Ekhtiari, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+framework+for+categorizing+electrode+montages+in+transcranial+direct+current+stimulation.">A framework for categorizing electrode montages in transcranial direct current stimulation.</a> Front Hum. Neurosci. 9, 54 (2015).</li><li>Rossini, P. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-invasive+electrical+and+magnetic+stimulation+of+the+brain,+spinal+cord,+roots+and+peripheral+nerves:+Basic+principles+and+procedures+for+routine+clinical+and+research+application.+An+updated+report+from+an+I.F.C.N.+Committee.">Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee.</a> Clin.Neurophysiol. 126 (6), 1071-1107 (2015).</li><li>Guerra, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phase+Dependency+of+the+Human+Primary+Motor+Cortex+and+Cholinergic+Inhibition+Cancelation+During+Beta+tACS.">Phase Dependency of the Human Primary Motor Cortex and Cholinergic Inhibition Cancelation During Beta tACS.</a> Cereb. Cortex. 26 (10), 3977-3990 (2016).</li><li>Fertonani, A., Ferrari, C., Miniussi, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+do+you+feel+if+I+apply+transcranial+electric+stimulation?+Safety,+sensations+and+secondary+induced+effects.">What do you feel if I apply transcranial electric stimulation? Safety, sensations and secondary induced effects.</a> Clin. 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Questo approccio rappresenta un'occasione unica per testare direttamente online effetti di TAC della corteccia motoria primaria misurando corticospinal uscita attraverso i deputati di registrazione. Tuttavia, il posizionamento della bobina TMS sopra l'elettrodo TAC rappresenta una fase critica che deve essere eseguita con precisione. Pertanto, in primo luogo vorremmo suggerire gli sperimentatori trovano un punto di destinazione di singolo impulso TMS, poi segnano sul cuoio capelluto e, solo dopo che, posizionare l'elettr...

Stimolazione elettrica transcranica (tES) è una tecnica di neuromodulatory che consente la modifica degli stati neuronali attraverso diversi attuali forme d'onda1. Tra diversi tipi di tES, transcranial stimolazione a corrente alternata (TAC) consente la consegna dei potenziali oscillatori esterni sinusoidale in una gamma di frequenza specifica e la modulazione dell'attività neurale fisiologica sottostante percettivo, motorio e cognitivo processi2. Mediante TAC, è possibile studiare potenziali relazioni causali tra attività oscillatoria endogeno e processi cerebrali.
In vivo, è stato dimostrato che chiodare l'attività neurale è sincronizzato a diverse frequenze, guida, suggerendo che il firing neuronale può essere trascinato da campi elettricamente applicati3. Nei modelli animali, debole TAC sinusoidale trascina la frequenza di Scarica del pool neuronale corticale diffusa4. In esseri umani, TAC combinato con online elettroencefalografia (EEG) permette l'induzione al cosiddetto effetto "Trascinamento" su attività oscillatoria endogeno interagendo con le oscillazioni del cervello in un modo specifico di frequenza5. Tuttavia, combinando TAC con metodi di neuroimaging per una migliore comprensione dei meccanismi online è ancora discutibile a causa di artefatti indotta da AC6. Inoltre, non è possibile registrare direttamente il segnale EEG sopra l'area di destinazione stimolato senza l'utilizzo di un elettrodo di forma di anello che è una soluzione discutibile7. Così, c'è una mancanza di studi sistematici su questo argomento.
Finora, non c'è alcuna chiara evidenza circa gli effetti durevoli del TAC dopo cessazione di stimolazione. Solo pochi studi hanno indicato gli post-effetti deboli e poco chiari di TAC sul sistema motorio8. Inoltre, la prova di EEG non è ancora chiara circa le conseguenze della TAC9. D'altra parte, molti studi di TAC hanno mostrato effetti online prominenti10,11,12,13,14,15,16 , 17 , 18, che sono difficili da misurare a livello fisiologico a causa di vincoli tecnici. Così, l'obiettivo generale del nostro metodo è quello di fornire un approccio alternativo per verificare gli effetti online e dipendente dalla frequenza dei TAC sulla corteccia di motore (M1) fornendo singolo impulso di stimolazione magnetica transcranica (TMS). TMS permette ai ricercatori di "sonda" lo stato fisiologico del corteccia motoria umana19. Inoltre, registrando i potenziali evocati motori (MEP) sulla mano controlaterale del soggetto, possiamo studiare gli effetti dei TAC in corso11. Questo approccio ci permette con precisione monitor cambiamenti nell'eccitabilità corticospinale misurando l'ampiezza MEP durante stimolazione elettrica online consegnata a diverse frequenze in modo priva di artefatti. Inoltre, questo approccio può anche testare online effetti di qualsiasi altra forma d'onda di tES.
Per dimostrare gli effetti combinati dei TAC-TMS, ci mostrerà il protocollo applicando la stimolazione 20 Hz AC sopra la corteccia motoria primaria (M1) mentre online neuronavigated singolo impulso TMS viene recapitato intervallata da intervalli casuali da 3 a 5 s al fine di testare M1 eccitabilità corticale.

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			<td height="42" style="height:42px;width:213px;">BrainStim, high-resolution transcranial stimulator</td>
			<td style="width:136px;">E.M.S., Bologna, Italy</td>
			<td style="width:123px;">EMS-BRAINSTIM</td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:213px;">Pair of 1,5m cables for connection of conductive silicone electrodes</td>
			<td style="width:136px;">E.M.S., Bologna, Italy</td>
			<td style="width:123px;">EMS-CVBS15</td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Reusable conductive silicone electrodes 50x50mm</td>
			<td style="width:136px;">E.M.S., Bologna, Italy</td>
			<td style="width:123px;">FIA-PG970/2</td>
			<td style="width:157px;"></td>
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			<td height="42" style="height:42px;width:213px;">Reusable spontex sponge for electrode 50x100mm</td>
			<td style="width:136px;">E.M.S., Bologna, Italy</td>
			<td style="width:123px;">FIA-PG916S</td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Rubber belts &#8211; 75 cm</td>
			<td style="width:136px;">E.M.S., Bologna, Italy</td>
			<td style="width:123px;">FIA-ER-PG905/8</td>
			<td style="width:157px;"></td>
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			<td height="42" style="height:42px;width:213px;">Plastic non traumatic button</td>
			<td style="width:136px;">E.M.S., Bologna, Italy</td>
			<td style="width:123px;">FIA-PG905/99</td>
			<td style="width:157px;"></td>
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		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Brainstim</td>
			<td style="width:136px;">E.M.S., Bologna, Italy</td>
			<td style="width:123px;"></td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">MagPro X100 MagOption - transcranial magnetic stimulator</td>
			<td style="width:136px;">MagVenture, Farum, Denmark</td>
			<td style="width:123px;">9016E0731</td>
			<td style="width:157px;"></td>
		</tr>
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			<td height="42" style="height:42px;width:213px;">8-shaped coil MC-B65-HO-2</td>
			<td style="width:136px;">MagVenture, Farum, Denmark</td>
			<td style="width:123px;">9016E0462</td>
			<td style="width:157px;"></td>
		</tr>
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			<td height="42" style="height:42px;width:213px;">Chair with neckrest</td>
			<td style="width:136px;">MagVenture, Farum, Denmark</td>
			<td style="width:123px;">9016B0081</td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:213px;">Localite TMS Navigator - Navigation platform, Premium edition</td>
			<td style="width:136px;">Localite, GmbH, Germany</td>
			<td style="width:123px;">21223</td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:213px;">Localite TMS Navigator - MR-based software, import data for morphological MRI (DICOM, NifTi)</td>
			<td style="width:136px;">Localite, GmbH, Germany</td>
			<td style="width:123px;">10226</td>
			<td style="width:157px;"></td>
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		<tr height="57">
			<td height="57" style="height:57px;width:213px;">MagVenture 24.8 coil tracker, Geom 1</td>
			<td style="width:136px;">Localite, GmbH, Germany</td>
			<td style="width:123px;">5221</td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">Electrode wires for surface EMG</td>
			<td style="width:136px;">&#160;EBNeuro, Italy&#160;</td>
			<td style="width:123px;">6515</td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Surface Electrodes for EEG/EMG</td>
			<td style="width:136px;">&#160;EBNeuro, Italy&#160;</td>
			<td style="width:123px;">6515</td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">BrainAmp ExG amplifier - bipolar amplifier&#160;</td>
			<td style="width:136px;">Brain Products, GmbH, Germany</td>
			<td style="width:123px;"></td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">&#160;BrainVision Recorder 1.21.0004&#160;</td>
			<td style="width:136px;">Brain Products, GmbH, Germany</td>
			<td style="width:123px;"></td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Nuprep Skin Prep Gel&#160;</td>
			<td style="width:136px;">Weaver and Company, USA</td>
			<td></td>
			<td style="width:157px;"></td>
		</tr>
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			<td height="21" style="height:21px;width:213px;">Syringes</td>
			<td style="width:136px;"></td>
			<td style="width:123px;"></td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">Sticky tape</td>
			<td style="width:136px;"></td>
			<td style="width:123px;"></td>
			<td style="width:157px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">NaCl solution</td>
			<td style="width:136px;"></td>
			<td style="width:123px;"></td>
			<td style="width:157px;"></td>
		</tr>
	</tbody>
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effects of transcranial alternating current stimulation on the primary motor cortex by online combined approach with transcranial magnetic stimulation

Corrente alternata la stimolazione transcranica (TAC) è una tecnica di neuromodulatory in grado di agire attraverso forme d'onda sinusoidali elettriche in una specifica frequenza e a loro volta modulano in corso attività oscillatoria corticale. Questo neurotool consente l'istituzione di un nesso di causalità tra attività oscillatoria endogeno e comportamento. La maggior parte degli studi TAC hanno dimostrato effetti di TAC. Tuttavia, piccolo è conosciuto circa i meccanismi di azione di questa tecnica a causa i manufatti AC-indotto sui segnali di elettroencefalografia (EEG). Qui vi mostriamo un approccio unico per studiare online effetti fisiologici di frequenza specifico di TAC della corteccia motoria primaria (M1) utilizzando singolo impulso di stimolazione magnetica transcranica (TMS) per sondare le modifiche eccitabilità corticale. Nel nostro setup, la bobina TMS è posizionata sopra l'elettrodo di TAC, mentre i potenziali evocati motori (MEP) sono raccolti per verificare gli effetti dei M1-TAC in corso. Finora, questo approccio è stato utilizzato principalmente per studiare i sistemi visive e motori. Tuttavia, l'installazione corrente di TAC-TMS può spianare la strada per le indagini future delle funzioni cognitive. Pertanto, le forniamo un manuale passo-passo e video linee guida per la procedura.

La prima prova di un approccio combinato di TAC/TMS è stata indicata da Kanai et nel 2010. In quello studio, gli autori hanno applicato TAC sopra la corteccia visiva primaria (V1) e ha dimostrato una frequenza specifica modulazione dell'eccitabilità corticale visual misurata da online indotta da TMS phosphene percezione15. Una versione più raffinata del protocollo è stata adottata per studiare una fisiologica modulazione dell'eccitabilità della cortec...

Watch this Scientific Journal Video about Effects of Transcranial Alternating Current Stimulation on the Primary Motor Cortex by Online Combined Approach with Transcranial Magnetic Stimulation at JoVE

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

Corrente alternata la stimolazione transcranica (TAC) permette la modulazione dell'eccitabilità corticale in un modo frequenza-specifico. Qui vi mostriamo un approccio unico che combina online TAC con singolo impulso di stimolazione magnetica transcranica (TMS) al fine di "sondare" eccitabilità corticale mediante potenziali evocati motore.

Effetti della stimolazione transcranica con corrente alternata la corteccia motoria primaria di approccio combinato Online con stimolazione magnetica transcranica

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

The overall goal of this procedure is to assess modulation of ongoing effects of transcranial alternated current stimulation by means of single path transcranial magnetic path stimulation in a novel online combined approach. Transcranial electrical stimulation is a neuromodulatory technique that affects neuronal states through different current waveform. It is commonly used in neuroscience to investigate brain motor and cognitive functions.The most used approaches are based on direct current stimulation, random noise, and alternating current stimulation, which are able to induce changes in neuron activity. Both inside and outside the neurons, causing alteration of resting membrane potential and consequently modifying neuronal synaptic efficiency. TACS allow us to deliver sinusoidal external oscillatory potential in a specific frequency range.By inducing the so-called entrainment effect on the endogenous oscillatory activity. Here we are introducing a novel method which combine TACS and single path CMS during ongoing stimulation of the primary motor cortex. The method allow us to test online alternating current stimulation effects on primary motor cortex by means of single pulse TMS induced motor evoked potential.We are going to show an entire set of equipment needed to run an online combined TACS-TMS protocol by stimulation of the primary motor cortex. The list of equipment includes an electrical stimulation device which can generate electrical alternated current, for example BrainStim. Connected by two-surface saline soaked sponge electrodes size five to seven centimeters.In order to minimize skin sensation, the electrodes are completely saturated with the saline solution to keep impedance below 10 kiloOhm throughout the whole stimulation session. The target electrode is placed over the scalp corresponding to the primary motor cortex hotspot by using specific elastic straps while the reference electrode is placed over the ipsilateral shoulder by using sticky tape in a so-called monopole montage. In humans, oscillations in different frequencies reflect different behavior and cognitive processes that underlie different states of neural network activity.As typically measured by encephalography or by magneto-encephalography. Oscillations in the human brain are ranging from ultra-slow to ultra-fast oscillations. There are usually simultaneously present and can modulate and interact with each other.However, the link between oscillatory activity and brain processes has always been established by correlational methods. Therefore the issue of whether brain oscillations directly reflect fundamental mechanism in cortical information processing, or just an epiphenomenon is still unresolved. By using TACS we can causally modulate brain oscillations in a frequency-specific fashion, and in turn influence physiological neuronal activity linked to resting state, perceptual and cognitive processes.To set up TCS protocol using the BrainStim device, first check the battery status. Then stimulation parameters are manipulated by our special software. Frequency, duration, shape of the current.And transferred to the device by Bluetooth connection. By using the software, open a new session and manage a new protocol or stimulation. For example, the protocol will be named as Beta.Set the frequency of stimulation in our case it will be 20Hz, tune the waveform as sinusoidal, and set the total duration of the stimulation protocol, for example 600 seconds. Finally set the intensity of stimulation at 1 milliAmp while offset, fade in, fade out, and fade is set at zero. Then when the Bluetooth function is activated on the device, upload the protocol from the software to the stimulator.Then proceed by checking whether the protocol has been successfully transferred to the device. Now move to the TMS part. First place electrodes for a surface EMG to measure motor lock potentials by single pulse TMS.Clean the skin using a cleaning scrub under all the electrodes to achieve a low skin impedance, below 10 kiloOhm. Here we took a first dorsal interressus muscle and used and used a bipolar belly tendon montage. Put active electrode on the muscle, reference electrode on the bone, two centimeters distally and ground electrode more proximally on the arm.Motor lock potentials are measured by argentum, argentum chloride electrodes connected to the BrainAmp DC amplifier by a connector box. We are using frameless TMS navigation system LocalEye TMS navigator to achieve proper positioning of the TMS coil. First we place the tracking sensors on the front of the participant.For TMS stimulation we are using magnetic stimulator in a bi-phasic regime and an H-shaped 75 millimeter swing red stimulation coil. Then using the video of participant's structural T-one MRI, and perform a current illustration of the participant's head in the 3-D MRI head model by navigation system. After that, accurately position the coil over the primary motor area of the head, the so-called motor knob region.Then start to test single pass TMS motor lock potentials. Once an optimal hotspot for the studied hand model cortical representation is found, this location is marked for the subsequent TCS target electrode placement. Adjust carefully the first elastic strap on the head with respect to the head center's position.Then take the target electrode position with the second stripe. Once TCS electrodes are placed both on the skull and on the ipsilateral shoulder, proceed to connect them to the stimulator. Before starting the stimulation session, ensure that position of the target electrode is centered over the marked hotspot by visual inspection.Then place the TMS coil over the TCS electrodes by readjusting intensity and orientation using neuro-navigation in order to find the hotspot again. At this stage, method of the resting model threshold for this new combined TCS-TMS montage by taking into account the thickness of the target electrode. Set the intensity of stimulation along the experiment at 110%of their resting motor threshold.Most of the TCS studies showed prominent online effects, at the same time, there is still no clear evidence about long-lasting effects of TCS after stimulation cessation. Only few studies in the literature showed weak and unclear after-effects with respect to those ones who used online TCS. EG evidence is not clear about TCS after-effects either.In vivo it was shown that spike in activity is synchronized with different driving frequencies suggesting that neuronal firing can be entrained by electrically applied fields. Thus in animal models weak sinusoidal TCS entrains the discharged frequency of the widespread cortical-neuronal pulse. In humans recent evidence showed that online TCS can induce entrainment effect on the EG signature.However, the TCS EG approach is still questionable, firstly because of the AC-induced artifacts and secondly because it's not practically possible to directly capture the EG signal of the stimulated area. Such combined TCS-TMS montage allows to observe especially for the sensorimotor system the online frequency specific TCS effects on the cortical spinal output by using as a probe single pass TMS of the primary motor cortex. Thus, start the 20Hz electrical stimulation protocol while delivering online TMS single pulses interspersed by random intervals, from three to five seconds.For instance, we can show the increase of motor lock potential amplitudes during online 20Hz TCS with respect to 10Hz or sham stimulation. On this picture you can see an example of the experimental design where TMS coil is placed over the target TCS electrode. This experiment target red electrodes are placed on the left motor cortex and the right parietal cortex.The blue reference electrode is placed on the midline corresponding to PZ position of the 1020 international EG system. The coil is held on the sponge electrode placed over the left motor cortex. The human motor cortex addressed has an activity at about 20Hz.Frequent collaborators provided the crucial evidence of 20Hz activity at rest in humans by showing the online increase of the cortico-spinal excitability while stimulation was applied at 20Hz. On the graph the Y-axis represents the mean MEP amplitude as measured by TMS single pulse while the TCS stimulation was ongoing. The X-axis represents different stimulation frequencies.Only TCS delivered at 20Hz on the motor cortex increased the corticospinal output. Whereas there was no effect of the stimulation on other frequencies or other stimulation of the parietal cortex. This was the first evidence of an online frequency-specific effect of TCS on the motor cortex measured by TACS, TMS combined approach.The rationale of combining the use of TMS and TACS lies on different information that they convey. By recording motor evoked potentials on the contralateral hand to the primary motor cortex we can check the artifact-free effects of ongoing TCS. This allow us to accurately monitor changes in cortical excitability by motor evoked potentials during electrical stimulation delivered at different frequencies in an artifact-free fashion.This new approach can be used to test online effect of any other forms of transcranial electrical stimulation.

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