Name: transcranial direct current stimulation for online gamers
Uploaded: 2019-11-09T13:00:00
Description: Watch this Scientific Journal Video about Transcranial Direct Current Stimulation for Online Gamers at JoVE.com

This study was supported by the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (2015M3C7A1064832, 2015M3C7A1028373, 2018M3A6A3058651) and by the National Institutes of Health (NIHNIMH 1R01MH111896, NIH-NINDS 1R01NS101362).

All experimental procedures presented in this protocol have been approved by the Institutional Review Board and are in accordance with the Declaration of Helsinki.
1. Research Participants
<ol>
	<li>Recruit individuals who report that they play online games (the gamer group) and those who report that they do not play online games (the non-gamer group). 
	NOTE: Here, we included individuals with two or more IGD symptoms according to the Diagnostic and Statistical Manual ...

<ol>
	<li>Chen, Y. F., Peng, S. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=University+students'+Internet+use+and+its+relationships+with+academic+performance,+interpersonal+relationships,+psychosocial+adjustment,+and+self-evaluation.">University students' Internet use and its relationships with academic performance, interpersonal relationships, psychosocial adjustment, and self-evaluation.</a> CyberPsychology &amp; Behavior. 11 (4), 467-469 (2008).</li><li>Ho, R. C., 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=The+association+between+internet+addiction+and+psychiatric+co-morbidity:+a+meta-analysis.">The association between internet addiction and psychiatric co-morbidity: a meta-analysis.</a> BMC Psychiatry. 14, 183 (2014).</li><li>Pawlikowski, M., Brand, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Excessive+Internet+gaming+and+decision+making:+do+excessive+World+of+Warcraft+players+have+problems+in+decision+making+under+risky+conditions.">Excessive Internet gaming and decision making: do excessive World of Warcraft players have problems in decision making under risky conditions.</a> Psychiatry Research. 188 (3), 428-433 (2011).</li><li>Zajac, K., Ginley, M. K., Chang, R., Petry, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatments+for+Internet+gaming+disorder+and+Internet+addiction:+A+systematic+review.">Treatments for Internet gaming disorder and Internet addiction: A systematic review.</a> Psychology of Addictive Behaviors. 31 (8), 979-994 (2017).</li><li>Weinstein, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+Update+Overview+on+Brain+Imaging+Studies+of+Internet+Gaming+Disorder.">An Update Overview on Brain Imaging Studies of Internet Gaming Disorder.</a> Frontiers in Psychiatry. 8, 185 (2017).</li><li>Park, B., Han, D. H., Roh, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neurobiological+findings+related+to+Internet+use+disorders.">Neurobiological findings related to Internet use disorders.</a> Psychiatry and Clinical Neurosciences. 71 (7), 467-478 (2017).</li><li>Kober, H., 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=Prefrontal-striatal+pathway+underlies+cognitive+regulation+of+craving.">Prefrontal-striatal pathway underlies cognitive regulation of craving.</a> Proceedings of the National Academy of Sciences of the United States of America. 107 (33), 14811-14816 (2010).</li><li>Li, C. 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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=Neuromodulation+of+decision-making+in+the+addictive+brain.">Neuromodulation of decision-making in the addictive brain.</a> Substance Use &amp; Misuse. 45 (11), 1766-1786 (2010).</li><li>Fujimoto, 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=Deficit+of+state-dependent+risk+attitude+modulation+in+gambling+disorder.">Deficit of state-dependent risk attitude modulation in gambling disorder.</a> Translational Psychiatry. 7 (4), 1085 (2017).</li><li>Choi, J., 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=Structural+alterations+in+the+prefrontal+cortex+mediate+the+relationship+between+Internet+gaming+disorder+and+depressed+mood.">Structural alterations in the prefrontal cortex mediate the relationship between Internet gaming disorder and depressed mood.</a> Scientific Reports. 7 (1), 1245 (2017).</li><li>Yuan, K., 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=Microstructure+abnormalities+in+adolescents+with+internet+addiction+disorder.">Microstructure abnormalities in adolescents with internet addiction disorder.</a> PLoS One. 6 (6), 20708 (2011).</li><li>Ko, C. 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W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laterality+of+Brain+Activation+for+Risk+Factors+of+Addiction.">Laterality of Brain Activation for Risk Factors of Addiction.</a> Current Drug Abuse Reviews. 9 (1), 1-18 (2016).</li><li>Tian, 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=PET+imaging+reveals+brain+functional+changes+in+internet+gaming+disorder.">PET imaging reveals brain functional changes in internet gaming disorder.</a> European Journal of Nuclear Medicine and Molecular Imaging. 41 (7), 1388-1397 (2014).</li><li>Nitsche, M. 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We have presented a tDCS and neuroimaging protocol for online gamers and assessed its feasibility. The results demonstrated that repeated sessions of tDCS over the DLPFC reduced online game addiction symptoms and average time spent on games and increased self-control. An increase in self-control was correlated with a decrease in addiction symptoms. Moreover, the abnormal asymmetry of rCMRglu in the DLPFC where the right side was greater than the left side was improved after the tDCS sessions in the gamer group. These res...

In recent years, increasing attention has been paid to excessive online game use since its associations with negative impact on mental health and daily functioning as well as with internet gaming disorder (IGD) have been reported1,2,3. Although several treatment strategies including pharmacotherapy and cognitive-behavioral therapy have been evaluated, evidence for their effectiveness is limited4.
Previous studies have suggested that IGD may share clinical and neurobiological similarities with other behavioral addictions and substance use disorders5,6. It has been reported that the dorsolateral prefrontal cortex (DLPFC) is closely involved in the pathophysiology of substance and behavioral addiction such as craving7, impulse control8, decision making9, and cognitive flexibility10. Several neuroimaging studies on IGD have reported structural and functional impairments in the DLPFC6. In particular, structural neuroimaging studies revealed a reduction in gray matter density in the DLPFC11,12 and a functional magnetic resonance imaging (fMRI) study found an altered cued-induced activity in the DLPFC of patients with IGD13. In addition, functional asymmetry of the brain may contribute to impulsivity and craving in addictions including IGD. For instance, cue-induced craving for online gaming could be related to right prefrontal activations14. However, alterations of regional cerebral metabolic rate of glucose (rCMRglu) associated with excessive online game use or IGD remain to be further investigated compared to other brain deficits15.
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that applies a weak electric current (1-2 mA) through electrodes attached to the scalp to modulate neuronal membrane potentials. Generally, the cortical excitability is increased under the anode electrode and decreased under the cathode electrode16. tDCS has become a popular method because it is simple, inexpensive, and safe to administer compared to other brain stimulation techniques such as transcranial magnetic stimulation (TMS) that uses a magnetic pulse to generate an electrical current in the brain tissue under the coil. According to a recent review, the use of conventional tDCS protocols has not produced any serious adverse effects or irreversible injury and is associated with only mild and transient itching or tingling sensation under the stimulation area17.
Several studies have demonstrated favorable results of tDCS18,19,20 and repetitive TMS21,22 over the DLPFC for treating behavioral and substance addiction. However, further studies are needed to investigate the effects of brain stimulation techniques on online game use and the underlying brain changes.
The aim of this study is to present a protocol for applying repeated sessions of tDCS over the DLPFC and neuroimaging to examine the underlying neural correlates in gamers using 18F-&#64258;uoro-2-deoxyglucose positron emission tomography (FDG-PET), as well as to assess its feasibility. Specifically, we focused on changes in addiction symptoms, average time spent on games, self-control, and asymmetry of rCMRglu in the DLPFC.

<table border="0" cellpadding="0" cellspacing="0" style="width:1425px;" width="1425">
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		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Discovery STE PET/CT Imaging System</td>
			<td style="width:389px;">GE Healthcare</td>
			<td style="width:161px;"></td>
			<td style="width:576px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">MarsBaR region of interest toolbox for SPM</td>
			<td style="width:389px;">Matthew Brett</td>
			<td style="width:161px;"></td>
			<td>Neuroimaging analysis software; http://marsbar.sourceforge.net/</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Statistical Parametric Mapping 12</td>
			<td>Wellcome Centre for Human Neuroimaging</td>
			<td style="width:161px;"></td>
			<td>Neuroimaging analysis software; https://www.fil.ion.ucl.ac.uk/spm/software/spm12/</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:299px;">Transcranial direct current stimulation device</td>
			<td style="width:389px;">Ybrain</td>
			<td style="width:161px;">YDS-301N</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">WFU_PickAtlas</td>
			<td colspan="2">ANSIR Laboratory, Wake Forest University School of Medicine</td>
			<td>Neuroimaging analysis software; https://www.nitrc.org/projects/wfu_pickatlas/</td>
		</tr>
	</tbody>
</table>

transcranial direct current stimulation for online gamers

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that applies a weak electric current to the scalp to modulate neuronal membrane potentials. Compared to other brain stimulation methods, tDCS is relatively safe, simple, and inexpensive to administer.
Since excessive online gaming can negatively affect mental health and daily functioning, developing treatment options for gamers is necessary. Although tDCS over the dorsolateral prefrontal cortex (DLPFC) has demonstrated promising results for various addictions, it has not been tested in gamers. This paper describes a protocol and a feasibility study for applying repeated tDCS over the DLPFC and neuroimaging to examine the underlying neural correlates in gamers.
At baseline, individuals who play online games report average weekly hours spent on games, complete questionnaires on addiction symptoms and self-control, and undergo brain 18F-&#64258;uoro-2-deoxyglucose positron emission tomography (FDG-PET). The tDCS protocol consists of 12 sessions over the DLPFC for 4 weeks (anode F3/cathode F4, 2 mA for 30 min per session). Then, a follow-up is conducted using the same protocol as the baseline. Individuals who do not play online games receive only baseline FDG-PET scans without tDCS. Changes of clinical characteristics and asymmetry of regional cerebral metabolic rate of glucose (rCMRglu) in the DLPFC are examined in gamers. In addition, asymmetry of rCMRglu is compared between gamers and non-gamers at baseline.
In our experiment, 15 gamers received tDCS sessions and completed baseline and follow-up scans. Ten non-gamers underwent FDG-PET scans at the baseline. The tDCS reduced addiction symptoms, time spent on games, and increased self-control. Moreover, abnormal asymmetry of rCMRglu in the DLPFC at baseline was alleviated after tDCS.
The current protocol may be useful for assessing treatment efficacy of tDCS and its underlying brain changes in gamers. Further randomized sham-controlled studies are warranted. Moreover, the protocol can be applied to other neurological and psychiatric disorders.

A total of 15 gamers (Table 1) and 10 non-gamers were recruited. The mean age of the gamer group (21.3 &#177; 1.4) was significantly lower than that of the non-gamer group (28.8 &#177; 7.5) (t = -3.81, p &#60; 0.001). There were 8 men in the gamer group and 6 men in the non-gamer group (&#967;2 = 0.11, p = 0.74).
Behavioral results using linear mixed models indicate that the tDCS sessions successfully lowered the IAT score (z = -4.29, p &#60; 0.001), weekly hours sp...

Watch this Scientific Journal Video about Transcranial Direct Current Stimulation for Online Gamers at JoVE.com

Transcranial Direct Current Stimulation for Online Gamers

We present a protocol and a feasibility study for applying transcranial direct current stimulation (tDCS) and neuroimaging assessment in online gamers.

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that applies a weak electric current to the scalp to modulate ...

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