tDCS Guidelines: Efficacy in Neurological and Psychiatric Disorders

Author Names

Felipe Fregni, Mirret M. El-Hagrassy, Kevin Pacheco-Barrios, Sandra Carvalho, Jorge Leite, Marcel Simis, Jerome Brunelin, Ester Miyuki Nakamura-Palacios, Paola Marangolo, Ganesan Venkatasubramanian, Daniel San-Juan, Wolnei Caumo, Marom Bikson, André R. Brunoni, Neuromodulation Center Working Group

Published Date: July 2020

Journal Name: International Journal of Neuropsychopharmacology

Abstract

This comprehensive review and meta-analysis aim to provide evidence-based guidelines for the use of transcranial direct current stimulation (tDCS) in various neurological and psychiatric disorders. The review focuses on conditions such as major depressive disorder, chronic pain, Parkinson’s disease, stroke, epilepsy, schizophrenia, and addiction. The findings categorize the effectiveness of tDCS into three levels: effective (Level A), probably effective (Level B), and possibly effective (Level C). The study highlights the variability in tDCS protocols, emphasizing the need for careful consideration of stimulation parameters and patient selection to optimize therapeutic outcomes.

Key Concepts

• Transcranial Direct Current Stimulation (tDCS): A non-invasive brain stimulation technique that modulates neuronal activity, is used to treat various neurological and psychiatric conditions.

• Evidence-Based Medicine (EBM): A clinical decision-making approach that integrates the best available research evidence with clinical expertise and patient values.

• Neurological and Psychiatric Disorders: The conditions reviewed include major depressive disorder, chronic pain, Parkinson’s disease, stroke, epilepsy, schizophrenia, and addiction.

• Literature Review: The review is based on a systematic evaluation of PubMed-indexed clinical trials, following PRISMA guidelines to ensure methodological rigour.

Procedure Highlights - Research Methodology

1. Study Design: Systematic review and meta-analysis following PRISMA guidelines, including randomized controlled trials (RCTs) with repeated tDCS sessions for neurological and psychiatric disorders.

2. Inclusion Criteria: English-language, PubMed-indexed RCTs with more than one tDCS session, excluding single-session studies for primary analysis but including them in descriptive data.

3. Classification of Evidence: Clinical outcomes were classified as positive or negative based on improvement in active versus sham tDCS groups. The risk of bias was assessed using the Jadad Scale, and recommendations were made according to the level of evidence (A, B, C).

Results - Findings of the Research

• Depression: tDCS was found to be effective (Level A) in treating major depressive disorder, with significant improvements in depressive symptoms across multiple studies.

• Chronic Pain: tDCS was probably effective (Level B) for conditions such as neuropathic pain, fibromyalgia, and migraine, with significant pain reduction in most trials.

• Parkinson’s Disease: tDCS was probably effective (Level B) for motor function and cognition in Parkinson’s disease, though the effects varied depending on the stimulation parameters.

• Stroke: The effectiveness of tDCS in stroke recovery was mixed, with some studies showing positive effects on motor function, while others showed no significant improvement.

• Epilepsy and Schizophrenia: tDCS showed possible effectiveness (Level C) in reducing seizure frequency in epilepsy and improving symptoms in schizophrenia.

• Addiction: Limited evidence suggested that tDCS might be effective (Level C) in reducing cravings and relapses in alcohol and drug addiction.

Discussion and Conclusion of the Research

The study provides a comprehensive evaluation of the clinical efficacy of tDCS across various neurological and psychiatric disorders. The results support the use of tDCS as a treatment option for major depressive disorder and chronic pain, with potential applications in other conditions such as Parkinson’s disease and epilepsy. However, the review also highlights the need for standardized protocols and further research to determine the optimal parameters for tDCS treatment.

Link to the Original Paper

Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders

Author Information

• Felipe Fregni: Neuromodulation Center, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Boston, USA.

• Mirret M. El-Hagrassy: Neuromodulation Center, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Boston, USA.

• Kevin Pacheco-Barrios: Universidad San Ignacio de Loyola, Lima, Peru.

• Sandra Carvalho: School of Psychology, University of Minho, Braga, Portugal.

• Jorge Leite: Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal.

• Marcel Simis: University of Sao Paulo Medical School, Sao Paulo, Brazil.

• Jerome Brunelin: Lyon Neuroscience Research Center, UCB Lyon 1, Lyon, France.

• Ester Miyuki Nakamura-Palacios: Federal University of Espírito Santo, Brazil.

• Paola Marangolo: Università Federico II, Naples, Italy.

• Ganesan Venkatasubramanian: National Institute of Mental Health and Neurosciences, Bangalore, India.

• Daniel San-Juan: National Institute of Neurology and Neurosurgery, Mexico City, Mexico.

• Wolnei Caumo: Universidade Federal do Rio Grande do Sul, Brazil.

• Marom Bikson: The City College of New York, New York, USA.

• André R. Brunoni: Universidade de São Paulo, Brazil.

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The content provided here is an interpretation of a research paper for educational purposes. It is simplified to make the findings accessible to a general audience. For detailed information, please refer to the original research paper.