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Therapeutic effects of non-invasive brain stimulation with direct currents (tDCS) in neuropsychiatric diseases
Abstract
Neuroplasticity, which is the dynamic structural and functional reorganization of central nervous system connectivity due to environmental and internal demands, is recognized as a major physiological basis for adaption of cognition, and behavior, and thus of utmost importance for normal brain function. Pathological alterations of plasticity are increasingly explored as pathophysiological foundation of diverse neurological and psychiatric diseases. Non-invasive brain stimulation techniques (NIBS), such as repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), are able to induce and modulate neuroplasticity in humans. Therefore, they have potential to alter pathological plasticity on the one hand, and foster physiological plasticity on the other, in neuropsychiatric diseases to reduce symptoms, and enhance rehabilitation. tDCS is an emerging NIBS tool, which induces glutamatergic plasticity via application of relatively weak currents through the scalp in humans. In the last years its efficacy to treat neuropsychiatric diseases has been explored increasingly. In this review, we will give an overview of pathological alterations of plasticity in neuropsychiatric diseases, gather clinical studies involving tDCS to ameliorate symptoms, and discuss future directions of application, with an emphasis on optimizing stimulation effects.
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“Cognitive training effects with tDCS in other disorders and healthy subjects have been shown to last up to 6 months (Boggio et al., 2012; Kuo et al., 2014) and even 1 year (Katz et al., 2017).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Kuo et al., 2014
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“Moreover, our stimulation method did not follow the usual tDCS protocols for the treatment of clinical symptoms during daytime as reviewed by [48,49]: a) in comparison to most other studies, we applied DC only in one single stimulation session; b) the applied current strength in our study was significantly lower than in other studies (0.25 mA vs. 1e2 mA); and c) DC stimulation in our study was not”
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“…et al., 2014), exercise (Rajab et al., 2014; Voss et al., 2010), cognitive training (Mackey et al., 2013; Voss et al., 2012), and brain stimulation (Kuo et al., 2013; Polanía et al., 2012; Sehm et al., 2012), as well as sustained changes following a single session of a neurofeedback paradigm…”
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“…the introduction of this technology in its current form, positive results have been reported in psychiatry (Martin et al., 2011, 2013; Blumberger et al., 2012; Demirtas-Tatlidede et al., 2013; Wolkenstein and Plewnia, 2013) and neurorehabilitation (Webster et al., 2006; Lindenberg et al., 2012).”
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“This capability is thought to be 353 responsible for tDCS’s ability to restore and normalise pathological or physiological plasticity 354 impairing brain functioning in patient populations, and to augment cognition in healthy 355 participants (44).”
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“How might M1 stimulation promote analgesia in patients with chronic pain? One hypothesis states that M1 stimulation suppresses pain perception directly by inhibiting activity in the lateral thalamus [35, 36].”
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“Understanding the mechanisms by which micro and macro changes occur after tDCS could help to increase its effectiveness in altering neuroplastic mechanisms in order promote healing and recovery (Peled, 2004; 2005; Spedding et al., 2003; Kays et al., 2012; Kuo et al., 2013).”
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“Beneficial effects of tDCS have been reported in the treatment of psychiatric (mainly depression and schizophrenia) and neurological diseases, as well as in the rehabilitation of cognitive, motor, and sensory functions after a stroke [8,13].”
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“…brain stimulation techniques that alter neuronal excitability and enhance cortical plasticity with training protocols to enhance outcomes in neuropsychiatric patients, including dementia, pain, addiction, anxiety, and depression (Nitsche et al., 2008; Halko et al., 2011; Kuo et al., 2013).”
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“Repeat administration of these currents is increasingly considered as a potential therapeutic modality for psychiatry due to the ability to produce sustained changes in neural function, possibly by inducing neuroplastic changes (Kuo et al., 2014).”
Transcranial direct current stimulation (tDCS) – Application in neuropsychology
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“Indeed, especially neuroplasticityinducing tDCS-protocols have been shown to affect a variety of functions in healthy humans, and patients suffering from neuropsychiatric diseases (Flöel, 2014; Kuo et al., 2014; Kuo and Nitsche, 2012).”
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“Transcranial direct current stimulation (tDCS) represents an alternative approach to treat neuropsychiatric disorders (Kuo et al. 2014).”
BackgroundModulation of total sleep time by transcranial direct current stimulation (tDCS)
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“Previous studies have shown that plasticity induction or modification in the human central nervous system with NIBS has various functional effects on learning, working memory and cognitive processes [15,16].”
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“…it was found that tDCS is effective in treating a variety of psychiatric and neurological conditions, including depression (D'Urso et al. 2013; Kuo et al. 2014), Parkinson's disease (Li et al. 2015; Pereira et al. 2013), autism (D'Urso et al. 2014), and epilepsy (Fregni et al. 2006; Nitsche…”
Impact of transcranial direct current stimulation on fatigue in multiple sclerosis
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“We expected anodal prefrontal stimulation to improve fatigue symptoms, primarily because the left prefrontal cortex seems to be hypo-active in fatigue, and excitability-enhancing tDCS of this area has been demonstrated to improve cognitive functions and clinical symptoms in various populations of healthy humans, and p…”
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Potentials and limits to enhance cognitive functions in healthy and pathological aging by tDCS
Prehn, K., & Flöel, A. (2015) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2015.00355 · Cited by 103
“…that resemble synaptic plasticity of glutamatergic connections (namely, synaptic LTP and LTD), which can outlast the duration of stimulation for some hours (Bindman et al., 1964; Nitsche et al., 2003), atDCS might be particularly suited for treating AD patients (Floel, 2014; Kuo et al., 2014).”
BackgroundKuo, H.-I., Paulus, W., Batsikadze, G., Jamil, A., Kuo, M., & Nitsche, M. A. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2015.270 · Cited by 105
New treatment approaches for severe and enduring eating disorders
Treasure, J., Cardi, V., Leppanen, J., & Turton, R. (2015) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.06.007 · Cited by 91
“To indicate its efficacy as a clinical treatment research with larger sample sizes from multiple sites may be helpful using a multi-modal assessment of outcomes rather than just visual analogue scales to assess cravings [95].”
BackgroundIntracranial Electrophysiology of the Human Default Network
Fox, K. C. R., Foster, B. L., Kucyi, A., Daitch, A. L., & Parvizi, J. (2018) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2018.02.002 · Cited by 96
Shaping Memory Accuracy by Left Prefrontal Transcranial Direct Current Stimulation
Zwissler, B., Sperber, C., Aigeldinger, S., Schindler, S., Kissler, J., & Plewnia, C. (2014) · Journal of Neuroscience · doi:10.1523/jneurosci.5407-13.2014 · Cited by 96
“Moreover, tDCS enables to enhance adaptive and to ameliorate maladaptive neuroplastic processes with potentially therapeutic effects on various neuropsychiatric disorders (Kuo et al., 2014).”
BackgroundYun, K., Song, I., & Chung, Y. (2016) · Alzheimer s Research & Therapy · doi:10.1186/s13195-016-0218-6 · Cited by 88
“Recently, transcranial direct current stimulation (tDCS), a method used to noninvasively stimulate specific cortical regions of the brain with a mild (<2 mA) and persistent current [13–15], has shown a clinically significant effect on various neuropsychiatric diseases [16].”
BackgroundMethodInfluentialNeurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review
Rubia, K., Westwood, S. J., Aggensteiner, P.-M., & Brandeis, D. (2021) · Cells · doi:10.3390/cells10082156 · Cited by 91
“Combined effects of cognitive training with tDCS in other disorders and healthy subjects have been shown to last up to 6 months [150,151] (Boggio et al., 2012; Kuo et al., 2014) and 1 year (Katz et al., 2017) [125].”
BackgroundTargeting the biased brain: non-invasive brain stimulation to ameliorate cognitive control.
Plewnia, C., Schroeder, P. A., & Wolkenstein, L. (2015) · Lancet psychiatry · doi:10.1016/s2215-0366(15)00056-5 · Cited by 82
Gbadeyan, O., Steinhauser, M., McMahon, K. L., & Meinzer, M. (2016) · Brain stimulation · doi:10.1016/j.brs.2016.03.018 · Cited by 83
Sotnikova, A., Soff, C., Tagliazucchi, E., Becker, K., & Siniatchkin, M. (2017) · Brain Topography · doi:10.1007/s10548-017-0552-4 · Cited by 85
“Keywords ADHD · Transcranial direct current stimulation · Working memory · fMRI”
The COMT Val/Met Polymorphism Modulates Effects of tDCS on Response Inhibition
Nieratschker, V., Kiefer, C., Giel, K. E., Krüger, R., & Plewnia, C. (2014) · Brain stimulation · doi:10.1016/j.brs.2014.11.009 · Cited by 83
Dondé, C., Amad, A., Nieto, I., Brunoni, A. R., Neufeld, N. H., Bellivier, F., Poulet, E., & Geoffroy, P. A. (2017) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2017.05.021 · Cited by 87
Klauss, J., Anders, Q. S., Felippe, L. V., Nitsche, M. A., & Nakamura-Palacios, E. M. (2018) · Frontiers in Pharmacology · doi:10.3389/fphar.2018.00716 · Cited by 80
“The extension of tDCS sessions may clinically matters as 10 daily sessions have shown to result in more effective and longlasting effects than 5 daily sessions (Valle et al., 2009; Kuo et al., 2014).”
BackgroundResultCan Transcranial Direct Current Stimulation Augment Extinction of Conditioned Fear?
Wout‐Frank, M. V. ‘., Mariano, T. Y., Garnaat, S. L., Reddy, M. K., Rasmussen, S. A., & Greenberg, B. D. (2016) · Brain stimulation · doi:10.1016/j.brs.2016.03.004 · Cited by 81
“Nonetheless, this inherent disadvantage might in fact be beneficial as it increases the likelihood that (multiple) nodes of targeted circuitry may be affected for potential neuropsychiatric treatment [54].”
BackgroundMeinzer, M., Lindenberg, R., Sieg, M. M., Nachtigall, L., Ulm, L., & Flöel, A. (2014) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2014.00253 · Cited by 81
“A large number of behavioral studies have demonstrated beneficial effects of anodal and dual-tDCS on cognition, language and motor functions (Flöel, 2012, 2014; Monti et al., 2013; Kuo et al., 2014).”
Backgroundvan Montfort, S. J. T., van Dellen, E., Stam, C. J., Ahmad, A., Mentink, L. J., Kraan, C. W., Zalesky, A., & Slooter, A. J. C. (2019) · NeuroImage Clinical · doi:10.1016/j.nicl.2019.101809 · Cited by 86
Wu, Y., Mo, J., Sui, L., Zhang, J., Hu, W., Zhang, C., Wang, Y., Liu, C., Zhao, B., Xiu, W., et al. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.655412 · Cited by 84
Wischnewski, M., Mantell, K. E., & Opitz, A. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.08.017 · Cited by 78
Non-invasive Brain Stimulation Therapy in Multiple Sclerosis: A Review of tDCS, rTMS and ECT Results
Palm, U., Ayache, S. S., Padberg, F., & Lefaucheur, J. (2014) · Brain stimulation · doi:10.1016/j.brs.2014.09.014 · Cited by 78
“The use of tDCS as a NIBS technique for the treatment of neuropsychiatric disorders is exponentially growing in the past years [24].”
MethodPaßmann, S., Külzow, N., Ladenbauer, J., Antonenko, D., Grittner, U., Tamm, S., & Flöel, A. (2016) · Brain stimulation · doi:10.1016/j.brs.2016.04.016 · Cited by 88
Sauvaget, A., Trojak, B., Bulteau, S., Jiménez‐Múrcia, S., Fernández‐Aranda, F., Wolz, I., Menchón, J. M., Achab, S., Vanelle, J., & Grall‐Bronnec, M. (2015) · Frontiers in Neuroscience · doi:10.3389/fnins.2015.00349 · Cited by 81
“Moreover, reviews and Frontiers in Neuroscience | www.frontiersin.org 2 October 2015 | Volume 9 | Article 349 comprehensive work about tDCS in the field of psychiatry and addictions did not have considered BAs (Feil and Zangen, 2010; Kuo et al., 2014; Tortella et al., 2015).”
BackgroundLabruna, L., Jamil, A., Fresnoza, S. M., Batsikadze, G., Kuo, M., Vanderschelden, B., Ivry, R. B., & Nitsche, M. A. (2015) · Brain stimulation · doi:10.1016/j.brs.2015.08.014 · Cited by 76
Boonstra, T. W., Nikolin, S., Meisener, A.-C., Martin, D. M., & Loo, C. K. A. (2016) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2016.00270 · Cited by 74
“…including depression (Arul-Anandam and Loo, 2009; Nitsche et al., 2009; Loo et al., 2010, 2012; Brunoni et al., 2013), Frontiers in Human Neuroscience | www.frontiersin.org 1 June 2016 | Volume 10 | Article 270 stroke (Boggio et al., 2007; Baker et al., 2010), and dementia (Kuo et al., 2014).”
BackgroundSteinberg, F., Pixa, N. H., & Fregni, F. (2019) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2018.00534 · Cited by 75
“, 2018), and schizophrenia treatments (Gorczynski and Faulkner, 2010; Kuo et al., 2014; Smith et al., 2015; Yokoi et al., 2018).”
BackgroundInfluentialBrunoni, A. R., Shiozawa, P., Truong, D. Q., Javitt, D. C., Elkis, H., Fregni, F., & Bikson, M. (2014) · Expert Review of Medical Devices · doi:10.1586/17434440.2014.911082 · Cited by 75
“In the past decade, transcranial direct current stimulation (tDCS) is another non-pharmacological intervention that has shown promising results in several neuropsychiatric disorders [13] .”
BackgroundD’Urso, G., Brunoni, A. R., Anastasia, A., Micillo, M., de Bartolomeis, A., & Mantovani, A. (2015) · Neurocase · doi:10.1080/13554794.2015.1045522 · Cited by 72
Nikolin, S., Boonstra, T. W., Loo, C. K. A., & Martin, D. M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0181833 · Cited by 73
Fronto-parietal coherence response to tDCS modulation in patients with disorders of consciousness
Bai, Y., Xia, X., Wang, Y., Guo, Y., Yang, Y., He, J., & Xiaoli Li, A. (2017) · International Journal of Neuroscience · doi:10.1080/00207454.2017.1403440 · Cited by 70
“It has been used for treating many psychiatric or neurological disorders such as autism [4], Parkinson’s disease [5,6], depression [7,8], epilepsy [9,10] and stroke”
A meta-analysis of transcranial direct current stimulation for schizophrenia: “Is more better?”
Kim, J., Iwata, Y., Plitman, E., Caravaggio, F., Chung, J. K., Shah, P., Blumberger, D. M., Pollock, B. G., Remington, G. J., Graff‐Guerrero, A., et al. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.12.009 · Cited by 70
Senço, N. M., Huang, Y., D’Urso, G., Parra, L. C., Bikson, M., Mantovani, A., Shavitt, R. G., Hoexter, M. Q., Miguel, E. C., & Brunoni, A. R. (2015) · Expert Review of Medical Devices · doi:10.1586/17434440.2015.1037832 · Cited by 67
“In this context, tDCS is a new non-pharmacological treatment showing promising results in several neuropsychiatric disorders [19].”
BackgroundTranscranial direct current stimulation for hyperactivity and noncompliance in autistic disorder
D’Urso, G., Bruzzese, D., Ferrucci, R., Priori, A., Pascotto, A., Galderisi, S., Altamura, A. C., & Bravaccio, C. (2015) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2015.1014411 · Cited by 68
“…direct current stimulation (tDCS), have proven to be effective, and, not least, safe in treating psychiatric and neurological disorders (Kuo et al. 2014; Lefaucheur et al. 2014). rTMS has been also used in AD patients and was able to partially revert their neurocognitive defi cits, as…”
Astrocytes as a target of transcranial direct current stimulation (tDCS) to treat depression
Monai, H., & Hirase, H. (2017) · Neuroscience Research · doi:10.1016/j.neures.2017.08.012 · Cited by 68
Recent Advances in Non-invasive Brain Stimulation for Major Depressive Disorder
Liu, S., Sheng, J., Li, B., & Zhang, X. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00526 · Cited by 68
“…NBS techniques have been found to be useful for regulating healthy individual control of consciousness, and positive therapeutic effects have been reported for a range of psychiatric disorders, including depression, Alzheimer’s disease, and epilepsy (Kuo et al., 2014; De Raedt et al., 2015).”
BackgroundKirimoto, H., Tamaki, H., Matsumoto, T., Sugawara, K., Suzuki, M., Oyama, M., & Onishi, H. (2014) · Brain stimulation · doi:10.1016/j.brs.2014.09.016 · Cited by 65
Reprint of: Transcranial direct current stimulation (tDCS) – Application in neuropsychology
Shin, Y., Foerster, Á., & Nitsche, M. A. (2015) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2015.06.021 · Cited by 68
“Moreover, fostering respective physiological processes might also be able to improve psychological and behavioral processes in health and disease (Flöel, 2014; Kuo et al., 2014; Kuo and Nitsche, 2012).”
BackgroundNon-invasive brain stimulation in Parkinson’s disease: Exploiting crossroads of cognition and mood
Dinkelbach, L., Brambilla, M., Manenti, R., & Brem, A. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.01.021 · Cited by 61
Metadata
- Authors
- Kuo, M.-F., Paulus, W., & Nitsche, M. A.
- Affiliations
- Universitätsmedizin Göttingen (DE)
- Corresponding author
- Nitsche, Michael A.
- Venue
- NeuroImage
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 85
- Pages
- 948-960
- ISSN
- 1053-8119 (ISSN-L)
- OpenAlex
- W2057070604
- Cited by
- 415
- References
- 149
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 18 · 2023: 16 · 2022: 22 · 2021: 32 · 2020: 27 · 2019: 29 · 2018: 40 · 2017: 50 · 2016: 55 · 2015: 51 · 2014: 31
- FWCI
- 4.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- NeuroImage (publishedVersion)
- PubMed (publishedVersion)
- GRO (submittedVersion)
- Funders
- German Research Society (Ni 683/4-2, Ni 683/6-1)
- German Ministry for Education and Research (03IPT605E)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Keywords
- transcranial direct current stimulation, non-invasive brain stimulation, neuroplasticity, neuropsychiatric disorders, stimulation optimization
- MeSH terms
- Mental Disorders, Electric Stimulation Therapy, Humans, Neuronal Plasticity, Tinnitus, Pain Management
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