Andrea Antal

Universitätsmedizin Göttingen · Department of Neurology

Numerous complex and multi-faceted ethical questions arise from the innovation of neurotechnologies. Addressing these issues effectively requires the involvement of a diverse range of stakeholders, including patients, treatment providers, home users, scientists and engineers from different disciplines, and industry representatives. Different groups...

Non-invasive brain stimulation (NIBS) techniques such as transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) have made great progress in recent years and offer boundless potential for the neuroscientific research and treatment of disorders. However, the possible use of NIBS devices for neuro-doping and neuroenh...

Background Extensive audio‐motor training and psychological stress can cause professional musicians acute overstrain‐injury and chronic pain, resulting in damaged careers and diminished quality of life. It has also been previously shown that musicians might perceive pain differently than non‐musicians. Therefore, the aim of our study was to quantif...

Here, we present five different insights on the use of neuromodulation strategies for effective pain management in clinical practice. Experts briefly illustrate the various techniques available and the complexities involved in evaluating their effectiveness. Additionally, they highlight the challenges for widespread adoption in clinical practice an...

A new type of non-invasive deep-brain stimulation is conceived and demonstrated by computer simulations. The process is based on spatio-temporal Fourier synthesis using multiple electrode pairs with sinusoidal current drive to limit skin sensations and concentrate the stimulus power to a small spatial volume and into large rare spikes in the time d...

The escalating global burden of age-related neurodegenerative diseases and associated healthcare costs necessitates innovative interventions to stabilize or enhance cognitive functions. Deficits in working memory (WM) are linked to alterations in prefrontal theta–gamma cross-frequency coupling. Low-intensity transcranial alternating current stimula...

Objective: This study investigated the efficacy of combining at-home anodal transcranial direct current stimulation (tDCS) of the left primary motor cortex (M1) with mindfulness meditation (MM) in fibromyalgia patients trained in mindfulness. Methods: Thirty-seven patients were allocated to receive ten daily sessions of MM paired with either anoda...

Introduction With aging, dual task (DT) ability declines and is more cognitively demanding than single tasks. Rapidly declining DT performance is regarded as a predictor of neurodegenerative disease. Task training and non-invasive transcranial electrical stimulation (tES) are methods applied to optimize the DT ability of the elderly. Methods A sys...

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A significant amount of European basic and clinical neuroscience research includes the use of transcranial magnetic stimulation (TMS) and low intensity transcranial electrical stimulation (tES), mainly transcranial direct current stimulation (tDCS). Two recent changes in the EU regulations, the introduction of the Medical Device Regulation (MDR) (2...

The rise in the global population of older adults underscores the significance to investigate age-related cognitive disorders and develop early treatment modalities. Previous research suggests that non-invasive transcranial Alternating Current Stimulation (tACS) can moderately improve cognitive decline in older adults. However, non-declarative cogn...

Nicht-invasive Hirnstimulation ist ein sehr vielversprechendes Feld in der therapeutischen Anwendung von Methoden der klinischen Neurophysiologie. Die Vielzahl der physikalisch möglichen Stimulationsparameter erfordern eine detaillierte Kenntnis der einzelnen Verfahren, wie sie in diesem Curriculum vermitteln werden.

Prioritizing mental health through accessible healthcare is crucial. Non-invasive brain stimulation (NIBS) has the potential to significantly improve the treatment of mental diseases. In a participatory process involving various stakeholders, recommendations were developed for policy makers, health authorities, healthcare providers of NIBS, Industr...

Temporal interference stimulation (TIS) aims at targeting deep brain areas during transcranial electrical alternating current stimulation (tACS) by generating interference fields at depth. Although its modulatory effects have been demonstrated in animal and human models and stimulation studies, direct experimental evidence is lacking for its utilit...

Aging is often accompanied by a decline in cognitive functions, with memory being particularly affected. Recent studies suggest that cognitive training sessions that teach memory strategies relevant to daily life may benefit seniors who live in the community. However, it is possible that the cognitive improvement observed in these programs results...

Introduction Obstructive sleep apnoea (OSA) is a multisystem, debilitating, chronic disorder of breathing during sleep, resulting in a relatively consistent pattern of cognitive deficits. More recently, it has been argued that those cognitive deficits, especially in middle-aged patients, may be driven by cardiovascular and metabolic comorbidities,...

Background: Low intensity transcranial electrical stimulation (tES) and meditation are two promising, yet variable, non-pharmacological interventions. Growing research is investigating combined effects of both techniques on one's cognitive, emotional, and physical health. Objective: This article reviews the current research that combines tES and...

Background This double-blinded, randomized and sham-controlled pilot clinical trial aimed to investigate the preliminary clinical efficacy and feasibility of combining mindfulness meditation (MM) and transcranial direct current stimulation (tDCS) for pain and associated symptoms in patients with fibromyalgia syndrome (FMS). Methods Included FMS pa...

Objective Although relatively costly and non-scalable, non-invasive neuromodulation interventions are treatment alternatives for neuropsychiatric disorders. The recent developments of highly-deployable transcranial electric stimulation (tES) systems, combined with mobile-Health technologies, could be incorporated in digital trials to overcome metho...

Non-invasive electrical stimulation methods, such as transcranial alternating current stimulation (tACS), are increasingly used in human neuroscience research and offer potential new avenues to treat neurological and psychiatric disorders. However, their often variable effects have also raised concerns in the scientific and clinical communities. Th...

Transcranial (electro)magnetic stimulation (TMS) is currently the method of choice to non-invasively induce neural activity in the human brain. A single transcranial stimulus induces a time-varying electric field in the brain that may evoke action potentials in cortical neurons. The spatial relationship between the locally induced electric field an...

Attempts to enhance human memory and learning ability have a long tradition in science. This topic has recently gained substantial attention because of the increasing percentage of older individuals worldwide and the predicted rise of age-associated cognitive decline in brain functions. Transcranial brain stimulation methods, such as transcranial m...

Background Anxiety, conduct and depressive disorders represent three highly prevalent psychiatric conditions in adolescents. A shared underpinning of these disorders is a shortcoming in emotion regulation, connected to the functioning of the ventromedial prefrontal cortex. Thus, an intervention able to target the suggested neural correlate seems to...

Objective The influence of the TMS-parameters on the efficacy and reliability to induce diaphragmatic motor-evoked potentials (diMEPs) has not been studied so far. Therefore, the objective of the present research is to probe the role of TMS- waveform (monophasic- [Mo] vs. biphasic-pulses [Bi]) and current direction (posterior-anterior [Pa] vs. ante...

Low-intensity transcranial electrical stimulation (tES), including alternating or direct current stimulation, applies weak electrical stimulation to modulate the activity of brain circuits. Integration of tES with concurrent functional MRI (fMRI) allows for the mapping of neural activity during neuromodulation, supporting causal studies of both bra...

Objective: Hemianopia following occipital stroke is believed to be mainly due to local damage at or near the lesion site. Yet, MRI studies suggest functional connectivity network (FCN) reorganization also in distant brain regions. Because it is unclear if reorganization is adaptive or maladaptive, compensating for, or aggravating vision loss, we c...

Noninvasive brain stimulation techniques (NiBS) have gathered substantial interest in the study of dementia, considered their possible role in help defining diagnostic biomarkers of altered neural activity for early disease detection and monitoring of its pathophysiological course, as well as for their therapeutic potential of boosting residual cog...

Background At early stages, dementia disorders share similar clinical symptoms. For an appropriate classification, more practical and non‐invasive diagnostic methods are needed. Transcranial magnetic stimulation (TMS) assess non‐invasively the imbalance of cortical excitability and related neurotransmitters levels in the brain(1‐3). Characterizing...

The world's population is aging. With this comes an increase in the prevalence of age-associated diseases, which amplifies the need for novel treatments to counteract cognitive decline in the elderly. One of the recently discussed non-pharmacological approaches is transcranial direct current stimulation (tDCS). TDCS delivers weak electric currents...

Because current flow cannot be measured directly in the intact retina or brain, current density distribution models were developed to estimate it during magnetic or electrical stimulation. A paradigm is now needed to evaluate if current flow modeling can be related to physiologically meaningful signs of true current distribution in the human brain....

This is the second chapter of the series on the use of clinical neurophysiology for the study of movement disorders. It focusses on methods that can be used to probe neural circuits in brain and spinal cord. These include use of spinal and supraspinal reflexes to probe the integrity of transmission in specific pathways; transcranial methods of brai...

Through neuromodulation of neural activity, transcranial alternating current stimulation (tACS) interacts with neural oscillations in a frequency- and phase-specific manner, thereby influencing human brain function. Currents are applied at the scalp with intensities up to 4 mA peak to peak (except for electroconvulsive therapy with much higher inte...

Introduction: 1) During tES, increasing intracellular Ca2+ levels beyond those needed for inducing LTP may collapse aftereffects. 2) State-dependent plastic aftereffects are reduced when applied during muscle activation as compared to rest. 3) Cortical surround inhibition by antagonistic muscle activation inhibits the center-innervated agonist. O...

Background: Occipital strokes often cause permanent homonymous hemianopia leading to significant disability. In previous studies, non-invasive electrical brain stimulation (NIBS) has improved vision after optic nerve damage and in combination with training after stroke. Objective: We explored different NIBS modalities for rehabilitation of hemia...

Background Low intensity transcranial electrical stimulation (tES), including alternating or direct current stimulation (tACS or tDCS), applies weak electrical stimulation to modulate brain circuits. Integration of tES with concurrent functional magnetic resonance imaging (fMRI) allows neuromodulation of brain regions while mapping network function...

As the field of noninvasive brain stimulation (NIBS) expands there is a growing need for comprehensive guidelines on training practitioners in the safe and effective administration of NIBS techniques in their various research and clinical applications. This article provides recommendations on the structure and content of this training. Three differ...

Background: Low intensity, high-frequency transcranial alternating current stimulation (tACS) applied over the motor cortex decreases the amplitude of motor evoked potentials. This double-blind, placebo-controlled parallel group study aimed to test the efficacy of this method for acute management of migraines. Methods: The patients received either...

s Sensorimotor mu-alpha rhythm reflects the state of cortical excitability. Repetitive transcranial magnetic stimulation (rTMS) can modulate neural synchrony by inducing periodic electric fields (E-fields) in the cortical networks. We hypothesized that the increased synchronization of mu-alpha rhythm would inhibit the corticospinal excitability ref...

This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical setti...

For decades visual field defects were considered irreversible because it was thought that in the visual system the regeneration potential of the neuronal tissues is low. Nevertheless, there is always some potential for partial recovery of the visual field defect that can be achieved through induction of neuroplasticity. Neuroplasticity refers to th...

The two most frequently used techniques for the non-invasive modulation of brain activity are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). These techniques have repeatedly been used to modulate the activity of a given area within a neuronal network to study pathophysiological changes in mig...

Cognitive control is a mental process, which underlies adaptive goal-directed decisions. Previous studies have linked cognitive control to electrophysiological fluctuations in the θ band and θ-γ cross-frequency coupling (CFC) arising from the cingulate and frontal cortices. However, to date, the behavioral consequences of different forms of θ-γ CFC...

Repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (TES) are noninvasive brain stimulation techniques that are increasingly used as therapeutic approaches in psychiatric disorders. As for any therapeutic intervention, including drugs, it is necessary to delineate their safety limits, including adverse effect...

Non-invasive neuromodulation techniques such as transcranial direct current stimulation (tDCS) enable researchers and health care professionals to gain unique insight into brain functions and to treat a number of neurological and psychiatric conditions. Repeated applications of anodal tDCS over the primary motor cortex (M1) have been shown to produ...

Background The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be rest...

PurposeIdentifying factors that affect recovery or restoration of neurological function is a key goal of rehabilitation in neurology and ophthalmology. One such factor can be prolonged mental stress, which may be not only the consequence of nervous system damage but also a major risk factor, or cause, of neural inactivation. Using the visual system...

Cognitive control is a hypothetical mental process, which underlies adaptive goal-directed decisions. Previous studies have linked cognitive control to electrophysiological fluctuations in the theta band and theta-gamma cross-frequency coupling (CFC) arising from the cingulate and frontal cortices. Yet, to date the behavioral consequences of differ...

Understanding the mechanisms by which intermittent theta burst stimulation (iTBS) protocols exert changes in the default-mode network (DMN) is paramount to develop therapeutically more effective approaches in the future. While a full session (3000 pulses) of 10 Hz repetitive transcranial magnetic stimulation (HF-rTMS) reduces the functional connect...

The visual system has one of the most complex structures of all sensory systems and is perhaps the most important sense for everyday life. Its functional organization was extensively studied for decades in animal and humans, for example by correlating circumscribed anatomical lesions in patients with the resulting visual dysfunction. During the pas...

Low vision is still a little known area of ophthalmology and requires constant study, a multifactorial approach, multiple skills and a two-way dialogue with the other sectors of the ophthalmological discipline. The lack of communication among experts hampers a higher level of cognition about this topic. This volume, in the philosophy of Low Vision...

Among the brain regions involved in the aesthetic evaluation of paintings, the prefrontal cortex seems to play a pivotal role. In particular, consistent neuroimaging evidence indicates that activity in the dorsolateral prefrontal cortex (mainly in the left hemisphere) and in medial and orbital sectors of the prefrontal cortex is linked to viewing a...

Noninvasive neuromodulation, including repetitive trans­cranial magnetic stimulation (rTMS) and direct current stimulation (tDCS), provides researchers and health care professionals with the ability to gain unique insights into brain functions and treat several neurological and psychiatric conditions. Undeniably, the number of published research an...

Behavioral response conflict arises in the color-word Stroop task and triggers the cognitive control network. Midfrontal theta-band oscillations correlate with adaptive control mechanisms during and after conflict resolution. In order to prove causality, in two experiments, we applied transcranial alternating current stimulation (tACS) at 6 Hz to t...

Transcranial electrical stimulation (tES) aims to alter brain function non-invasively by applying current to electrodes on the scalp. Decades of research and technological advancement are associated with a growing diversity of tES methods and the associated nomenclature for describing these methods. Whether intended to produce a specific response s...

Understanding the mechanisms by which transcranial magnetic stimulation protocols exert changes in the default mode network (DMN) is paramount to develop therapeutically more effective approaches in the future. A full session (3000 pulses) of 10 Hz repetitive transcranial magnetic stimulation (HF-rTMS) reduces the functional connectivity (FC) of th...

High frequency repetitive transcranial magnetic stimulation (HF-rTMS) delivered to the left dorsolateral prefrontal cortex (DLPFC) is an effective treatment option for treatment resistant depression. However, the underlying mechanisms of a full session of HF-rTMS in healthy volunteers have not yet been described. Here we investigated, with a person...