Fregni F, Pascual-Leone ATechnology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nat Clin Pract Neurol 3:383-393

Harvard Medical School and the Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Nature Clinical Practice Neurology (Impact Factor: 7.64). 08/2007; 3(7):383-93. DOI: 10.1038/ncpneuro0530
Source: PubMed


In neurology, as in all branches of medicine, symptoms of disease and the resulting burden of illness and disability are not simply the consequence of the injury, inflammation or dysfunction of a given organ; they also reflect the consequences of the nervous system's attempt to adapt to the insult. This plastic response includes compensatory changes that prove adaptive for the individual, as well as changes that contribute to functional disability and are, therefore, maladaptive. In this context, brain stimulation techniques tailored to modulate individual plastic changes associated with neurological diseases might enhance clinical benefits and minimize adverse effects. In this Review, we discuss the use of two noninvasive brain stimulation techniques--repetitive transcranial magnetic stimulation and transcranial direct current stimulation--to modulate activity in the targeted cortex or in a dysfunctional network, to restore an adaptive equilibrium in a disrupted network for best behavioral outcome, and to suppress plastic changes for functional advantage. We review randomized controlled studies, in focal epilepsy, Parkinson's disease, recovery from stroke, and chronic pain, to illustrate these principles, and we present evidence for the clinical effects of these two techniques.

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Available from: Alvaro Pascual-Leone
    • "These methods stimulate the brain either by inducing an electrical field using a magnetic coil placed against the head (TMS), or by applying weak electrical currents via electrodes on the scalp (tDCS) (Nuffield Council on Bioethics 2013). For both methods, patients remain conscious while undergoing the procedure, and if appropriate guidelines and precautions are followed they are generally considered safe (Fregni and Pascual-Leone 2007; Rossi et al. 2009). There is evidence suggesting that tDCS can improve recognition memory in Alzheimer's disease (Ferruci et al. 2008) and modulate declarative memory (Javadi and Walsch 2012), while TMS can enhance episodic memory in young and healthy adults (Gagnon et al. 2011) and modulation of memory retrieval of emotional material (Balconi and Ferrari 2012). "
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    • "The combination of brain imaging and a neuronavigation system is the current gold standard in the field of NIBS [14] and may improve the results of NIBS-based therapeutic interventions [15] [16] [17] [18] [19] [20]; however, there are some disadvantages . These include difficulty in using these systems for studies of posterior brain areas that can fall outside of the neuronavigation system's field of view and, most importantly, the high cost of these systems, which can exceed $50,000. "
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    ABSTRACT: A key issue in the field of noninvasive brain stimulation (NIBS) is the accurate localization of scalp positions that correspond to targeted cortical areas. The current gold standard is to combine structural and functional brain imaging with a commercially available “neuronavigation” system. However, neuronavigation systems are not commonplace outside of specialized research environments. Here we describe a technique that allows for the use of participant-specific functional and structural MRI data to guide NIBS without a neuronavigation system. Surface mesh representations of the head were generated using Brain Voyager and vectors linking key anatomical landmarks were drawn on the mesh. Our technique was then used to calculate the precise distances on the scalp corresponding to these vectors. These calculations were verified using actual measurements of the head and the technique was used to identify a scalp position corresponding to a brain area localized using functional MRI.
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    • "After stroke, high frequency (4 5 Hz) or low frequency ( r1 Hz) rTMS may be used to increase ipsilesional or decrease contralesional excitability respectively. Given recent evidence of functional S1–S1 connections mediated by the CC in the human brain (Brodie et al., 2014), theoretically either of these rTMS approaches could be used to reestablish the balance of interhemispheric excitability after stroke (Fregni and Pascual-Leone, 2007; Nowak et al., 2009). The majority of previous rTMS studies have focused on modulation of M1 excitability. "
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