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Clinical application of tDCS

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Overview of transcranial direct current stimulation

Publié dans : Santé & Médecine
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Clinical application of tDCS

  1. 1. tDCSの臨床研究 Clinical application of tDCS Yuma Yokoi, MD 2015
  2. 2. 2 Conflict Of Interest
  3. 3. 3 tDCS stands for transcranial direct current stimulation 経頭蓋 直流電気 刺激
  4. 4. 4 Direct current Anode 陽極 Cathode 陰極 Current 電流 Battery 電池
  5. 5. 5 h/o tDCS 18th/19th century: Galvanism 20th century: prosperity of ECT and disregard of tDCS
  6. 6. 6 Current tDCS (a)Stimulator (b)Anode electrode (c)Cathode electrode (d)Strap (e)Rubber band (Yokoi [in press])
  7. 7. 7 tDCS devices (Guleyupoglu 2013)
  8. 8. • Current intensity 電流量 ( 0.5 to 2 mA ) • Duration 刺激時間 ( 5 to 40 min ) • Frequency 刺激頻度 (3~5/week, 1~2/day) • Size of electrodes 電極サイズ ( 3 to 100 cm2) → Current density 電流密度 ( A / m2 ) Total charge 総電流量 ( Coulombs ) 8 dose of tDCS
  9. 9. • High-definition tDCS – Many electrodes • tACS (transcranial alternating current stimulation) • tRNS (transcranial random noise stimulation) 9 variants of tDCS (Guleyupoglu 2013)
  10. 10. 10 Mechanism of Action (Filmer 2014)
  11. 11. 11 Mechanism of Action (Filmer 2014) (Purpura 1965) motor evoked potentials (MEPs)
  12. 12. 12 Mechanism of Action (Santarnecchi 2014)
  13. 13. 13 Mechanism of Action (Filmer 2014) Anodal stimulation inhibits GABA (Mondino 2014, Stagg 2011) Long-term potentiation (LDP)-like 長期増強
  14. 14. 14 Mechanism of Action (Filmer 2014) Cathodal stimulation inhibits glutamate (Stagg 2011) Long-term depression (LDP)-like 長期抑制
  15. 15. • DLPFC (Dorsolateral prefrontal cortex) 15 Rationale for treating depression ( Kim 2014 )
  16. 16. 16 Mechanism of action is complex ◯ Electricity  Nonfocal (Russel 2013) • Anatomical factors  up to 50% – Geometory of sulci and gyri (Miranda 2013) – Thickness of cerebrospinal fluid (CSF) and skull (Opitz 2015) – Cathodal stimulation? (Filmer 2013) ◯ Neurotransmitter  GABA, glutamate, catecholamine, acetylcholine and serotonin (Stagg 2011, Medeiros 2012, Mondino 2014)
  17. 17. 17 Mechanism of action is complex ( Kuo 2013 )
  18. 18. 18 Safety ( Tortella 2015 ) かゆみ ひりひり 頭痛 焼ける感じ 不快感
  19. 19. 19 Meta-analysis of tDCS for depression (Shiozawa 2014)
  20. 20. ADAPT研究 Ameliorating Depression in Alzheimer’s disease Patients by Transcranial direct current stimulation A randomized, double-blind, sham-controlled trial アルツハイマー病のうつに対して経頭蓋直 流電気刺激を行うRCT ClinicalTrials.gov Identifier: NCT02351388 UMIN ID:UMIN000014561 科研費番号:26860958 20 ADAPT研究
  21. 21. Participants アルツハイマー病患者 MINH基準でのdAD診断 Intervention/Control tDCS 週5日×3週 実刺激 or 偽刺激 二重盲検RCT Outcome 安全性・忍容性 CSDD(コーネル認知症 抑うつ尺度)のBLからの 変化 など Sample size 実刺激10+偽刺激10 Phase 1/2 21 アウトライン

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