Brain stimulation delivered at home by an electrode headset appears to strengthen the benefits of cognitive training video games in patients with multiple sclerosis (MS).
That’s the main finding of a new study looking into the benefits of transcranial direct current stimulation (tDCS).
“Our research adds evidence that tDCS, while done remotely under a supervised treatment protocol, may provide an exciting new treatment option for people with multiple sclerosis who cannot get relief for some of their cognitive symptoms,” said Leigh E. Charvet, PhD, an associate professor of neurology and the director of research at NYU Langone’s Multiple Sclerosis Comprehensive Care Center.
Charvet partnered with researchers from the City College of New York and from Soterix Medical, which owns the patent on the tDCS device used in the study.
The researchers hypothesized that a low amplitude current, delivered through electrodes placed on the patient’s head, would cause neurons to fire more easily and quickly and thus increase the amount of learning and cognitive benefit to patients playing cognitive training games. The games are designed to challenge information processing, attention, and memory.
To study the idea, the researchers recruited 45 patients with MS. Twenty-five of those patients used the combination of video games and tDCS targeting the patient’s dorsolateral prefrontal cortex. The other 20 patients played the video games without the transcranial stimulation.
Patients underwent 10 sessions with the video game. Those receiving the tDCS treatment were contacted via video conference before each session and given a code by a study technician. The code system allowed the researchers to control tDCS dosing.
At the end of the sessions, patients receiving the video game/tDCS combination saw significantly greater improvement in complex attention and response times compared to the patients who didn’t undergo tDCS. That benefit seemed to increase over time, suggesting that the benefits might accumulate over time. There was, however, no significant difference between the patient groups when it came to basic attention measures and other standard cognitive measures, like Brief International Cognitive Assessment in MS (BICAMS) test scores.
Charvet said the improvements shown in the study could have significant quality of life benefits for patients.
“Many MS medications are aimed at preventing disease flares but those drugs do not help with daily symptom management, especially cognitive problems,” she said. “We hope tDCS will fill this crucial gap and help improve quality of life for people with MS.”
Charvet also noted that because the treatment can be done at home, patients who have difficulty traveling could still benefit from the treatment.
Still, Charvet cautioned that it’s not yet known how long the benefits of tDCS and cognitive training will last. That’s one reason she and her colleagues are working to recruit patients for another study that will involve 20 sessions, double the treatment course of the first study.
MS is one of several conditions tDCS could potentially treat. According to Soterix’s website, the company has also investigated tDCS’ efficacy treating patients with fibromyalgia, migraines, depression, and aphasia after stroke, among others.
The study, titled “Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis,” was published Feb. 22 in the journal Neuromodulation: Technology at the Neural Interface.
Objective: In this study we assessed the clinical effect of cerebellar repetitive transcranial magnetic stimulation (rTMS) on tremor severity in patients with essential tremor.
Background: Essential tremor is a low mortality yet quite disabling disorder with an overall prevalence of 0.9% of general population. It is the second most common adult movement disorder after restless leg syndrome. The high prevalence of this disorder, especially among elderly patients, and the need for less harmful and more effective treatments necessitates exploration of new non-invasive therapeutic options that are directed to the pathology of the disorder.
Methods: This is a double blind, sham controlled, add-on, 2 by 2 crossover randomized clinical trial. A total of 23 patients assigned into two groups of either sham (n=10) or rTMS (n=13) treatment with a two-month washout period before crossing over. Intervention consisted of 900-pulse 1Hz rTMS at 90% resting mote threshold over each cerebellar hemisphere for 5 consecutive days. Tremor severity was assessed by Fahn-Tolosa-Marin (FTM) scale at baseline and at days 5, 12 and 30 after intervention. Analysis performed using two-way repeated measures analysis of variance.
Results: Although analysis of the main outcome measure showed no statistically significant benefit on the effect of treatment, a significant effect of time in a subscale of FTM was observed between days 5 and 12. Pattern of changes in tremor severity scores revealed a slower return to lower than baseline values in the rTMS group in contrast to a more rapid and larger increase to near baseline values in the sham group. These results, however, did not reach statistical significance. Subgroup analyses showed a non-significant decreasing trend in tremor severity among patients with a positive family history of tremor and those with less chronic disease. No major adverse event was observed in this study.
Conclusions: Our findings justifies conduct of further research with larger samples to assess the effect of multiple cerebellar rTMS rounds in essential tremor and probably suggests the subgroups of patients benefit the most.
Stimulating a precise location of the brain’s memory center with electromagnetic pulses improves the memory of older adults with age-related memory loss to the level of young adults, reports a new Northwestern Medicine study.
“Older people’s memory got better up to the level that we could no longer tell them apart from younger people,” said lead investigator Joel Voss, associate professor at Northwestern University Feinberg School of Medicine. “They got substantially better.”
The study used Transcranial Magnetic Stimulation (TMS) to target the hippocampus – the brain region that atrophies as people grow older, which is responsible for memory decline.
The study will be published April 17 in Neurology.
“It’s the part of the brain that links two unrelated things together into a memory, like the place you left your keys or your new neighbor’s name,” Voss said. “Older adults often complain about having trouble with this.”
This type of memory worsens as we age. Nearly all people experience a decline in their memory ability as they age.
The new study of 16 people — ages 64 to 80 with normal age-related memory problems – shows it’s possible to alter memory ability in older adults using this type of brain stimulation, Voss said. “There is no previous evidence that the specific memory impairments and brain dysfunction seen in older adults can be rescued using brain stimulation or any other method.”
Voss’s team located the hippocampus – which is smaller in older adults – individually for each participant with an fMRI. An fMRI (functional MRI) measures how active a part of the brain is at a given time.
Then, they located an area of the parietal lobe that communicates with the hippocampus for stimulation delivery. This spot was behind and slightly above a person’s left ear, but everyone had a slightly different spot.
It isn’t possible to directly stimulate the hippocampus with TMS, which is noninvasive, because it’s too deep in the brain for the magnetic fields to penetrate. So, Voss and colleagues identified a superficial brain region close to the surface of the skull with high connectivity to the hippocampus.
“We stimulated where brain activity is synchronized to the hippocampus, suggesting that these regions talk to each other,” said first author
At baseline, younger and older adults were given memory tasks in which they learned arbitrary relations between paired things, such as this object goes on this spot on the computer screen. Younger adults score about 55 percent correct and older adults less than 40 percent correct.
The research team then applied high-frequency repetitive magnetic stimulation to the spot for five consecutive days for 20 minutes a day. Stimulating this area improved the function of regions important for memory that are disrupted by aging, evident by more neural activity visible on an fMRI.
Then, 24 hours after the final stimulation, the subjects were given a new memory test in which they had to learn new arbitrary relations between paired things. After the brain stimulation, older adults scored at the level of young adults on the memory tasks.
he study also used a fake placebo stimulation condition, which did not improve memory.
Voss and colleagues will next test this approach on participants with mild cognitive impairment, the early stage of Alzheimer’s disease. They will be stimulating the brain for longer periods of time.
Voss isn’t certain how long the effects could last. He suggests the enhanced memory effects could last longer with more stimulation. For instance, when depression is treated with TMS for five weeks, those patients get an antidepressant effect that lasts for many months, he noted. In a future study, Voss will be stimulating the brain in persons with age-related memory loss for more weeks to test this.
Magnetic stimulation of the brain improves working memory, offering a new potential avenue of therapy for individuals living with Alzheimer’s disease and other forms of dementia, according to new research from the Duke University School of Medicine.
Healthy younger and older adult participants who received a therapy called repetitive transcranial magnetic stimulation (TMS) performed better on a memory task than during an TMS-like placebo in the study, which was published here in PLoS One.
“This study relies on highly individualized parameters, from the selection of the stimulated target, based on fMRI activation, to the selection of the difficulty, titrated according to subjects’ performance. Now that we have shown that these specific parameters can improve performance in healthy subjects, we will be able to extend it to populations with memory deficits,” said Lysianne Beynel, PhD, a postdoctoral associate in the Department of Psychiatry and Behavioral Sciences.
Working memory is the process of recalling and then using relevant information while performing a task. It’s a key component of day-to-day tasks like driving to a new location, making a recipe, or following instructions. Individuals with Alzheimer’s disease, which will more than double by 2050, and other forms of dementia, experience progressive loss of working memory and other forms of cognition, leading to a greater risk of injury or death and reducing their ability to function without home care.
Twenty-nine young adults and 18 older adults completed the study, which involved trying to remember and then reproduce a series of letters in alphabetical order. The authors applied either online high-frequency (5Hz) TMS, or a placebo-like sham over the left prefrontal cortex, an area on the brain responsible for higher executive function. Participants of all ages who received TMS performed better than those who received the TMS-like placebo.
“Interestingly, we only saw this effect during when participants were trying their hardest, suggesting a real use-it-or-lose it principle at work here,” said co-author Simon W. Davis, PhD. “Contrary to much of what we hear, aging brains have a remarkable capability to remember past events and to use that information in a flexible manner. The brain stimulation applied in our study shows that older adults benefited just as much as the young.”
Other authors of the study include Roberto Cabeza, PhD, Courtney Crowell, Susan Hilbig, Wesley Lim, Hannah Palmer, Alexandra Brito, Duy Nguyen, Luber Bruce, and Sarah Lisanby. This research was supported by grant U01 AG050618 from the National Institute on Aging.