clinical application of tdcs
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tDCS の臨床研究Clinical application of tDCS
Yuma Yokoi, MD2015
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Conflict Of Interest
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tDCS stands for
transcranial direct current stimulation
経頭蓋 直流電気 刺激
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Direct current
Anode陽極
Cathode陰極
Current電流
Battery電池
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h/o tDCS
18th/19th century: Galvanism
20th century: prosperity of ECT and disregard of tDCS
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Current tDCS
(a)Stimulator(b)Anode electrode(c)Cathode electrode(d)Strap(e)Rubber band
(Yokoi [in press])
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tDCS devices
(Guleyupoglu 2013)
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• 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 )
dose of tDCS
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• High-definition tDCS– Many electrodes
• tACS (transcranial alternating current stimulation)
• tRNS (transcranial random noise stimulation)
variants of tDCS
(Guleyupoglu 2013)
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Mechanism of Action (Filmer 2014)
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Mechanism of Action (Filmer 2014)
(Purpura 1965)motor evoked potentials (MEPs)
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Mechanism of Action (Santarnecchi 2014)
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Mechanism of Action (Filmer 2014)
Anodal stimulation inhibits
GABA(Mondino 2014, Stagg 2011)
Long-term potentiation
(LDP)-like長期増強
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Mechanism of Action (Filmer 2014)
Cathodal stimulation inhibits
glutamate(Stagg 2011)
Long-term depression
(LDP)-like長期抑制
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• DLPFC (Dorsolateral prefrontal cortex)
Rationale for treating depression
( Kim 2014 )
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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)
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Mechanism of action is complex
( Kuo 2013 )
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Safety
( Tortella 2015 )
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Meta-analysis of tDCS for depression
(Shiozawa 2014)
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ADAPT 研究Ameliorating Depression in Alzheimer’s disease Patients by Transcranial direct current stimulationA 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 RCTClinicalTrials.gov Identifier: NCT02351388UMIN ID:UMIN000014561科研費番号 :26860958
ADAPT 研究
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Participantsアルツハイマー病患者MINH 基準での dAD 診断
Intervention/ControltDCS 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
アウトライン
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