Highlights
- •Transcranial direct current stimulation (tDCS) has been evaluated in a limited number of pharmacoresistant epilepsy patients, but treatment parameters remain undefined.
- •Safety and efficacy of two cathodal tDCS protocols were evaluated in patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS).
- •Three and five sessions decreased seizure frequency and interictal epileptiform discharges in MTLE-HS patients, compared to placebo.
Abstract
Background
Transcranial direct current stimulation (tDCS) has been evaluated in medication refractory
epilepsy patients. The results have been inconclusive and protocols have varied between
studies.
Objective
To evaluate the safety and efficacy of two protocols of tDCS in adult patients with
mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS).
Methods
This is a randomized placebo-controlled, double-blinded clinical trial, with 3 arms,
3 sessions, 5 sessions and placebo stimulation. Frequency of seizures (SZs), interictal
epileptiform discharges (IEDs) and adverse effects (AEs) were registered before and
after treatment, and at 30 and 60 days follow-up. Descriptive statistics, k-related
samples, Friedman's test, and relative risk (RR) estimation were used for analysis.
Results
We included twenty-eight subjects (3d n = 12, 5d n = 8, placebo n = 8), 16/28 (57%) men, age 37.8(±10.9) years old. There was a significant reduction
of the frequency of SZs at one (p = 0.001) and two (p = 0.0001) months following cathodal tDCS compared to baseline in the 3 arms (p = 0.0001). The mean reduction of SZ frequency at two months in both active groups
was significantly higher than placebo (−48% vs. −6.25%, p < 0.008). At 3 days (−43.4%
vs. −6.25%, p < 0.007) and 5 days (−54.6% vs. −6.25%, p < 0.010) individual groups
showed a greater reduction of SZs. A significant IED reduction effect was found between
baseline and immediately after interventions (p = 0.041) in all groups. Side effects were minor.
Conclusions
Cathodal tDCS technique of 3 and 5 sessions decreased the frequency of SZs and IEDs
(between baseline and immediately post-tDCS) in adult patients with MTLE-HS compared
to placebo tDCS.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Brain Stimulation: Basic, Translational, and Clinical Research in NeuromodulationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mesial temporal lobe epilepsy.J Clin Neurophysiol. 2012; 29: 356-365
- A randomized, controlled trial of surgery for temporal-lobe epilepsy.NEJM. 2001; 345: 311-318
- Deep brain stimulation for epilepsy.Neurother. 2008; 5: 59-67
- Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects.Neurosci Biobehav Rev. 2005; 29: 493-500
- Treatment of depression with transcranial direct current stimulation (tDCS): a review.Exp Neurol. 2009; 219: 14-19
- Transcranial direct current stimulation: state of the art 2008.Brain Stimul. 2008; 1: 206-223
- Transcranial direct current stimulation in epilepsy.Brain Stimul. 2015; 8: 455-464
- Transcranial direct current stimulation in refractory continuous spikes and waves during slow sleep: a controlled study.Epilepsy Res. 2011; 97: 142-145
- Transcranial direct current stimulation for treatment of refractory childhood focal epilepsy.Brain Stimul. 2013; 6: 696-700
- A controlled clinical trial of cathodal DC polarization in patients with refractory epilepsy.Epilepsia. 2006; 47: 335-342
- Transcranial direct current stimulation in adolescent and adult Rasmussen's encephalitis.Epilepsy Behav. 2011; 20: 126-131
- Suppression of seizure by cathodal transcranial direct current stimulation in an epileptic patient – a case report.Ann Rehabil Med. 2011; 35: 579-582
- Feasibility of focal transcranial DC polarization with simultaneous EEG recording: preliminary assessment in healthy subjects and human epilepsy.Epilepsy Behav. 2012; 25: 417-425
- ILAE Commission on Neurosurgery of Epilepsy. ILAE Commission Report. Mesial temporal lobe epilepsy with hippocampal sclerosis.Epilepsia. 2004; 45: 695-714
- Evaluation of sham transcranial direct current stimulation for randomized, placebo-controlled clinical trials.Brain Stimul. 2013; 6: 690-695
- A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation.Int J Neuropsychopharmacol. 2011; 14: 1133-1145
- Guideline 1: minimum technical requirements for performing clinical electroencephalography.J Clin Neurophysiol. 2006; 23: 86-91
- A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury.Pain. 2006; 122: 197-209
- Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease.Mov Disord. 2006; 21: 1693-1702
- A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia.Arthritis Rheum. 2006; 54: 3988-3998
- Transcranial direct current stimulation of the unaffected hemisphere in stroke patients.Neuroreport. 2005; 16: 1551-1555
- Temporal cortex direct current stimulation enhances performance on a visual recognition memory task in Alzheimer disease.J Neurol Neurosurg Psychiatr. 2008; 80: 444-447
- Anticonvulsant effects of transcranial direct-current stimulation (tDCS) in the rat cortical ramp model of focal epilepsy.Epilepsia. 2009; 47: 1216-1224
- Intractable temporal lobe epilepsy with rare spikes is less severe than with frequent spikes.Neurology. 2003; 60: 1290-1295
- What clinical trial designs have been used to test antiepileptic drugs and do we need to change them?.Epileptic Disord. 2012; 14: 124-131
- Neuropeptides in epilepsy.Neuropeptides. 2013; 47: 467-475
- Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex.J Physiol. 2005; 568: 291-303
- Non-synaptic mechanisms underlie the after-effects of cathodal transcutaneous direct current stimulation of the human brain.J Physiol. 2005; 568: 653-663
- Time course of the induction of homeostatic plasticity generated by repeated transcranial direct current stimulation of the human motor cortex.J Neurophysiol. 2011; 105: 1141-1149
- High-dose ketamine hydrochloride maintains somatosensory and magnetic motor evoked potentials in primates.Neurol Res. 2001; 23: 881-886
- Pharmacological control of facilitatory I-wave interaction in the human motor cortex. A paired transcranial magnetic stimulation study.Electroencephalogr Clin Neurophysiol. 1998; 109: 321-330
- Partially non-linear stimulation intensity-dependent effects of direct current stimulation on motor cortex excitability in humans.J Physiol. 2013; 591: 1987-2000
- Polarity-sensitive modulation of cortical neurotransmitters by transcranial stimulation.J Neurosci. 2009; 29: 5202-5206
- Is plasticity of GABAergic mechanisms relevant to epileptogenesis?.Adv Exp Med Biol. 2014; 813: 133-150
- Outlasting excitability shifts induced by direct current stimulation of the human brain.Suppl Clin Neurophysiol. 2004; 57: 708-714
- Local suppression of epileptiform activity by electrical stimulation in rat hippocampus in vitro.J Physiol. 2003; 547: 427-434
- Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans.J Physiol. 2003; 553: 293-301
- The action of brief polarizing currents on the cerebral cortex of the rat (1) during current flow and (2) in the production of long-lasting after-effects.J Physiol. 1964; 172: 369-382
- Pharmacological approach to the mechanisms of transcranial DC-stimulation-induced after-effects of human motor cortex excitability.Brain. 2002; 125: 2238-2247
- Long-lasting increased excitability differs in dentate gyrus vs. CA1 in freely moving chronic epileptic rats after electrically induced status epilepticus.Hippocampus. 2002; 12: 311-324
- Safety limits of cathodal transcranial direct current stimulation in rats.Clin Neurophysiol. 2009; 120: 1161-1167
- MRI study of human brain exposed to weak direct current stimulation of the frontal cortex.Clin Neurophysiol. 2004; 115: 2419-2423
- GABAergic modulation of DC stimulation-induced motor cortex excitability shifts in humans.Eur J Neurosci. 2004; 19: 2720-2726
Article info
Publication history
Published online: August 31, 2016
Accepted:
August 29,
2016
Received in revised form:
August 23,
2016
Received:
March 27,
2016
Footnotes
Submission statements: All authors have seen and agree with the contents of the manuscript.
Daniel San-Juan, M.D., principal author takes full responsibility for the data, the analyses and interpretation, and the conduct of the research; also Daniel San-Juan, M.D. has full access to all of the data; and has the right to publish any and all data separate and apart from any sponsor.
Daniel San-Juan, M.D., principal author takes full responsibility for clinical trial data and the data results will be deposited in a clinical trials database (clinicaltrials.gov with the identifier NCT01763294).
We certify that the submission (aside from an abstract) is not under review at any other publication.
Other information: This study was registered at ClinicalTrials.gov with the identifier NCT01763294, and the name “A Controlled Clinical Trial of Cathodal Transcranial Direct Current Stimulation in Patients with Refractory Epilepsy”. The full trial protocol can be accessed in the Clinical Research Department of the National Institute of Neurology and Neurosurgery in Mexico.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
