Transcranial Direct Current Stimulation (tDCS) is the application of very low doses of electricity to the head and through the brain. The current delivered is very low, 2 mAmps or less. This low-level current changes the ability of neurons to depolarize – making it either easier, or harder, depending on how the current is applied. Through tDCS we can encourage more or less activity in a given region of the brain, which can be helpful for a variety of neurological concerns.
The benefits of this therapy are just beginning to be understood in areas like MS, epilepsy, Parkinson’s Disease, Alzheimer’s Dementia, Brain Injury, and Stroke recovery. Completed trials have shown defined benefits in Fibromyalgia, Major Depression, and Migraine. In general, it appears to be beneficial for central neuropathic pain. Side effects are minimal. The most common reported are tingling and itching at the electrode site, and headaches during the treatments.
tDCS for Depression
In double blinded, placebo controlled trials, tDCS was as effective as sertraline (a SSRI antidepressant) for the treatment of depression, and when combined, the effect was better than either alone.
Side benefits of tDCS in trials, and what we see in the clinic, include improved cognition, less pain (in patients with neuropathic pain), and improved psychomotor speed (i.e. being able to coordinate thinking fast with doing something fast like driving a car).
tDCS for Fibromyalgia and Migraine Headaches
In September 2016, Health Canada approved tDCS for the treatment of Fibromyalgia and Migraine. This approval was based on 16 studies showing effective treatment of Fibromyalgia, Migraine, and pain associated with Spinal Cord Injury.
tDCS has been shown to be helpful, but is not yet approved for, the treatment of the following conditions:
- complex regional pain syndrome (CRPS)
- post-stroke pain and recovery
- central sensitization pain syndromes
- multiple sclerosis pain
- ghost limb pain
- mild cognitive impairment
- improving motor function in a variety of conditions
Treatments usually start out with 3-weeks of daily sessions 5-days a week, for 30 minutes each. After this, the frequency of treatment declines based upon what condition is being treated. For example, after the initial 3 weeks, patients being treated for depression begin once weekly or biweekly treatments for 2-3 months, and then once monthly thereafter for another 2-3 months.
The initial 3 weeks of 5-days a week treatment is a decent commitment and must be planned well. Patients who are new to Acacia will need to do an initial visit with one of our NDs. Patients with Bipolar disorder, with a history of mania, or with cochlear or metal implants are not candidates for tDCS.
You can read more about this treatment by following the links below:
- Transcranial direct current stimulation in the neuromodulation of pain in fibromyalgia: A case study. DalĺAgnol L., Pascoal-Faria P., Barros Cecílio S., Corrêa FI. (2015)
- Clinically Effective Treatment of Fibromyalgia Pain With High-Definition Transcranial Direct Current Stimulation: Phase II Open-Label Dose Optimization. Castillo-Saavedra L., Gebodh N., Bikson M., Diaz-Cruz C., Brandao R., Coutinho L., Truong D., Datta A., Shani-Hershkovich R., Weiss M., Laufer I., Reches A., Peremen Z., Geva A., Parra L.C., Fregni F. (2015)
- Transcranial direct current stimulation as a treatment for patients with fibromyalgia: a randomized controlled trial. Fagerlund A.J., Hansen O.A., Aslaksen P.M. (2015)
- Focal modulation of the primary motor cortex in fibromyalgia using 4×1-ring high-definition transcranial direct current stimulation (HD-tDCS): immediate and delayed analgesic effects of cathodal and anodal stimulation. Villamar M.F., Wivatvongvana P., Patumanond J., Bikson M., Truong D.Q., Datta A., Fregni F. (2013)
- Non-invasive brain stimulation approaches to fibromyalgia pain. Short B., Borckardt J.J., George M., Beam W., Reeves S.T. (2009)
- Efficacy of anodal transcranial direct current stimulation (tDCS) for the treatment of fibromyalgia: results of a randomized, sham-controlled longitudinal clinical trial. Valle A., Roizenblatt S., Botte S., Zaghi S., Riberto M., Tufik S., Boggio P.S., Fregni F. (2009)
- Site-specific effects of transcranial direct current stimulation on sleep and pain in fibromyalgia: a randomized, sham-controlled study. Roizenblatt S., Fregni F., Gimenez R., Wetzel T., Rigonatti S.P., Tufik S., Boggio P.S., Valle A.C. (2007)
- A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Fregni F., Gimenes R., Valle A.C., Ferreira M.J., Rocha R.R., Natalle L., Bravo R., Rigonatti S.P., Freedman S.D., Nitsche M.A., Pascual-Leone A., Boggio P.S. (2006)
- State-of-art neuroanatomical target analysis of high-definition and conventional tDCS montages used for migraine and pain control. DaSilva A.F., Truong D.Q., DosSantos M.F., Toback R.L., Datta A., Bikson M. (2015)
- Prophylactic treatment in menstrual migraine: A proof-of-concept study. Wickmann F., Stephani C., Czesnik D., Klinker F., Timäus C., Chaieb L., Paulus W., Antal A. (2015)
- Transcranial direct current stimulation in the prophylactic treatment of migraine based on interictal visual cortex excitability abnormalities: A pilot randomized controlled trial. Rocha S., Melo L., Boudoux C., Foerster Á., Araújo D., Monte-Silva K. (2014)
- Clinical effectiveness of primary and secondary headache treatment by transcranial direct current stimulation. Pinchuk D., Pinchuk O., Sirbiladze K., Shugar O. (2013)
- tDCS-induced analgesia and electrical fields in pain-related neural networks in chronic migraine. Dasilva A.F., Mendonca M.E., Zaghi S., Lopes M., Dossantos M.F., Spierings E.L., Bajwa Z., Datta A., Bikson M., Fregni F. (2012)
- Migraine prophylaxis by anodal transcranial direct current stimulation, a randomized, placebo-controlled trial. Auvichayapat P., Janyacharoen T., Rotenberg A., Tiamkao S., Krisanaprakornkit T., Sinawat S., Punjaruk W., Thinkhamrop B., Auvichayapat N. (2012)
More pain studies showing efficacy:
- Reduction of chronic abdominal pain in patients with inflammatory bowel disease via transcranial direct current stimulation: a randomized controlled trial. Volz M.S., Farmer A., Siegmund B. (2015)
- Pain reduction associated with improved functional interhemispheric balance following transcranial direct current stimulation for post-stroke central pain: A case study. Morishita T., Hyakutake K., Saita K., Takahara M., Shiota E., Inoue T. (2015)
- Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis. Mehta S., McIntyre A., Guy S., Teasell R.W., Loh E. (2015)
- Transcranial direct current stimulation and exercises for treatment of chronic temporomandibular disorders: a blind randomised-controlled trial. Oliveira L.B., Lopes T.S., Soares C., Maluf R., Goes B.T., Sá K.N., Baptista A.F. (2015)
- Analgesic effect of transcranial direct current stimulation on central post-stroke pain. Bae S.H., Kim G.D., Kim K.Y. (2014)
- Randomized, sham controlled trial of transcranial direct current stimulation for painful diabetic polyneuropathy. Kim Y.J., Ku J., Kim H.J., Im D.J., Lee H.S., Han K.A., Kang Y.J. (2013)
- Postoperative analgesic effect of transcranial direct current stimulation in lumbar spine surgery: a randomized control trial. Dubois P.E., Ossemann M., de Fays K., De Bue P., Gourdin M., Jamart J., Vandermeeren Y. (2013)
- Transcranial direct current stimulation (tDCS) reduces postsurgical opioid consumption in total knee arthroplasty (TKA). Borckardt J.J., Reeves S.T., Robinson S.M., May J.T., Epperson T.I., Gunselman R.J., Schutte H.D., Demos H.A., Madan A., Fredrich S., George M.S. (2013)
- Effects of anodal transcranial direct current stimulation on chronic neuropathic pain in patients with multiple sclerosis. Mori F., Codecà C., Kusayanagi H., Monteleone F., Buttari F., Fiore S., Bernardi G., Koch G., Centonze D. (2009)
- A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Fregni F., Boggio P.S., Lima M.C., Ferreira M.J., Wagner T., Rigonatti S.P., Castro A.W., Souza D.R., Riberto M., Freedman S.D., Nitsche M.A., Pascual-Leone A. (2006)
Major Depression trials
- Trial of Electrical Direct-Current Therapy versus Escitalopram for Depression. Brunoni A.R., Moffa A.H., Sampaio-Junior B., Borrione L., Moreno M.L., Fernandes R.A., Veronezi B.P., Nogueira B.S., Aparicio L.V.M., Razza L.B., Chamorro R., Tort L.C., Fraguas R., Lotufo P.A., Gattaz W.F., Fregni F., Benseñor I.M.; ELECT-TDCS Investigators. (2017)
- Transcranial direct current stimulation for the treatment of post-stroke depression: results from a randomised, sham-controlled, double-blinded trial. Valiengo L.C., Goulart A.C., de Oliveira J.F., Benseñor I.M., Lotufo P.A., Brunoni A.R. (2017)
- Concurrent cognitive control training augments the antidepressant efficacy of tDCS: a pilot study. Segrave R.A., Arnold S., Hoy K., Fitzgerald P.B. (2014)
- The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. Brunoni, A.R, Valiengo L., Baccaro A., Zanao T.A., de Oliveira J.F., Goulart A., Boggio P.S., Lotufo P.A., Bensenor I.M., Fregni,F. (2013)
- Transcranial direct current stimulation for depression: 3-week, randomized, sham-controlled trial. Loo C.K., Alonzo A., Martin D., Mitchell P.B., Galvez V., Sachdev P. (2012)
- A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Boggio P.S., Rigonatti S.P., Riberiro R.B., Myczkowski M.L., Nitsche M.A., Pascual-Leone A., Fregni F.(2008)