Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).

By J. Lefaucheur, Andrea Antal, S. Ayache, D. Benninger, J. Brunelin, F. Cogiamanian, M. Cotelli, D. De Ridder, Roberta Ferrucci, B. Langguth and 13 more. Clinical Neurophysiology, 2017

1,563 citations recorded by the source corpus.

A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.

Subfields: Anesthesiology and Pain Medicine, Neurology

View Paper: https://www.semanticscholar.org/paper/a3535decd397e34936e29e292d9ee82a73b6951b

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

1. K. Seppi
2. M. Coelho
3. S. Fox
4. R. Katzenschlager
5. C. Sampaio
6. Shen-Yang Lim
7. B. Barton
8. R. D. de Bie

Citations in the corpus

• Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines (2020, neutral): “To date, only a few studies have reported results obtained in patients who underwent repeated sessions of robotized nTMS (Lefaucheur et al., 2017; Pommier et al., 2016; Quesada et al., 2018, 2020).”
• International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson's disease (2018, result): “Physiotherapy-based exercises including treadmill, aerobic, and strengthening/balance exercises continue to be the most common intervention in PD.”