What is tDCS?
Transcranial Direct Current Stimulation, or simply tDCS, is a non-invasive neurostimulation technology, used to modulate neuronal activity and increase synaptic plasticity by applying a low-intensity current to the scalp through two or more electrodes.
The method can affect the activation of neuronal networks but is not strong enough to initiate non-existing neuronal activity.
The technology in itself is nothing new. What is new is that we make this technology available in a simple format, both for clinicians and their clients, to get the full benefits of tDCS.
What can tDCS be used for?
Although the modern idea of tDCS is relatively new (around 20 years old), the concept of utilising subthreshold stimulation to modify brain activity dates back millenia. In the ancient world the greek and romans used proto-tDCS techniques as antidepressants and as an analgesic (Largus, 1887). Interestingly, both of these applications are seeing a lot of research today.
Overall applications of tDCS can be split into cognitive enhancements observed in healthy individuals, and clinical benefits observed in a number of clinical groups.
The specific impact of tDCS is determined by various factors, with the primary factor being the positioning of electrodes, which dictates the regions of the brain that the current flows over. Depending on the application, different montages may be necessary.
SUGGESTED CLINICAL APPLICATIONS
TMS Maintenance
Following successful TMS treatment, incorporating tDCS stimulation can prove to be a valuable strategy to prevent relapse and ensure the ongoing mental health of your patients.
Depression
There is level A evidence (definitely effective) for tDCS stimulation over the left prefrontal cortex to improve depression symptoms. The client doesn’t have to complete any particular tasks, and they can wear the PlatoWork tDCS headset in the comfort of their own home.
Cravings and addiction
There is level B evidence (probably effective) for tDCS stimulation over the right prefrontal cortex to reduce cravings in various addiction disorders including nicotine, alcohol, cannabis, cocaine, gambling and more.
Clinical use
As a relatively side-effect free method for changing neural activity, there has been a great deal of research in using tDCS as a treatment tool for a variety of disorders. Namely, tDCS is growing in popularity as a treatment tool for depression. Several weeks of sessions are associated with a significant reduction in depressive symptoms (Kalu et al. 2012, Lin et al. 2021). The mild side effect profile of tDCS allows it to be easily combined with other treatments or for it to be used to maintain benefits from treatment. tDCS is approved as a depression treatment in the EU.
There is also strong evidence for the effectiveness of tDCS in the treatment for addiction. Studies show reduced cravings after tDCS stimulation in cases of overeating, and smoking. tDCS also induced changes in white matter structures predicting reduced cravings in drug abuse (Fregni et al. 2008, Sauvaget et al. 2015, Nakamura-Palacios et al. 2016)
Lastly, tDCS has long been examined in the context of pain management. Studies suggest a significant and long lasting reduction in perceived pain after even brief periods of stimulation (Ayache et al. 2016, Boggio et al. 2008).
Experimental use
The field of tDCS is rapidly expanding, with the number of peer-reviewed papers increasing from just a few a year two decades ago, to almost 1000 annually in recent years. While some areas of research are still in the early stages of research, we remain dedicated to supporting alternative protocols and uses.
Examples of novel tDCS research, that could be replicated with PlatoWork, are as diverse as providing relief from tinnitus (Faber et al. 2012), significantly decreasing auditory hallucinations in schizophrenia (Bunelin et al. 2012), and improving recognition memory in Alzheimer patients (Ferrucci et al. 2008). It’s highly likely that any application you can think of has already been explored among the hundreds of others that have been examined.
What can the PlatoWork headset do?
The PlatoWork tDCS headset allows clinicians access to high precision and quality tDCS technology. The PlatoWork tDCS headset features three electrodes that enable users to locate the correct scalp position and mount the headset appropriately, resulting in a range of montages. In addition, the PlatoWork tDCS headset is equipped with multiple layers of failsafe mechanisms, thereby preventing any malfunction of the headset.
By allowing each electrode to function as an anode or cathode and offering three different tilt positions on the head, the PlatoWork tDCS headset can facilitate numerous processes that can create dozens of clinically and scientifically significant applications. The two most commonly used montages are quite similar though:
Anode left dorsolateral prefrontal cortex, cathode right dorsolateral cortex: Mostly referred to as the bifrontal montage, this is the electrode placement used most frequently in tDCS research. The montage has been found to affect a wide range of cognitive metrics in healthy individuals improving learning speeds and working memory. In clinical settings it has been found to be effective in reducing symptoms of depression, addiction cravings, and pains.
Cathode left dorsolateral prefrontal cortex, anode right dorsolateral cortex: The same montage as above but with the polarities switched. This montage has repeatedly shown to be effective in improving intuition and creativity across a wide range of tests.
What exactly does tDCS do in the brain?
At its core, tDCS is a relatively straightforward technology: two electrodes placed on the head receive a current sent by a battery. The current passes through one electrode, traverses the underlying brain areas and exits through the other electrode. What occurs within the brain while under the influence of the electric field is particularly interesting:
tDCS modifies the firing threshold of neurons, allowing them to fire more easily. As a result, there is an increase in overall neuronal activity. This, in turn, causes the onset of a process called long term potentiation, which causes a further increase in firing rates, and also the physical growth of new connections and the strengthening of existing connections (Stagg et al. 2018, Reato et al. 2019). tDCS not only increases brain activity directly but also promotes brain plasticity, accelerating learning speeds and helping break out of negative feedback loops. The direct effects of stimulation typically last for up to an hour following the session, while indirect effects, such as the formation of new connections and alterations to the brain states, can last much longer.
Prof. Alexander Sack, PhD
Clinical use of TES and neuromodulation
Using PlatoWork
Recommended use
- Stimulate up to 5 times a week, 1 session a day
- 30 minute stimulation per session (pre-programmed in the app)
- Stimulation can, with benefit, be beneficially applied during other therapeutic interventions such as talk therapy.
Precautions
tDCS should not be used in the following cases, as safety concern still remain:
- Pregnancy
- Individuals under 18 years of age
- Individuals with metallic or electric implants over the jaw line, such as metal plates in the skull, cochlear implants or deep brain stimulation electrodes
- Individuals with epilepsy or a history of seizures
tDCS without clinical supervision
PlatoScience strongly advises against using tDCS as a treatment tool for psychiatric, neurological or developmental disorders without the support and guidance of a healthcare professional. If you are considering using tDCS as a treatment, a relevant medical personnel should always be consulted.
While tDCS is generally considered a safe form of brain stimulation, there are a few important safety measures that must be taken into account to ensure that devices like the PlatoWork tDCS headset can only deliver the desired current and voltage. These safety measures include:
1) The electronics in the control unit are designed with a physical maximum load just above the amount needed for stimulation. Additionally, current and voltage limitation circuitry is needed in case of failure.
2) During use, the headset’s charging port is obstructed, making it impossible to connect the device to any other power source during stimulation.
3) The firmware and software controlling the hardware include several safety measures that immediately stop stimulation if the continuously measured voltage and current deviate from normal operating limits. This ensures that the headset cannot deliver more electricity than the amount proven to be safe for human subjects.
As a result, the PlatoWork tDCS headset is registered as a Class I medical device under the EU Medical Device Directive, 93/42/EEC, and ensuring a high quality and safe product for our users is our top priority.
Potential side effects
Numerous studies have confirmed that tDCS has a high safety profile. Most people experience only minor side effects, such as a tingling sensation underneath the electrodes and temporary reddening of the skin after the electrodes are removed. This reddening is caused by increased blood flow to the area, and it usually disappears within 15 - 30 minutes after stimulation.
Although more severe side effects can occur, they are very rare. For example, some people may experience first degree burns or tension headaches, and a few cases of second degree burns have been reported in the last 20 years.
It’s important to note that all reported side effects have been temporary, and no permanent side effects have ever been reported. This is why tDCS is such a great technology for home use; it can effectively change brain activity with fewer side effects compared to other techniques that are similarly powerful.
Regulatory information
PlatoScience is a legal entity registered in Denmark. The information provided on this page is based on regulations for the EU medical device market under the EU Medical Device Regulations (EU) 2017/745. If you are visiting this page from a different territory, the accuracy of the content on this website may not be applicable to your local jurisdiction. In such cases, PlatoScience cannot be held responsible for any inaccuracies in the information provided. For further information, please contact us directly, or contact the regulatory authorities in your territory.
Safety of Transcranial Direct Current Stimulation
A safety analysis conducted with over 33 000 sessions and 1000 subjects with repeated sessions.
Physiology of Transcranial Direct Current Stimulation
TDCS physiological mechanism such as acute regional effects, neuroplastic effects, cerebral network impact.
Brain stimulation improves learning more than performance
Evidence for the modulation of long-term synaptic plasticity by tES in practically relevant learning tasks.
tDCS enhances motor synergy and sequence learning
tDCS augmented synergy learning, leading subsequently to faster and more synchronised execution.
References per section
Section 'Clinical use'
Ayache, S. S., Palm, U., Chalah, M. A., Al-Ani, T., Brignol, A., Abdellaoui, M., ... & Lefaucheur, J. P. (2016). Prefrontal tDCS decreases pain in patients with multiple sclerosis. Frontiers in neuroscience, 10, 147.
Boggio, P. S., Zaghi, S., Lopes, M., & Fregni, F. (2008). Modulatory effects of anodal transcranial direct current stimulation on perception and pain thresholds in healthy volunteers. European journal of neurology, 15(10), 1124-1130
Fregni, F., Liguori, P., Fecteau, S., Nitsche, M. A., Pascual-Leone, A., & Boggio, P. S. (2008). Cortical stimulation of the prefrontal cortex with transcranial direct current stimulation reduces cue-provoked smoking craving: a randomized, sham-controlled study. Journal of Clinical Psychiatry, 69(1), 32-40.
Kalu, U. G., Sexton, C. E., Loo, C. K., & Ebmeier, K. P. (2012). Transcranial direct current stimulation in the treatment of major depression: a meta-analysis. Psychological medicine, 42(9), 1791-1800.
Lin, Y. Y., Chang, C. C., Huang, C. C. Y., Tzeng, N. S., Kao, Y. C., & Chang, H. A. (2021). Efficacy and neurophysiological predictors of treatment response of adjunct bifrontal transcranial direct current stimulation (tDCS) in treating unipolar and bipolar depression. Journal of Affective Disorders, 280, 295-304.
Nakamura-Palacios, E. M., Lopes, I. B. C., Souza, R. A., Klauss, J., Batista, E. K., Conti, C. L., ... & de Souza, R. S. M. (2016). Ventral medial prefrontal cortex (vmPFC) as a target of the dorsolateral prefrontal modulation by transcranial direct current stimulation (tDCS) in drug addiction. Journal of Neural Transmission, 123(10), 1179-1194.
Sauvaget, A., Trojak, B., Bulteau, S., Jiménez-Murcia, S., Fernández-Aranda, F., Wolz, I., ... & Grall-Bronnec, M. (2015). Transcranial direct current stimulation (tDCS) in behavioral and food addiction: a systematic review of efficacy, technical, and methodological issues. Frontiers in Neuroscience, 9, 349.
Section 'Cognitive enhancements'
Fregni F, Boggio PS, Nitsche M, Bermpohl F, Antal A, Feredoes E, Marcolin MA, Rigonatti SP, Silva MT, Paulus W, Pascual-Leone A. Anodal transcranial direct current stimulation of prefrontal cortex enhances working memory. Exp Brain Res. 2005 Sep;166(1):23-30. Epub 2005 Jul 6. PubMed PMID: 15999258
Hertenstein, E., Waibel, E., Frase, L., Riemann, D., Feige, B., Nitsche, M. A., ... & Nissen, C. (2019). Modulation of creativity by transcranial direct current stimulation. Brain stimulation.
Ke Y, Wang N, Du J, Kong L, Liu S, Xu M, An X, Ming D. The Effects of Transcranial Direct Current Stimulation (tDCS) on Working Memory Training in Healthy Young Adults. Front Hum Neurosci. 2019 Feb 1;13:19. doi: 10.3389/fnhum.2019.00019.
Mayseless, N., & Shamay-Tsoory, S. G. (2015). Enhancing verbal creativity: modulating creativity by altering the balance between right and left inferior frontal gyrus with tDCS. Neuroscience, 291, 167-176.
Nitsche, M. A., & Paulus, W. (2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of physiology, 527(3), 633-639.
Section 'Experimental use'
Faber, M., Vanneste, S., Fregni, F., & De Ridder, D. (2012). Top down prefrontal affective modulation of tinnitus with multiple sessions of tDCS of dorsolateral prefrontal cortex. Brain stimulation, 5(4), 492-498.
Brunelin, J., Mondino, M., Gassab, L., Haesebaert, F., Gaha, L., Suaud-Chagny, M. F., ... & Poulet, E. (2012). Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. American Journal of Psychiatry, 169(7), 719-724.
Ferrucci, R., Mameli, F., Guidi, I., Mrakic-Sposta, S., Vergari, M., Marceglia, S. E. E. A., ... & Priori, A. (2008). Transcranial direct current stimulation improves recognition memory in Alzheimer disease. Neurology, 71(7), 493-498.
Section 'What exactly does tDCS do in the brain?'
Reato, D., Salvador, R., Bikson, M., Opitz, A., Dmochowski, J., & Miranda, P. C. (2019). Principles of transcranial direct current stimulation (tDCS): introduction to the biophysics of tDCS. In Practical guide to transcranial direct current stimulation (pp. 45-80). Springer, Cham.
Stagg, C. J., Antal, A., & Nitsche, M. A. (2018). Physiology of transcranial direct current stimulation. The journal of ECT, 34(3), 144-152.
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