Abstract
TDCS most common adverse effects are burning, tingling, itching, headache, and discomfort on the site of stimulation. These adverse effects occur in up to one-third of patients and are generally mild, short-lived, and well-tolerated. Skin redness is a common adverse effect that occurs in most patients, although skin burning is rare and often associated with repeated tDCS sessions and poor humidification of sponges. Severe adverse effects, including seizures, cardiac arrest, permanent disability and damage, have not been reported in tDCS adult trials thus so far. Regarding safety, studies indicate that the doses used clinically are much lower than necessary to induce lesions and are not associated with damage. Nonetheless, the statement that tDCS is “safe” should be tempered down considering that its adverse effects are often underreported in most studies and the risk of induction of adverse effects in special populations (e.g., hypomanic switch in depressed patients, or seizures in patients with epilepsy) has not been sufficiently investigated yet.
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Poreisz C, Boros K, Antal A, Paulus W. Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients. Brain Res Bull. 2007;72:208–14.
Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, et al. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int J Neuropsychopharmacol. 2011;14:1133–45.
Kessler SK, Turkeltaub PE, Benson JG, Hamilton RH. Differences in the experience of active and sham transcranial direct current stimulation. Brain Stimul. 2012;5:155–62.
Russo R, Wallace D, Fitzgerald PB, Cooper NR. Perception of comfort during active and sham transcranial direct current stimulation: a double blind study. Brain Stimul. 2013;6:946–51.
Fertonani A, Ferrari C, Miniussi C. What do you feel if I apply transcranial electric stimulation? Safety, sensations and secondary induced effects. Clin Neurophysiol. 2015;126(11):2181–8.
Durand S, Tartas M, Bouye P, Koitka A, Saumet JL, et al. Prostaglandins participate in the late phase of the vascular response to acetylcholine iontophoresis in humans. J Physiol. 2004;561:811–9.
Guarienti F, Caumo W, Shiozawa P, Cordeiro Q, Boggio PS, et al. Reducing transcranial direct current stimulation-induced erythema with skin pretreatment: considerations for sham-controlled clinical trials. Neuromodulation. 2014;18(4):261–5.
Ambrus GG, Paulus W, Antal A. Cutaneous perception thresholds of electrical stimulation methods: comparison of tDCS and tRNS. Clin Neurophysiol. 2010;121:1908–14.
Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, et al. Transcranial direct current stimulation: state of the art 2008. Brain Stimul. 2008;1:206–23.
Dundas JE, Thickbroom GW, Mastaglia FL. Perception of comfort during transcranial DC stimulation: effect of NaCl solution concentration applied to sponge electrodes. Clin Neurophysiol. 2007;118:1166–70.
Brunoni AR, Nitsche MA, Bolognini N, Bikson M, Wagner T, et al. Clinical research with transcranial direct current stimulation (tDCS): challenges and future directions. Brain Stimul. 2012;5:175–95.
Turi Z, Ambrus GG, Ho KA, Sengupta T, Paulus W, et al. When size matters: large electrodes induce greater stimulation-related cutaneous discomfort than smaller electrodes at equivalent current density. Brain Stimul. 2014;7:460–7.
Ambrus GG, Antal A, Paulus W. Comparing cutaneous perception induced by electrical stimulation using rectangular and round shaped electrodes. Clin Neurophysiol. 2011;122:803–7.
Berlim MT, Van den Eynde F, Daskalakis ZJ. Clinical utility of transcranial direct current stimulation (tDCS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. J Psychiatr Res. 2013;47:1–7.
Shiozawa P, Fregni F, Bensenor IM, Lotufo PA, Berlim MT, et al. Transcranial direct current stimulation for major depression: an updated systematic review and meta-analysis. Int J Neuropsychopharmacol. 2014;17(9):1443–52.
Kuo MF, Paulus W, Nitsche MA. Therapeutic effects of non-invasive brain stimulation with direct currents (tDCS) in neuropsychiatric diseases. Neuroimage. 2013;85(3):948–60.
Vandermeeren Y, Jamart J, Ossemann M. Effect of tDCS with an extracephalic reference electrode on cardio-respiratory and autonomic functions. BMC Neurosci. 2010;11:38.
Nitsche MA, Nitsche MS, Klein CC, Tergau F, Rothwell JC, et al. Level of action of cathodal DC polarisation induced inhibition of the human motor cortex. Clin Neurophysiol. 2003;114:600–4.
Tadini L, El-Nazer R, Brunoni AR, Williams J, Carvas M, et al. Cognitive, mood, and electroencephalographic effects of noninvasive cortical stimulation with weak electrical currents. J ECT. 2011;27:134–40.
Liebetanz D, Koch R, Mayenfels S, Konig F, Paulus W, et al. Safety limits of cathodal transcranial direct current stimulation in rats. Clin Neurophysiol. 2009;120:1161–7.
Bikson M, Rahman A, Datta A. Computational models of transcranial direct current stimulation. Clin EEG Neurosci. 2012;43:176–83.
Palm U, Keeser D, Schiller C, Fintescu Z, Reisinger E, et al. Skin lesions after treatment with transcranial direct current stimulation (tDCS). Brain Stimul. 2008;1:386–7.
Frank E, Wilfurth S, Landgrebe M, Eichhammer P, Hajak G, et al. Anodal skin lesions after treatment with transcranial direct current stimulation. Brain Stimul. 2010;3:58–9.
Rodriguez N, Opisso E, Pascual-Leone A, Soler MD. Skin lesions induced by transcranial direct current stimulation (tDCS). Brain Stimul. 2014;7:765–7.
Wang J, Wei Y, Wen J, Li X. Skin burn after single session of transcranial direct current stimulation (tDCS). Brain Stimul. 2015;8:165–6.
Palm U, Feichtner KB, Hasan A, Gauglitz G, Langguth B, et al. The role of contact media at the skin-electrode interface during transcranial direct current stimulation (tDCS). Brain Stimul. 2014;7:762–4.
Loo CK, Martin DM, Alonzo A, Gandevia S, Mitchell PB, et al. Avoiding skin burns with transcranial direct current stimulation: preliminary considerations. Int J Neuropsychopharmacol. 2011;14:425–6.
Arul-Anandam AP, Loo C, Mitchell P. Induction of hypomanic episode with transcranial direct current stimulation. J ECT. 2010;26:68–9.
Baccaro A, Brunoni AR, Bensenor M, Fregni F. Hypomanic episode in unipolar depression during transcranial direct current stimulation. Acta Neuropsychiatr. 2010;22:316–8.
Brunoni AR, Valiengo L, Zanao T, de Oliveira JF, Bensenor IM, et al. Manic psychosis after sertraline and transcranial direct-current stimulation. J Neuropsychiatry Clin Neurosci. 2011;23:E4–5.
Ekici B. Transcranial direct current stimulation-induced seizure: analysis of a case. Clin EEG Neurosci. 2015;46:169.
Iuculano T, Cohen Kadosh R. The mental cost of cognitive enhancement. J Neurosci. 2013;33:4482–6.
Brunoni AR, Zanao TA, Ferrucci R, Priori A, Valiengo L, et al. Bifrontal tDCS prevents implicit learning acquisition in antidepressant-free patients with major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2012;43C:146–50.
Bikson M, Rahman A, Datta A, Fregni F, Merabet L. High-resolution modeling assisted design of customized and individualized transcranial direct current stimulation protocols. Neuromodulation. 2012;15:306–15.
Moliadze V, Schmanke T, Andreas S, Lyzhko E, Freitag CM, et al. Stimulation intensities of transcranial direct current stimulation have to be adjusted in children and adolescents. Clin Neurophysiol. 2015;126:1392–9.
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Brunoni, A., Loo, C., Nitsche, M. (2016). Safety and Tolerability. In: Brunoni, A., Nitsche, M., Loo, C. (eds) Transcranial Direct Current Stimulation in Neuropsychiatric Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-33967-2_22
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DOI: https://doi.org/10.1007/978-3-319-33967-2_22
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