Skip to main content
SpringerLink
Log in

Clinical Research and Methodological Aspects for tDCS Research

  • Chapter
  • First Online:
Transcranial Direct Current Stimulation in Neuropsychiatric Disorders

Abstract

Although transcranial direct current stimulation (tDCS) is seemingly simple and easy to apply, specific aspects of sound application and design must be taken into consideration to obtain reliable results in clinical and research settings. This chapter provides an overview of methodological, design, and application techniques important for technically sound application of tDCS. Topics covered in this chapter include: clinical/research trial design; patient/participant screening practices; electrode selection, preparation, and placement; montage selection; assessment for adverse events/safety, and functional effects monitoring. This chapter is intended: (1) to provide information for education of researchers and clinicians new to tDCS, (2) to provide a description of methodological details important for experienced tDCS researchers and clinicians attempting to replicate clinical and research outcomes, and (3) to highlight methodological details important for consideration in clinical and research applications of tDCS.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Nitsche MA, Nitsche MA, Paulus W, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000;527(Pt 3):633–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Priori A, Berardelli A, Rona S, Accornero N, Manfredi M. Polarization of the human motor cortex through the scalp. Neuroreport. 1998;9(10):2257–60.

    Article  CAS  PubMed  Google Scholar 

  3. Horvath JC, Forte JD, Carter O. Quantitative review finds no evidence of cognitive effects in healthy populations from single-session transcranial direct current stimulation (tDCS). Brain Stimul. 2015;8(3):535–50.

    Article  PubMed  Google Scholar 

  4. Woods AJ, Bryant V, Sacchetti D, Gervits F, Hamilton R. Effects of electrode drift in transcranial direct current stimulation. Brain Stimul. 2015;8(3):515–9.

    Article  PubMed  Google Scholar 

  5. Batsikadze G, Moliadze V, Paulus W, Kuo M-F, Nitsche M. Partially non-linear stimulation intensity-dependent effects of direct current stimulation on motor cortex excitability in humans. J Physiol. 2013;591(Pt 7):1987–2000.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Nitsche MA, Fricke K, Henschke U, Schlitterlau A, Liebetanz D, Lang N, et al. Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. J Physiol. 2003;553(Pt 1):293–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. López-Alonso V, Cheeran B, Fernández-Del-Olmo M. Relationship between non-invasive brain stimulation-induced plasticity and capacity for motor learning. Brain Stimul. 2015;8(6):1209–19.

    Article  PubMed  Google Scholar 

  8. Fregni F, Fregni F, Boggio PS, Boggio PS, Nitsche M, Nitsche M, et al. Anodal transcranial direct current stimulation of prefrontal cortex enhances working memory. Exp Brain Res. 2005;166(1):23–30.

    Article  PubMed  Google Scholar 

  9. Hoy KE, Arnold SL, Emonson MRL, Daskalakis ZJ, Fitzgerald PB. An investigation into the effects of tDCS dose on cognitive performance over time in patients with schizophrenia. Schizophr Res. 2014;155(1-3):96–100.

    Article  PubMed  Google Scholar 

  10. Monte-Silva K, Kuo M-F, Liebetanz D, Paulus W, Nitsche MA. Shaping the optimal repetition interval for cathodal transcranial direct current stimulation (tDCS). J Neurophysiol. 2010;103(4):1735–40.

    Article  PubMed  Google Scholar 

  11. Carvalho S, Boggio PS, Gonçalves ÓF, Vigário AR, Faria M, Silva S, et al. Transcranial direct current stimulation based metaplasticity protocols in working memory. Brain Stimul. 2014;8(2):289–94.

    Article  PubMed  Google Scholar 

  12. Stagg CJ, Lin RL, Mezue M, Segerdahl A, Kong Y, Xie J, et al. Widespread modulation of cerebral perfusion induced during and after transcranial direct current stimulation applied to the left dorsolateral prefrontal cortex. J Neurosci. 2013;33(28):11425–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Stagg CJ, Jayaram G, Pastor D, Kincses ZT, Matthews PM, Johansen-Berg H. Polarity and timing-dependent effects of transcranial direct current stimulation in explicit motor learning. Neuropsychologia. 2011;49(5):800–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Martin DM, Liu R, Alonzo A, Green M, Loo CK. Use of transcranial direct current stimulation (tDCS) to enhance cognitive training: effect of timing of stimulation. Exp Brain Res. 2014;232(10):3345–51.

    Article  PubMed  Google Scholar 

  15. Woods AJ, Hamilton RH, Kranjec A, Minhaus P, Bikson M, Yu J, et al. Space, time, and causality in the human brain. Neuroimage. 2014;92:285–97.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gill J, Shah-Basak PP, Hamilton R. It’s the thought that counts: examining the task-dependent effects of transcranial direct current stimulation on executive function. Brain Stimul. 2014;8(2):253–9.

    Article  PubMed  Google Scholar 

  17. Antal A, Terney D, Poreisz C, Paulus W. Towards unravelling task-related modulations of neuroplastic changes induced in the human motor cortex. Eur J Neurosci. 2007;26(9):2687–91.

    Article  PubMed  Google Scholar 

  18. Bortoletto M, Veniero D, Thut G, Miniussi C. The contribution of TMS–EEG coregistration in the exploration of the human cortical connectome. Neurosci Biobehav Rev. 2014;49C:114–24.

    Google Scholar 

  19. Fritsch B, Reis J, Martinowich K, Schambra HM, Ji Y, Cohen LG, et al. Direct current stimulation promotes BDNF-dependent synaptic plasticity: potential implications for motor learning. Neuron. 2010;66(2):198–204.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ambrus GG, Al-Moyed H, Chaieb L, Sarp L, Antal A, Paulus W. The fade-in – short stimulation – fade out approach to sham tDCS – reliable at 1 mA for naïve and experienced subjects, but not investigators. Brain Stimul. 2012;5(4):499–504.

    Article  PubMed  Google Scholar 

  21. O’Connell NE, Cossar J, Marston L, Wand BM, Bunce D, Moseley GL, et al. Rethinking clinical trials of transcranial direct current stimulation: participant and assessor blinding is inadequate at intensities of 2mA. PLoS One. 2012;7(10):47514.

    Article  Google Scholar 

  22. Guleyupoglu B, Febles N, Minhas P, Hahn C, Bikson M. Reduced discomfort during high-definition transcutaneous stimulation using 6% benzocaine. Front Neuroeng. 2014;7:28.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Palm U, Keeser D, Schiller C, Fintescu Z, Reisinger E, Padberg F, et al. Skin lesions after treatment with transcranial direct current stimulation (tDCS). Brain Stimul. 2008;1(4):386–7.

    Article  PubMed  Google Scholar 

  24. Guarienti F, Caumo W, Shiozawa P, Cordeiro Q, Boggio PS, Benseñor IM, et al. Reducing transcranial direct current stimulation-induced erythema with skin pretreatment: considerations for sham-controlled clinical trials. Neuromodulation. 2015;18(4):261–5.

    Article  PubMed  Google Scholar 

  25. Datta A, Bansal V, Diaz J, Patel J, Reato D, Bikson M. Gyri-precise head model of transcranial direct current stimulation: improved spatial focality using a ring electrode versus conventional rectangular pad. Brain Stimul. 2009;2(4):201–7.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nikolin S, Loo CK, Bai S, Dokos S, Martin DM. Focalised stimulation using high definition transcranial direct current stimulation (HD-tDCS) to investigate declarative verbal learning and memory functioning. Neuroimage. 2015;117:11–9.

    Article  PubMed  Google Scholar 

  27. Minhas P, Bikson M, Woods AJ, Rosen AR, Kessler SK. Transcranial direct current stimulation in pediatric brain: a computational modeling study. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:859–62.

    PubMed  PubMed Central  Google Scholar 

  28. Kessler SK, Minhas P, Woods AJ, Rosen A, Gorman C, Bikson M. Dosage considerations for transcranial direct current stimulation in children: a computational modeling study. PLoS One. 2013;8(9):e76112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Gálvez V, Alonzo A, Martin D, Mitchell PB, Sachdev P, Loo CK. Hypomania induction in a patient with bipolar II disorder by transcranial direct current stimulation (tDCS). J ECT. 2011;27(3):256–8.

    Article  PubMed  Google Scholar 

  30. First MB, Williams JBW, Spitzer RL, Gibbon M. Structured clinical interview for DSM-IV-TR axis I disorders, clinical trials version (SCID-CT). New York, NY: New York State Psychiatric Institute; 2007.

    Google Scholar 

  31. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 Suppl 2:22–33;quiz 34–57.

    PubMed  Google Scholar 

  32. Keel JC, Smith MJ, Wassermann EM. A safety screening questionnaire for transcranial magnetic stimulation. Clin Neurophysiol. 2001;112(4):720.

    Article  CAS  PubMed  Google Scholar 

  33. Nitsche MA, Jaussi W, Liebetanz D, Lang N, Tergau F, Paulus W. Consolidation of human motor cortical neuroplasticity by D-cycloserine. Neuropsychopharmacology. 2004;29(8):1573–8.

    Article  CAS  PubMed  Google Scholar 

  34. Brunoni AR, Valiengo L, Baccaro A, Zanao TA, Oliveira AC, Goulart AC, et al. The sertraline versus electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry. 2013;70(4):383–91.

    Article  CAS  PubMed  Google Scholar 

  35. Nitsche MA, Lampe C, Antal A, Liebetanz D, Lang N, Tergau F, et al. Dopaminergic modulation of long-lasting direct current-induced cortical excitability changes in the human motor cortex. Eur J Neurosci. 2006;23(6):1651–7.

    Article  PubMed  Google Scholar 

  36. Brunoni AR, Ferrucci R, Bortolomasi M, Scelzo E, Boggio PS, Fregni F, et al. Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the major depressive episode: findings from a naturalistic study. Eur Psychiatry. 2013;28(6):356–61.

    Article  CAS  PubMed  Google Scholar 

  37. Loo CK, Martin DM, Alonzo A, Gandevia S, Mitchell PB, Sachdev P. Avoiding skin burns with transcranial direct current stimulation: preliminary considerations. Int J Neuropsychopharmacol. 2010;14(03):425–6.

    Article  PubMed  Google Scholar 

  38. Brunoni AR, Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Boggio PS, et al. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35(1):96–101.

    Article  CAS  PubMed  Google Scholar 

  39. Loo CK, Alonzo A, Martin D, Mitchell PB, Galvez V, Sachdev P. Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial. Br J Psychiatry. 2012;200(1):52–9.

    Article  PubMed  Google Scholar 

  40. Kalu UG, Sexton CE, Loo CK, Ebmeier KP. Transcranial direct current stimulation in the treatment of major depression: a meta-analysis. Psychol Med. 2012;42:1791–800.

    Article  CAS  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. Merrill DR, Bikson M, Jefferys JGR. Electrical stimulation of excitable tissue: design of efficacious and safe protocols. J Neurosci Methods. 2005;141(2):171–98.

    Article  PubMed  Google Scholar 

  43. Minhas P, Bansal V, Patel J, Ho JS, Diaz J, Datta A, et al. Electrodes for high-definition transcutaneous DC stimulation for applications in drug delivery and electrotherapy, including tDCS. J Neurosci Methods. 2010;190(2):188–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Minhas P, Datta A, Bikson M. Cutaneous perception during tDCS: role of electrode shape and sponge salinity. Clin Neurophysiol. 2011;122(4):637–8.

    Article  PubMed  Google Scholar 

  45. Kronberg G, Bikson M. Electrode assembly design for transcranial direct current stimulation: a FEM modeling study. IEEE Eng Med Biol Soc Annu Conf. 2012;2012:891–5.

    Google Scholar 

  46. Kessler SK, Minhas P, Woods AJ, Rosen A, Gorman C, Bikson M. Dosage considerations for transcranial direct current stimulation in children: a computational modeling study. PLoS One. 2013;8(9), e76112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Klem GH, Lüders HO, Jasper HH, Elger C. The ten-twenty electrode system of the international federation. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl. 1999;52:3–6.

    CAS  PubMed  Google Scholar 

  48. Oostenveld R, Praamstra P. The five percent electrode system for high-resolution EEG and ERP measurements. Clin Neurophysiol. 2001;112(4):713–9.

    Article  CAS  PubMed  Google Scholar 

  49. Seibt O, Brunoni AR, Huang Y, Bikson M. The pursuit of DLPFC: non-neuronavigated methods to target the left dorsolateral pre-frontal cortex with symmetric bicephalic transcranial direct current stimulation (tDCS). Brain Stimul. 2015;8(3):590–602.

    Article  PubMed  Google Scholar 

  50. Agnew WF, McCreery DB. Considerations for safety in the use of extracranial stimulation for motor evoked potentials. Neurosurgery. 1987;20(1):143–7.

    Article  CAS  PubMed  Google Scholar 

  51. Bronstein JM, Tagliati M, McIntyre C, Chen R, Cheung T, Hargreaves EL, et al. The rationale driving the evolution of deep brain stimulation to constant-current devices. Neuromodulation (US). 2015;18(2):85–9.

    Article  Google Scholar 

  52. Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int J Neuropsychopharmacol. 2011;14(8):1133–45.

    Article  PubMed  Google Scholar 

  53. Durand S, Fromy B, Bouyé P, Saumet JL, Abraham P. Vasodilatation in response to repeated anodal current application in the human skin relies on aspirin-sensitive mechanisms. J Physiol. 2002;540(Pt 1):261–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, Paulus W. Safety criteria for transcranial direct current stimulation (tDCS) in humans. Clin Neurophysiol. 2003;114(11):2220–2. author reply 2222–3.

    Article  PubMed  Google Scholar 

  55. Nitsche MA, Paulus W. Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology. 2001;57(10):1899–901.

    Article  CAS  PubMed  Google Scholar 

  56. Ekici B. Transcranial direct current stimulation-induced seizure: analysis of a case. Clin EEG Neurosci. 2015;46(2):169.

    Article  PubMed  Google Scholar 

  57. Lippold OC, Redfearn JW. Mental changes resulting from the passage of small direct currents through the human brain. Br J Psychiatry. 1964;110:768–72.

    Article  CAS  PubMed  Google Scholar 

  58. Parazzini M, Rossi E, Rossi L, Priori A, Ravazzani P. Evaluation of the current density in the brainstem during transcranial direct current stimulation with extra-cephalic reference electrode. Clin Neurophysiol. 2013;124(5):1039–40.

    Article  CAS  PubMed  Google Scholar 

  59. Parazzini M, Rossi E, Rossi L, Priori A, Ravazzani P. Numerical estimation of the current density in the heart during transcranial direct current stimulation. Brain Stimul. 2013;6(3):457–9.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Frank E, Wilfurth S, Landgrebe M, Eichhammer P, Hajak G, Langguth B. Anodal skin lesions after treatment with transcranial direct current stimulation. Brain Stimul. 2010;3(1):58–9.

    Article  PubMed  Google Scholar 

  62. Martin DM, Alonzo A, Ho K-A, Player M, Mitchell PB, Sachdev P, et al. Continuation transcranial direct current stimulation for the prevention of relapse in major depression. J Affect Disord. 2013;144(3):274–8.

    Article  PubMed  Google Scholar 

  63. Ho K-A, Taylor JL, Chew T, Gálvez V, Alonzo A, Bai S, et al. The effect of transcranial direct current stimulation (tDCS) electrode size and current intensity on motor cortical excitability: evidence from single and repeated sessions. Brain Stimul. 2016;9(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  64. Coffman BA, Clark VP, Parasuraman R. Battery powered thought: enhancement of attention, learning, and memory in healthy adults using transcranial direct current stimulation. Neuroimage. 2014;85(Pt 3):895–908.

    Article  PubMed  Google Scholar 

  65. Veniero D, Bortoletto M, Miniussi C. On the challenge of measuring direct cortical reactivity by TMS-EEG. Brain Stimul. 2014;7(5):759–60.

    Article  PubMed  Google Scholar 

  66. Baudewig J, Siebner HR, Bestmann S, Tergau F, Tings T, Paulus W, et al. Functional MRI of cortical activations induced by transcranial magnetic stimulation (TMS). Neuroreport. 2001;12(16):3543–8.

    Article  CAS  PubMed  Google Scholar 

  67. Stagg CJ, Nitsche MA. Physiological basis of transcranial direct current stimulation. Neuroscientist. 2011;17(1):37–53.

    Article  PubMed  Google Scholar 

  68. Woods AJ, Antal A, Bikson M, Boggio PS, Brunoni AR, Celnik P, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Clin Neurophysiol. 2016;127(2):1031–48.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Cognitive Aging and Memory, Institute on Aging, University of Florida, Clinical Translational Research Bldg, 2004 Mowry Rd, Gainesville, FL, 32610, USA

    Adam J. Woods Ph.D.

  2. Department of Aging and Geriatric Research, McKnight Brain Institute, University of Florida, Gainesville, FL, USA

    Adam J. Woods Ph.D.

  3. Department of Neuroscience, University of Florida, Gainesville, FL, USA

    Adam J. Woods Ph.D.

  4. Sydney Neurostimulation Centre (SyNC), School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia

    Donel M. Martin Ph.D.

Authors
  1. Adam J. Woods Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donel M. Martin Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam J. Woods Ph.D. .

Editor information

Editors and Affiliations

  1. Interdisciplinary Center for Applied Neuromodulation Department and Institute of Psychiatry Laboratory of Neurosciences (LIM-27), University Hospital and Service of Interdisciplinary Neuromodulation University of São Paulo, São Paulo, Brazil

    André Brunoni

  2. Department of Psychology and Neurosciences, Leibniz Research Center for Working Environments and Human Factors, Dortmund, Germany

    Michael Nitsche

  3. School of Psychiatry Black Dog Institute & St George Hospital, University of New South Wales, Sydney, New South Wales, Australia

    Colleen Loo

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Woods, A.J., Martin, D.M. (2016). Clinical Research and Methodological Aspects for tDCS Research. 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_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33967-2_26

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33965-8

  • Online ISBN: 978-3-319-33967-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation