Friday, November 6, 2015. 11:30 AM at New Jersey Institute of Technology  link

Talk title: The engineering foundations of non-invasive brain stimulation with weak currents

Few modern investigational medical devices have generated the excitement and research activity associated with transcranial Direct Current Stimulation (tDCS). During tDCS low-intensity DC current is applied across the scalp to treat neuropsychiatric diseases (including pain, depression, TBI, PTSD, epilepsy, tinnitus, stroke rehabilitation) or enhance cognitive performancetraining efficacy (including accelerated learning and memory); moreover tDCS has been suggested to produce minimal side-effects (undesired cognitive changes). This broad use of tDCS itself begs the question: how is specificity of behavioral changes achieved? And more broadly: how does tDCS work at the cellular level. This presentation introduces the current state-of-the-art and in-development technologies of tDCS. The biophysical foundations of tDCS are outlined including MRI-derived computational models of current flow, simulations and animal studies of neuromodulation, and finally essential challenges for ongoing rational and optimized application of tDCS in clinical and cognitive enhancements applications.

ity associated with transcranial Direct Current Stimulation (tDCS). During tDCS low-intensity DC current is applied across the scalp to treat neuropsychiatric diseases (including pain, depression, TBI, PTSD, epilepsy, tinnitus, stroke rehabilitation) or enhance cognitive performancetraining efficacy (including accelerated learning and memory); moreover tDCS has been suggested to produce minimal side-effects (undesired cognitive changes). This broad use of tDCS itself begs the question: how is specificity of behavioral changes achieved? And more broadly: how does tDCS work at the cellular level. This presentation introduces the current state-of-the-art and in-development technologies of tDCS. The biophysical foundations of tDCS are outlined including MRI-derived computational models of current flow, simulations and animal studies of neuromodulation, and finally essential challenges for ongoing rational and optimized application of tDCS in clinical and cognitive enhancements applications.

Both papers appear in a special issue of Progress in Brain Research.

Modeling sequence and quasi-uniform assumption in computational neurostimulation

Bikson M, Truong DQ, Mourdoukoutas A,  Aboseria M, Khadka N, Adair D, Rahman A

DOI: doi:10.1016/bs.pbr.2015.08.005 Journal Link  PDF: ModelingSequence2015

Abstract: Computational neurostimulation aims to develop mathematical constructs that link the application of neuromodulation with changes in behavior and cognition. This process is critical but daunting for technical challenges and scientific unknowns. The overarching goal of this review is to address how this complex task can be made tractable. We describe a framework of sequential modeling steps to achieve this: (1) current flow models, (2) cell polarization models, (3) network and information processing models, and (4) models of the neuroscientific correlates of behavior. Each step is explained with a specific emphasis on the assumptions underpinning underlying sequential implementation. We explain the further implementation of the quasi-uniform assumption to overcome technical limitations and unknowns. We specifically focus on examples in electrical stimulation, such as transcranial direct current stimulation. Our approach and conclusions are broadly applied to immediate and ongoing efforts to deploy computational neurostimulation.

Multilevel computational models for predicting the cellular effects of noninvasive brain stimulation

DOI: doi:10.1016/bs.pbr.2015.09.003  Journal Link  PDF: MultiLevelComputational

Rahman A, Lafon B, Bikson M

Abstract: Since 2000, there has been rapid acceleration in the use of tDCS in both clinical and cognitive neuroscience research, encouraged by the simplicity of the technique (two electrodes and a battery powered stimulator) and the perception that tDCS protocols can be simply designed by placing the anode over the cortex to “excite,” and the cathode over cortex to “inhibit.” A specific and predictive understanding of tDCS needs experimental data to be placed into a quantitative framework. Biologically constrained computational models provide a useful framework within which to interpret results from empirical studies and generate novel, testable hypotheses. Although not without caveats, computational models provide a tool for exploring cognitive and brain processes, are amenable to quantitative analysis, and can inspire novel empirical work that might be difficult to intuit simply by examining experimental results. We approach modeling the effects of tDCS on neurons from multiple levels: modeling the electric field distribution, modeling single-compartment effects, and finally with multicompartment neuron models.

SmartHealth interviews Marom Bikson on Oct 21, 2015

Read the full interview here

“Which kind of diseases could be improved thanks to electrical stimulation of the brain?

Almost any brain disease can benefit in theory from electrical stimulation.  Electrical stimulation may not always be a cure, but it can enhance the effects of other therapies and increase quality of life.  Applications include depression, chronic pain, epilepsy, learning and attention disorders, and other neuro-psychiatric disorders.”

The CURRNT October 13, 2015  listen here

Electrical brain stimulation moves from lab to home

Dr. Marom Bikson interviewed with other experts about home use of tDCS and other forms of neuromodulation such as Thync.

Computer Aided Design of the Body:
An Overview on Using Simpleware to Simulate and 3D Print Organs Date: Friday, October 16, 2015
Venue: City College of New York, Steinman Hall Room 401, 160 Convent Ave, New York, NY 10031 [Directions]

Who should attend:
This one-day course is aimed at those interested in creating high-quality 3D printed models of human anatomy from 3D image data. It will provide an overview to the processing of medical imaging data for the creation of tissue simulations and 3D printing. We will demonstrate typical workflows in Simpleware software for going from 3D image data to STL files suitable for 3D printing, including the ability to visualise and segment complex anatomical data. This will cover the benefits of using image-based models, examples of the work being done at CCNY, and will include opportunities for hands-on demos.You will learn how to:

You will learn how to:

1. Visualise and process image data from a wide range of 3D imaging modalities (e.g. MRI, CT, micro-CT)

2. Create and manipulate computer representations of different parts of the human anatomy

3. Import and position medical device designs within image data

4. Generate image and video files for presentations and demonstration

5. Export to 3D printing equipment

6. Export for the purpose of computer simulation using finite element methods

Organizers:

1. Neuromodec

2. Bhaskar Paneri

3. Marom Bikson PhD

4. Gozde Unal

Registration Today:
$50 ($25 Students)

UCLA Brain Mapping Center

December 10, 2015 1:00pm – 2:00pm
Neuroscience Research Building (NRB 132) 635 Charles Young Dr. South

link

“How does tDCS work for so many things?” Marom Bikson

Few neuroscience technologies have generated as much recent interest and debate as transcranial Direct Current Stimulation (tDCS). tDCS is explored for a remarkably wide range of behavioral interventions to treat neurological and psychiatric disorders, to accelerate rehabilitation after injury, and to enhance learning in healthy subjects. This talk reviews the technical and mechanism fundamentals of tDCS with the goal of explaining how specificity of action can be achieved. Specifically, how can tDCS be optimized and customized to produce specific changes in brain function. Data from computational models, animal testing, and clinical trials of tDCS is reviewed. New technologies such as High-Definition tDCS and EEG-tDCS coupling will be discussed.

A Feasibility Study of Bilateral Anodal Stimulation of the Prefrontal Cortex Using High-Definition Electrodes in Healthy Participants

J. Xu, S.M. Healy, D.Q. Truong, A. Datta, M. Bikson, M.N. Potenza.

Abstract: Transcranial direct current stimulation (tDCS†) studies often use one anode to increase cortical excitability in one hemisphere. However, mental processes may involve cortical regions in both hemispheres. This study’s aim was to assess the safety and possible effects on affect and working memory of tDCS using two anodes for bifrontal stimulation. A group of healthy subjects participated in two bifrontal tDCS sessions on two different days, one for real and the other for sham stimulation. They performed a working memory task and reported their affect immediately before and after each tDCS session. Relative to sham, real bifrontal stimulation did not induce significant adverse effects, reduced decrement in vigor-activity during the study session, and did not improve working memory. These preliminary findings suggest that bifrontal anodal stimulation is feasible and safe and may reduce task-related fatigue in healthy participants. Its effects on neuropsychiatric patients deserve further study.

Full PDF: Xu_HDtDCS_2015.compressed

Description:
An intensive one-day event with national and international leaders in transcranial direct current stimulation (tDCS) clinical research. The “Updates in tDCS Clinical Trials” mini-symposium will cover recent updates and results in tDCS clinical trials spanning applications in neurology, psychiatry, and rehabilitation. This course is intended for clinicians, researchers, and students employing tDCS. Lecturers will cover emerging techniques, novel developments, and anticipated outcomes for various tDCS applications. Ample time will be allowed for discussion with speakers. Note that tDCS remain an investigational techniques and is not FDA approved for any indication. The “Updates in tDCS Clinical Trials” mini-symposium is scheduled for the day after the NYC tDCS Fellowship. Though the course focuses on practical aspects of tDCS, no hands-on training is provided. This is a lecture series only. These events are separately managed and require separate registration.

Register Now:

• Regular Admissions: $150

• Student Admissions: $100.

Sarantos C, Bekritsky J, Khadka N, Bikson M, Adusumilli P
__________________________________________
Download: PDF published in Journal of Medical Devices DOI

Abstract

We developed and validated a first-generation compact handheld device for real-time wireless monitoring of tissue oxygen saturation during surgical procedures termed wireless intra-operative pulse oximetry (WiPOX). Based on clinical experience gained in our trials [1,9], we present here the design of a second generation WiPOX that includes a reticulated pressure-sensitive head serving two related functions. First, the often-restricted and sensitive environment in which the device is employed constrains both the angle of approach and visibility, necessitating a self-correcting reticulated swiveling head that acts to improve the contact angle between the sensor head and the tissue. Second, because the devices are hand-held, the pressure on the tissue (often a membrane) is determined by the operator; too little pressure produces poor signal to noise ratio (SNR) while too much pressure can occlude blood flow, also reducing SNR and possibly yielding erroneously low oxygenation measurements. To address this, our sensor head includes a novel mounting for multiple “balloon” style pressure sensors that provide feedback on tissue contact pressure and contact angle. The reticulated head and pressure sensor features function in tandem to improve tissue contact and ensure reliable measurements.
__________________________________________

The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial

Full Design Paper Download: ELECT_TDCSdesign_SMI_2015 2

CONTEXT AND OBJECTIVE: Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited due to refractoriness and adverse effects. We describe the study rationale and design of ELECT-TDCS (Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study), which is investigating a non-pharmacological treatment known as transcranial direct current stimulation (tDCS).

DESIGN AND SETTING: Phase-III, randomized, non-inferiority, triple-arm, placebo-controlled study, ongoing in São Paulo, Brazil.

METHODS: ELECT-TDCS compares the efficacy of active tDCS/placebo pill, sham tDCS/escitalopram 20 mg/day and sham tDCS/placebo pill, for ten weeks, randomizing 240 patients in a 3:3:2 ratio, respectively. Our primary aim is to show that tDCS is not inferior to escitalopram with a non-inferiority margin of at least 50% of the escitalopram effect, in relation to placebo. As secondary aims, we investigate several biomarkers such as genetic polymorphisms, neurotrophin serum markers, motor cortical excitability, heart rate variability and neuroimaging.

RESULTS: Proving that tDCS is similarly effective to antidepressants would have a tremendous impact on clinical psychiatry, since tDCS is virtually devoid of adverse effects. Its ease of use, portability and low price are further compelling characteristics for its use in primary and secondary healthcare. Multimodal investigation of biomarkers will also contribute towards understanding the antidepressant mechanisms of action of tDCS.

CONCLUSION: Our results have the potential to introduce a novel technique to the therapeutic arsenal of treatments for depression.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.Gov NCT01894815

DEVICE: SOTERIX MEDICAL CT 

HEADGEAR: SOTERIX MEDICAL “OLE” EASYSTRAP

Front. Neuroanat., 15 July 2015  Free Online or Download PDF: HD_tDCS_migraine

State-of-art neuroanatomical target analysis of high-definition and conventional tDCS montages used for migraine and pain control

Summary: Although transcranial direct current stimulation (tDCS) studies promise to modulate cortical regions associated with pain, the electric current produced usually spreads beyond the area of the electrodes’ placement. Using a forward-model analysis, this study compared the neuroanatomic location and strength of the predicted electric current peaks, at cortical and subcortical levels, induced by conventional and High-Definition-tDCS (HD-tDCS) montages developed for migraine and other chronic pain disorders. The electrodes were positioned in accordance with the 10–20 or 10–10 electroencephalogram (EEG) landmarks: motor cortex-supraorbital (M1-SO, anode and cathode over C3 and Fp2, respectively), dorsolateral prefrontal cortex (PFC) bilateral (DLPFC, anode over F3, cathode over F4), vertex-occipital cortex (anode over Cz and cathode over Oz), HD-tDCS 4 × 1 (one anode on C3, and four cathodes over Cz, F3, T7, and P3) and HD-tDCS 2 × 2 (two anodes over C3/C5 and two cathodes over FC3/FC5). M1-SO produced a large current flow in the PFC. Peaks of current flow also occurred in deeper brain structures, such as the cingulate cortex, insula, thalamus and brainstem. The same structures received significant amount of current with Cz-Oz and DLPFC tDCS. However, there were differences in the current flow to outer cortical regions. The visual cortex, cingulate and thalamus received the majority of the current flow with the Cz-Oz, while the anterior parts of the superior and middle frontal gyri displayed an intense amount of current with DLPFC montage. HD-tDCS montages enhanced the focality, producing peaks of current in subcortical areas at negligible levels. This study provides novel information regarding the neuroanatomical distribution and strength of the electric current using several tDCS montages applied for migraine and pain control. Such information may help clinicians and researchers in deciding the most appropriate tDCS montage to treat each pain disorder.

Intensity, Duration, and Location of High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief

Neurorehabilitation and Neural Repair DOI: 10.1177/1545968315595286  Download Paper: tDCS_HdtCS_Neurorehabil Neural Repair-2015-Shekhawat-1545968315595286

Giriraj Singh Shekhawat, Frederick Sundram, Marom Bikson, Dennis Truong, Dirk De Ridder, Cathy M. Stinear, David Welch,  Grant D. Searchfield

Background and Objective. Tinnitus is the perception of a phantom sound. The aim of this study was to compare current intensity (center anode 1 mA and 2 mA), duration (10 minutes and 20 minutes), and location (left temporoparietal area [LTA] and dorsolateral prefrontal cortex [DLPFC]) using 4 × 1 high-definition transcranial direct current stimulation (HD- tDCS) for tinnitus reduction. Methods. Twenty-seven participants with chronic tinnitus (>2 years) and mean age of 53.5 years underwent 2 sessions of HD-tDCS of the LTA and DLPFC in a randomized order with a 1 week gap between site of stimulation. During each session, a combination of 4 different settings were used in increasing dose (1 mA, 10 minutes; 1 mA, 20 minutes; 2 mA, 10 minutes; and 2 mA, 20 minutes). The impact of different settings on tinnitus loudness and annoyance was documented. Results. Twenty-one participants (77.78%) reported a minimum of 1 point reduction on tinnitus loudness or annoyance scales. There were significant changes in loudness and annoyance for duration of stimulation, F(1, 26) = 10.08, P < .005, and current intensity, F(1, 26) = 14.24, P = .001. There was no interaction between the location, intensity, and duration of stimulation. Higher intensity (2 mA) and longer duration (20 minutes) of stimulation were more effective. Conclusions. A current intensity of 2 mA for 20-minute duration was the most effective setting used for tinnitus relief. The stimulation of the LTA and DLPFC were equally effective for suppressing tinnitus loudness and annoyance.

Transcranial Direct Current Stimulation (tDCS): What Pain Practitioners Need to Know

By Helena Knotkova, PhD, Adam J. Woods, PhD, Marom Bikson, PhD and Michael A. Nitsche, MD

Non-invasive brain stimulation with tDCS is an emerging tool for adjunctive treatment of pain syndromes. Its long-lasting analgesic effects are probably caused by alterations of activity in cerebral pain-processing networks.

Link

Transcranial direct current stimulation in obsessive–compulsive disorder: emerging clinical evidence and considerations for optimal montage of electrodes

Expert Rev. Med. Devices, 1–11 (2015)

Full PDF: tDCSforOCD

Natasha M Senco, Yu Huang, Giordano D’Urso, Lucas C Parra, Marom Bikson, Antonio Mantovani, Roseli G Shavitt, Marcelo Q Hoexter, Eurıpedes C Miguel and Andre R Brunoni

Background: Neuromodulation techniques for obsessive–compulsive disorder (OCD) treatment have expanded with greater understanding of the brain circuits involved. Transcranial direct current stimulation (tDCS) might be a potential new treatment for OCD, although the optimal montage is unclear. Objective: To perform a systematic review on meta-analyses of repetitive transcranianal magnetic stimulation (rTMS) and deep brain stimulation (DBS) trials for OCD, aiming to identify brain stimulation targets for future tDCS trials and to support the empirical evidence with computer head modeling analysis. Methods: Systematic reviews of rTMS and DBS trials on OCD in Pubmed/MEDLINE were searched. For the tDCS computational analysis, we employed head models with the goal of optimally targeting current delivery to structures of interest. Results: Only three references matched our eligibility criteria. We simulated four different electrodes montages and analyzed current direction and intensity. Conclusion: Although DBS, rTMS and tDCS are not directly comparable and our theoretical model, based on DBS and rTMS targets, needs empirical validation, we found that the tDCS montage with the cathode over the pre-supplementary motor area and extra-cephalic anode seems to activate most of the areas related to OCD.

Soterix Medical HDExplore used.

Khadka N, Truong DQ, Bikson, M
___________________________________________
Download: PDF Published in Journal of Medical Devices DOI

Abstract

Within Electrode Current Steering (WECS) is a novel method that enhances reliability and tolerability of tDCS. The underlying assumption of WECS is steering current within electrodes but without altering current distribution in brain target. Through an exemplary case example of a realistic electrode and head geometry (FEM), we demonstrated how current flow in the brain is independent of current steering at the electrode. Three current split cases (even, partially uneven, and fully uneven), keeping total current (1 mA) fixed within the electrodes are tested. At the electrode-assembly interface with the skin, the current density distribution varied only incrementally across conditions (e.g. less than would be expected with even minor changes in electrode assembly or skin properties. There was no difference in the predicted electric filed at the brain target under all three cases. Thus, with such electrode assembly design, current steering to any functional electrode would not significantly increase current density in the skin (enhance tolerability during tDCS).

Behavioral and Cognitive Neuroscience Colloquium

Friday, 10:00 AM – 11:30 AM, May 8, 2015

Room C415A, The Graduate Center, 365 5th Ave, New York, NY 10016

Lucas Parra, City College, CUNY

 “Brains on Video”

Abstract: Much of the research on human brain function studies the relationship between neural activity and specific events in the world (flashes, beeps, button pushes, and associated features such as contrast, frequency, reaction time, etc). We decided to abandon this conventional approach and look instead at responses of the brain to ongoing natural stimuli, and in particular, video. We found that when an audience watches video, their fast encephalographic brain responses are similar, however, only if the audience is paying attention! The effect is so strong that we can detect an audience’s attentional engagement in segments as short as 5 seconds. Indeed, similarity of encephalographic responses is predictive of a number of behaviors that presumably correlated with viewer’s attention, such as whether they continue watching a program, whether they ‘like’ certain ad segments, whether they decide to ‘tweet’ about it, and whether they remember the content weeks after they saw it. We believe that analyzing fast ongoing neural activity in response to natural stimuli has tremendous potential for basic inquiry into the functioning of the human brain, and has evident and important practical implications.

Special 200+ page issue of

The frontiers of clinical research on transcranial direct current stimulation (tDCS) in Neuropsychiatry

ready for FREE download here.  We our work on the cover.

Includes our article

Inter-individual variation during transcranial direct current stimulation and normalization of dose using MRI-derived computational models

Available for individual download here

BME Day, May 01, 2015, Department of Biomedical Engineering, CCNY

Wireless Pulse Oximeter (WiPOX): Its Clinical Implications and Challenges

The WiPOX provides a tool for surgeons to objectively and reliably measure tissue viability during surgery rather than rely solely on their subjective visual inspection. Tissue ischemia is a major cause of wound dehiscence or anastomotic leakage resulting in significant morbidity and mortality occuring at a rate of 15 to 25%. Although measurement of systemic blood oxygenation status by finger-tip pulse oximetery is a mandatory requirement for every anesthetized patient, there is no standadrad procedure for intra-operative measurement of internal tissue oxygenation following complex resections and reconstructions.

Based on clinical experience gained in our trials, we present here the design of a second generation WiPOX that includes a reticulated pressure-sensitive head serving two related functions. First, the often-restricted and sensitive environment in which the device is employed constrains both the angle of approach and visibility, necessitating a self- correcting reticulated swiveling head that acts to improve the contact angle between the sensor head and the tissue. Second, because the devices is hand-held, the pressure on the tissue (often a membrane) is determined by the operator; too little pressure produces poor signal to noise ratio (SNR) while too much pressure can occlude blood flow, also reducing SNR and possibly yielding erroneously low oxygenation measurements. To address this, our sensor head includes a novel mounting for multiple “balloon” style pressure sensors that provide feedback on tissue contact pressure and contact angle. The reticulated head and pressure sensor features function in tandem to improve tissue contact and ensure
reliable measurements.

VENUE: Department of Biomedical Engineering, CCNY, ST 402

Harsh Baid, 17, of Bronx Science, wrote a piece of code that allows him to navigate the world of his favorite video game by moving his eyes.His project is enhancing gaming interfaces via gaze tracking. Baid approached Professor Lucas Parra, a professor of biomedical engineering at City College, to be his mentor.

Read more

Marom Bikson gives two lectures at Albert Einstein College of Medicine (Yeshiva University)

4/17/15

Kennedy Building Room 901.  Map

2-3 PM Transcranial Direct Current Stimulation: How can one thing work for everything?

3-4 PM  How electrotherapy devices work and why they fail to reach patients.