Dr. Marom Bikson presented to the IEEE ICES TC95 Subcommittee on “Engineering standards for tDCS”
Tuesday, 12 January 2016
Motorola Solutions, Inc., 8000 West Sunrise Blvd, Plantation, Florida 33322
Watch it here: VIDEO
This episode of TechKnow (Original Air Date: September 27, 2014) explores the applications of “hacking the brain.” For patients suffering from a variety of brain injuries and diseases—from depression to cerebral palsy— there is a sure of interest in an technique called transcranial Direct Current Stimulation (tDCS). Dr. Marom Bikson it interviewed as an expert on tDCS technology and its use at home. All features Soterix Medical technology used for neurorehabilitation.
A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation (tDCS) in Multiple Sclerosis (MS)
Margaret Kasschau 1,2, Kathleen Sherman1,2, Lamia Haider 2, Ariana Frontario 1,2, Michael Shaw1,2, Abhishek Datta 3, Marom Bikson 4, Leigh Charvet1,2
1 Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center, 2 Department of Neurology, Stony Brook Medicine, 3 Soterix Medical, Inc, 4 Department of Biomedical Engineering, The City College of New York
Watch the video here
Soterix Medical Mini-CT device used here
Neural Engineering Journal Club/Speaker Friday (Dec 18th) at 1 PM. Location is the new CCNY building, 3rd floor conference room Directions here
Brain-Machine Interfaces: The Perception-Action Closed Loop
Dr. José del R. Millán
http://actu.epfl.ch/news/neuroprotheses-l-esprit-aux-commandes/
Future neuroprosthetics will be tightly coupled with the user in such a way that the resulting system can replace and restore impaired upper limb functions because controlled by the same neural signals than their natural counterparts. However, robust and natural interaction of subjects with sophisticated prostheses over long periods of time remains a major challenge. To tackle this challenge we can get inspiration from natural motor control, where goal-directed behavior is dynamically modulated by perceptual feedback resulting from executed actions.
Current brain-computer interfaces (BCI) partly emulate human motor control as they decode cortical correlates of movement parameters –from onset of a movement to directions to instantaneous velocity– in order to generate the sequence of movements for the neuroprosthesis. A closer look, though, shows that motor control results from the combined activity of the cerebral cortex, subcortical areas and spinal cord. This hierarchical organization supports the hypothesis that complex behaviours can be controlled using the low-dimensional output of a BCI in conjunction with intelligent devices in charge to perform low-level commands.
A further component that will facilitate intuitive and natural control of motor neuroprosthetics is the incorporation of rich multimodal feedback and neural correlates of perceptual processes resulting from this feedback. As in natural motor control, these sources of information can dynamically modulate interaction.
Bio: José del R. Millán is the Defitech Professor at the Ecole Polytechnique Fédérale de Lausanne (EPFL) where he explores the use of brain signals for multimodal interaction and, in particular, the development of non-invasive brain-controlled robots and neuroprostheses. In this multidisciplinary research effort, Dr. Millán is bringing together his pioneering work on the two fields of brain-machine interfaces and adaptive intelligent robotics. He received his Ph.D. in computer science from the Univ. Politècnica de Catalunya (Barcelona, Spain) in 1992. His research on brain-machine interfaces was nominated finalist of the European Descartes Prize 2001 and he has been named Research Leader 2004 by the journal Scientific American for his work on brain-controlled robots. He is the recipient of the IEEE-SMC Nobert Wiener Award 2011 for his seminal and pioneering contributions to non-invasive brain-machine interfaces. Dr. Millán has coordinated a number of European projects on brain-machine interfaces.
UPDATE: Slides from talk Bikson_NAN2015final
Dr. Bikson to speak at the NANS 2015 meeting as part of a special session on NIBS.
Meeting details here Meeting is Dec 10-13 in Las Vegas.
Chair: Felipe Fregni
-Tim Wagner, PhD//Laura Dipietro, PhD
-Leon Morales, MD
-Marom Bikson, PhD
-Dylan Edwards, PhD
Dec 11: Non-Invasive Brain Neurostimulation
-from biophysical foundations to clinical implementation of neurostimulation technologies
-Using qEEG to guide non-invasive brain stimulation
-High-density transcranial direct current stimulation
-Using robotics and other therapies in combination with brain stimulation
Magstim Inside Interviews: 5 Minutes with leading researchers (Professor Marom Bikson)
Link Nov 18, 2015
Marom Bikson, a biomedical engineer at the City College of New York, who studies electricity’s effect on the body, says there are some essential questions scientists must answer before tDCS becomes widespread: what brain region should be stimulated and at what strength; and is stimulation better before, during or after an activity? “We’re in the ‘baby aspirin’ stages of tDCS,” says Bikson. “We have a tremendous amount to learn about how to optimize it.”
J Neurophysiol. 2015 Apr 1;113(7):2801-11. doi: 10.1152/jn.00784.2014. Epub 2015 Feb 11.
Transspinal direct current stimulation immediately modifies motor cortex sensorimotor maps.
Song W, Truong DQ, Bikson M, Martin JH.
Full PDF: SongBiksontsDCS_2015
Abstract: Motor cortex (MCX) motor representation reorganization occurs after injury, learning, and different long-term stimulation paradigms. The neuromodulatory approach of transspinal direct current stimulation (tsDCS) has been used to promote evoked cortical motor responses. In the present study, we used cathodal tsDCS (c-tsDCS) of the rat cervical cord to determine if spinal cord activation can modify the MCX forelimb motor map. We used a finite-element method model based on coregistered high-resolution rat MRI and microcomputed tomography imaging data to predict spinal current density to target stimulation to the caudal cervical enlargement. We examined the effects of cathodal and anodal tsDCS on the H-reflex and c-tsDCS on responses evoked by intracortical microstimulation (ICMS). To determine if cervical c-tsDCS also modified MCX somatic sensory processing, we examined sensory evoked potentials (SEPs) produced by wrist electrical stimulation and induced changes in ongoing activity. Cervical c-tsDCS enhanced the H-reflex, and anodal depressed the H-reflex. Using cathodal stimulation to examine cortical effects, we found that cervical c-tsDCS immediately modified the forelimb MCX motor map, with decreased thresholds and an expanded area. c-tsDCS also increased SEP amplitude in the MCX. The magnitude of changes produced by c-tsDCS were greater on the motor than sensory response. Cervical c-tsDCS more strongly enhanced forelimb than hindlimb motor representation and had no effect on vibrissal representation. The finite-element model indicated current density localized to caudal cervical segments, informing forelimb motor selectivity. Our results suggest that c-tsDCS augments spinal excitability in a spatially selective manner and may improve voluntary motor function through MCX representational plasticity.
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
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:
Neuromodec
Bhaskar Paneri
Marom Bikson PhD
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
“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
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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.
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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.