- •A group of European experts reviewed current evidence for therapeutic efficacy of tDCS.
- •Level B evidence (probable efficacy) was found for fibromyalgia, depression and craving.
- •The therapeutic relevance of tDCS needs to be further explored in these and other indications.
Posts Tagged fibromyalgia
The use of non-invasive brain neurostimulation (NIBS) techniques to treat neurological or psychiatric diseases is currently under development. Fatigue is a commonly observed symptom in the field of potentially treatable pathologies by NIBS, yet very little data has been published regarding its treatment. We conducted a review of the literature until the end of February 2017 to analyze all the studies that reported a clinical assessment of the effects of NIBS techniques on fatigue. We have limited our analysis to repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). We found only 15 studies on this subject, including 8 tDCS studies and 7 rTMS studies. Of the tDCS studies, 6 concerned patients with multiple sclerosis while 6 rTMS studies concerned fibromyalgia or chronic fatigue syndrome. The remaining 3 studies included patients with post-polio syndrome, Parkinson’s disease and amyotrophic lateral sclerosis. Three cortical regions were targeted: the primary sensorimotor cortex, the dorsolateral prefrontal cortex and the posterior parietal cortex. In all cases, tDCS protocols were performed according to a bipolar montage with the anode over the cortical target. On the other hand, rTMS protocols consisted of either high-frequency phasic stimulation or low-frequency tonic stimulation. The results available to date are still too few, partial and heterogeneous as to the methods applied, the clinical profile of the patients and the variables studied (different fatigue scores) in order to draw any conclusion. However, the effects obtained, especially in multiple sclerosis and fibromyalgia, are really carriers of therapeutic hope.
[Abstract] Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS) – Clinical Neurophysiology
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson’s disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer’s disease, tinnitus, depression, schizophrenia, and craving/addiction.
The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10–24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode.
It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
[WEB SITE] CLINICAL RESEARCH FINDS: NEURONTIN AND LYRICA ARE A DEATH SENTENCE FOR NEW BRAIN SYNAPSES – The American Health
BY: Byron J. Richards, Board Certified Clinical Nutritionist
Neurontin and its newer more potent version, Lyrica, are widely used for off-label indications that are an outright flagrant danger to the public. These blockbuster drugs were approved for use even though the FDA had no idea what they actually did in the brain. A shocking new study shows that they block the formation of new brain synapses1, drastically reducing the potential for rejuvenating brain plasticity – meaning that these drugs will cause brain decline faster than any substance known to mankind.
The problem of these drugs is compounded by their flagrant illegal marketing. Neurontin was approved by the FDA for epilepsy back in 1994. The drug underwent massive illegal off-label promotion that cost Warner-Lambert 430 million dollars (the very first big fine for off-label promotion). The drug is now owned by Pfizer. Pfizer also owns Lyrica, a super-potent version of Neurontin. It has been approved by the FDA for various types of pain and fibromyalgia. Lyrica is one of four drugs which a subsidiary of Pfizer illegally marketed, resulting in a $2.3 billion settlement against Pfizer.
Even though the marketing of these drugs has been heavily fined, they continue to rack up billions in sales from the off-label uses. Doctors use them for all manner of nerve issues because they are good at suppressing symptoms. However, such uses can no longer be justified because the actual mechanism of the drugs is finally understood and they are creating a significant long-term reduction in nerve health.
The researchers in the above study try to downplay the serious nature of the drugs by saying “adult neurons don’t form many new synapses.” That is simply not true. The new science is showing that brain health during aging relies on the formation of new synapses. Even these researchers managed to question the common use of these medications in pregnant women. How is a fetus supposed to make new nerve cells when the mother is taking a drug that blocks them?
These are the kind of situations the FDA should be all over. As usual, the FDA is sitting around pondering a suicide warning for Lyrica while its off-label uses include bi-polar disorder and migraine headaches. The FDA is likely to twiddle its thumbs for the next decade on the brain damage issue. Consumer beware.
Transcranial direct current stimulation (tDCS) is a non-invasive, painless brain stimulation method which uses electrical currents to modulate neuronal activity in specific parts of the brain. A constant, low intensity current is delivered through small electrodes attached to the scalp in order to either increase or reduce neuronal activity.
This is clearly a trending topic: although interest in tDCS dates back to the 1960s, a search in PubMed reveals that more than half of the articles on tDCS were published in the last two years.
Despite numerous studies on different applications for tDCS, its use is still not generally accepted in the clinical setting; tDCS is not an FDA-approved therapy, remaining mostly an experimental method. Although tDCS has been tested on numerous conditions such as depression, anxiety, schizophrenia, Parkinson’s disease, Alzheimer’s disease, chronic pain, fibromyalgia, and stroke, its efficacy is still largely inconclusive.
Many studies applying tDCS have already been published in 2015, as well as a few reviews analyzing its efficacy for different conditions. By gathering the available information for the application of tDSC in a specific context, reviews are particularly useful, allowing researchers to sort through all the conflicting data. And these have actually shown some promising applications for tDSC.
Learning and Memory
There have been claims that tDCS can enhance cognition in healthy adult populations, especially working memory and language production, spiking the interest in tDCS as a neuroenhancement tool.
tDCS seems to act as a neuromodulatory technique, inducing a long-term enhancement or reduction of signal transmission between neurons. By strengthening or weakening neuronal connections, it may facilitate learning and memory formation, as well as neural plasticity that contributes to functional recovery after stroke, for example.
However, a review on the effects of a single-session of tDCS showed that it did not have a significant effect on a variety of cognitive function such as language, episodic memory, working memory or mental arithmetic, just to name a few. Nevertheless, it did not exclude the possibility that tDCS may be effective after multiple sessions.
There are in fact many reports from studies in healthy subjects stating that tDCS enhances verbal performance and learning, improving such outcomes as verbal speed, fluency, and amount of verbal learning. These language enhancement outcomes could potentially be quite useful in treating language deficits associated with different pathological conditions. In fact, tDCS has been used to enhance treatment efficacy in post-stroke aphasia rehabilitation and the results seem promising, with tDCS being effective in increasing language skills despite a high variety of stimulation parameters and patient characteristics.
Language enhancement can also be applied to a word reading context. Repeated tDCS application to adults with developmental dyslexia has been shown to significantly improve reading speed and fluency.
Reports supporting a positive effect on memory enhancement can also be found. Different studies have demonstrated an improvement in working memory and episodic memory in healthy subjects, with an increase in accuracy and in response time. But again, the evidences are still considered insufficient for a clinical application.
These memory enhancement effects could be quite useful in both Alzheimer’s and Parkinson’s disease, and in post-stroke rehabilitation. Again, some promising outcomes in these pathologies have been reported, but there are still conflicting results.