tDCS の臨床研究Clinical application of tDCS

Yuma Yokoi, MD2015

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　 Conflict Of Interest

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　 tDCS stands for

transcranial direct current stimulation

経頭蓋 直流電気 刺激

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　 Direct current

Anode陽極

Cathode陰極

Current電流

Battery電池

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h/o tDCS

18th/19th century: Galvanism

20th century: prosperity of ECT and disregard of tDCS

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Current tDCS

(a)Stimulator(b)Anode electrode(c)Cathode electrode(d)Strap(e)Rubber band

(Yokoi [in press])

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tDCS devices

(Guleyupoglu 2013)

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• Current intensity 電流量 ( 0.5 to 2 mA )

• Duration 刺激時間 ( 5 to 40 min )

• Frequency 刺激頻度 (3~5/week, 1~2/day)

• Size of electrodes 電極サイズ ( 3 to 100 cm2)

→ Current density 電流密度 ( A / m2 )Total charge 総電流量 ( Coulombs )

dose of tDCS

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• High-definition tDCS– Many electrodes

• tACS (transcranial alternating current stimulation)

• tRNS (transcranial random noise stimulation)

variants of tDCS

(Guleyupoglu 2013)

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　 Mechanism of Action (Filmer 2014)

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　 Mechanism of Action (Filmer 2014)

(Purpura 1965)motor evoked potentials (MEPs)

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　 Mechanism of Action (Santarnecchi 2014)

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　 Mechanism of Action (Filmer 2014)

Anodal stimulation inhibits

GABA(Mondino 2014, Stagg 2011)

Long-term potentiation

(LDP)-like長期増強

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　 Mechanism of Action (Filmer 2014)

Cathodal stimulation inhibits

glutamate(Stagg 2011)

Long-term depression

(LDP)-like長期抑制

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• DLPFC (Dorsolateral prefrontal cortex)

　 Rationale for treating depression

( Kim 2014 )

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　 Mechanism of action is complex

◯ Electricity Nonfocal (Russel 2013)

• Anatomical factors up to 50%– Geometory of sulci and gyri (Miranda 2013)

– Thickness of cerebrospinal fluid (CSF) and skull (Opitz 2015)

– Cathodal stimulation? (Filmer 2013)

◯ Neurotransmitter GABA, glutamate, catecholamine, acetylcholine and serotonin (Stagg 2011, Medeiros 2012, Mondino 2014)

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　 Mechanism of action is complex

( Kuo 2013 )

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　 Safety

( Tortella 2015 )

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Meta-analysis of tDCS for depression

(Shiozawa 2014)

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ADAPT 研究Ameliorating Depression in Alzheimer’s disease Patients by Transcranial direct current stimulationA randomized, double-blind, sham-controlled trial

アルツハイマー病のうつに対して経頭蓋直流電気刺激を行う RCTClinicalTrials.gov Identifier: NCT02351388UMIN ID:UMIN000014561科研費番号 :26860958

　 ADAPT 研究

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Participantsアルツハイマー病患者MINH 基準での dAD 診断

Intervention/ControltDCS 週 5 日 ×3 週実刺激 or 偽刺激二重盲検 RCT

Outcome安全性・忍容性CSDD( コーネル認知症抑うつ尺度 ) の BL からの変化　など

Sample size実刺激 10+ 偽刺激 10 Phase 1/2

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