TDCS in Pediatric Hemiparesis

e12 Abstracts / Brain Stimulation 7 (2014) e1ee16
[7] Eran Dayan, Nitzan Censor, Ethan R Buch, Marco Sandrini, and intended target area of application of tDCS with functional or
Leonardo G Cohen. Noninvasive brain stimulation: from anatomic reorganization.
physiology to network dynamics and back. Nature neurosci-
ence, 16(7):838e844, 2013.
[8] Mario Dipoppa and Boris S Gutkin. Flexible frequency control of 39
cortical oscillations enables computations required for working Impact of baseline excitability on tDCS-induced plasticity
memory. Proceedings of the National Academy of Sciences, 2013. S. Fresnoza , M.-F. Kuo , W. Paulus , M.A. Nitsche
[9] Oded Meiron and Michal Lavidor. Prefrontal oscillatory stim- Dept. Clinical Neurophysiology, University Medical Center, Georg-
ulation modulates access to cognitive control references in August-University, Goettingen, Germany
retrospective metacognitive commentary. Clinical Neurophys- *E-mail: mnitsch1@wwdg.de.
iology, 2013.
Neuroplastic alterations of cortical excitability can be accom-
[10] Cornelia Pirulli, Anna Fertonani, and Carlo Miniussi. The role of
plished by non-invasive brain stimulation with transcranial direct
timing in the induction of neuromodulation in perceptual
currents (tDCS). Excitability alterations can last from some minutes
learning by transcranial electric stimulation. Brain stimulation,
for up to more than 24h after plasticity induction. However, sub-
2013.
stantial interindividual variability does exist with regard to the
[11] Albert Snowball, Ilias Tachtsidis, Tudor Popescu, Jacqueline duration and magnitude of the effects. The reasons for this vari-
Thompson, Margarete Delazer, Laura Zamarian, Tingting Zhu, ability have not been systematically explored. In a retrospective
and Roi Cohen Kadosh. Long-term enhancement of brain analysis in 22 healthy humans, we analyzed the dependence of
function and cognition using cognitive training and brain tDCS-induced motor cortex plasticity from baseline excitability, as
stimulation. Current Biology, 2013. defined by the transcranial magnetic stimulation (TMS) intensity
required to induce motor evoked potential amplitudes (MEP) of the
size of 1 mV. Lower TMS intensity was associated with larger
38 magnitude of tDCS-induced plasticity for both, the aftereffects of
anodal, and cathodal tDCS. We conclude that baseline excitability is
Safety of transcranial Direct Current Stimulation in Pediatric
an important factor for determination of the efficacy of tDCS at the
Hemiparesis: Determination of the Method for Locating the
individual level. The physiological, and anatomical reasons for this
Optimal Stimulation Site
association, as well as the opportunity to use this factor for opti-
B.T. Gillick a,*, T. Feyma b, J. Menk c, L.E. Krach d
a mizing tDCS effect, should be explored in future studies.
Brain Plasticity Laboratory, Department of Physical Medicine and
Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
b
Department of Pediatric Neurology, Gillette Children’s Specialty
Healthcare, St Paul, MN 40
c
Clinical and Translational Science Institute, Biostatistical Design and tACS- What goes on inside? The neural consequences of
Analysis Center, University of Minnesota Medical School, Minneapolis, transcranial alternating current stimulation
MN Kohitij Kar , Jacob Duijnhouwer , Bart Krekelberg
d
Department of Physical Medicine and Rehabilitation, University of Department of Neuroscience, Center for Molecular and Behavioral
Minnesota Medical School, Minneapolis, MN Neuroscience, Rutgers, The State University of New Jersey, Newark,
*E-mail: gillick@umn.edu. New Jersey 07102, USA
*E-mail: kohitij@vision.rutgers.edu.
Background/Objectives: Transcranial direct current stimulation
has the potential to maximize neuro recovery in children with There is considerable evidence for clinical and behavioral efficacy
unilateral congenital lesions and resultant hemiparesis. To investi- of transcranial alternating current stimulation (tACS). The effects
gate this device, optimal electrode location must be verified. Cur- range from suppressing Parkinsonian tremors to augmenting hu-
rent tDCS treatments rely on traditional EEG landmarks but, in man learning and memory. Despite widespread use, the neurobi-
children with unilateral lesions, the location of the motor hotspot ological mechanism of actions of tACS on the brain is unclear. We
may vary. Hypothesis: Conventional EEG landmarks differ from the have taken a threefold approach to probe tACS mechanisms. First,
motor hotspot in both the ipsilesional and contralesional hemi- we examined the behavioral effects of tACS on human motion
sphere in children with congenital hemiparesis. perception. Second, we used known motion models to generate
Design: Exploratory Cohort Study predictions about neural mechanisms that could produce the ef-
Participants and Setting: Ten children with congenital hemi- fects. Third, we tested these predictions by directly measuring
paresis due to a unilateral lesion at an academic facility (mean age tACS-induced neural activity changes in the macaque brain.
14.0 years, SD 3.67). In human subjects, we found that tACS (10 Hz, 0.5 mA) applied
Materials/Methods: Using transcranial magnetic stimulation over area hMT+, during coarse motion direction discrimination,
(TMS), motor threshold was found in each hemisphere with the first increases observers’ sensitivity. Based on reports suggesting that
dorsal interosseous (FDI) muscle at rest. Using the conventional tACS interacts with mechanisms of plasticity, we hypothesized that
EEG measurement system, C3 (left hemisphere) and C4 (right a reduction in adaptation might cause this effect. We tested this
hemisphere) motor landmarks were found. Measurements were hypothesis by applying tACS during visual motion adaptation. tACS
then made between the two points. over contralateral but not ipsilateral hMT+ mitigated the motion
Results: The average distance between the ipsilesional and con- aftereffect and sensitivity changes induced by adaptation. These
tralesional TMS hotspots and EEG landmarks were 3.2 3.1 cm and results suggest that tACS-induced membrane voltage modulations
2.9 1.9 centimeters, respectively. The proportion and 95% confi- reduce adaptation in the motion-selective neurons. Tuning curve
dence interval for agreement of the ipsilesional and contralesional estimates of macaque MT neurons showed that tACS attenuated the
TMS hotspots and EEG landmarks were 0.3, [0.07, 0.65] and 0.2, effects of motion adaptation on tuning amplitude and width. In
[0.03, 0.56], respectively. addition to single cell measures, tACS also mitigated adaptation-
Conclusions/Significance: Our research indicates that EEG land- induced changes in evoked LFP responses.
marks do not consistently indicate the optimal site of tDCS motor Our results provide novel insight into how tACS interacts with
cortex stimulation in children with unilateral lesions. This variation neural activity and establishes the awake, behaving macaque as an
can directly aff5ct the optimal electrode placement and the in-vivo animal model to study tACS mechanisms.

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e12 Abstracts / Brain Stimulation 7 (2014) e1ee16

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