Wiktor Wise
Electrical brain stimulation (EBS) is a technique used in research and clinical neurobiology to stimulate neurons and neural networks in the brain through direct or indirect excitation using electricity. This technique has been used to treat various mental disorders and neurological diseases. There are several types of brain stimulation therapies, including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and transcranial direct current stimulation (tDCS). These therapies can be administered through electrodes implanted in the brain or placed on the scalp, or by applying magnetic fields to the head. While these treatments have shown promising results in treating conditions such as depression, OCD, migraines, and epilepsy, there are still concerns about side effects and long-term safety, especially for at-home use.
| Characteristics | Values |
|---|---|
| Purpose | To stimulate a neuron or neural network in the brain through the direct or indirect excitation of its cell membrane |
| Types | Transcranial Magnetic Stimulation (TMS), Electroconvulsive Therapy (ECT), Transcranial Direct Current Stimulation (tDCS), Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS) |
| Application | Direct (electrodes implanted in the brain) or indirect (electrodes placed on the scalp) |
| Uses | Treatment of mental disorders, Parkinson's disease, epilepsy, tremors, depression, OCD, migraines, anxiety, Alzheimer's disease, ADHD, PTSD, substance use disorders, schizophrenia, schizoaffective disorder, mania, bipolar disorder, Tourette's syndrome |
| Effects | Improved focus, memory, mood, behavioural changes, hallucinations, feelings of body tingling, warmth, paresthesia, etc. |
| Downsides | Itching, irritation, small burns, fatigue, headache, memory loss, unexpected behaviours |
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What You'll Learn
Transcranial direct current stimulation (tDCS)
TDCS is a neuromodulation technique that can produce immediate and lasting changes in brain function. It can induce intracerebral current flow, which either increases or decreases neuronal excitability in the targeted area. This change in neuronal excitability alters brain function and can be used in various therapies. The direction of current flow differentiates anodal and cathodal stimulation. Anodal stimulation increases the probability of action potentials occurring, while cathodal stimulation decreases this likelihood.
TDCS has been proposed to promote both long-term potentiation and long-term depression, and its effects can be observed even after the stimulation ends. The duration and intensity of stimulation influence the duration of the cortical changes. tDCS has gained popularity over the past decade, with a growing list of potential applications, including depression, ADHD, Alzheimer's disease, neuropathic pain after spinal cord injury, and augmenting speech therapy for patients with acquired language disorders.
While tDCS has shown promising results, it has not been cleared by the FDA for any health condition and is considered investigational. More comprehensive research is needed to establish its effectiveness and safety, especially for at-home use. Some reported downsides include itching, irritation, small burns, fatigue, and headaches at the electrode sites.
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Electroconvulsive therapy (ECT)
The history of ECT dates back to the late 1930s, and it has been refined over the years to improve its safety and effectiveness. The treatment involves placing electrodes at specific locations on the scalp to deliver a higher level of electrical current than other brain stimulation therapies, such as transcranial direct current stimulation (tDCS). The electric current passing through the brain causes a brief seizure, and the usual course of ECT involves multiple administrations, typically given two or three times per week until the patient's symptoms subside.
There are different variations of ECT, including unilateral and bilateral ECT. Unilateral ECT involves placing an electrode on one side of the head, usually the right side, to minimize the impact on the brain's learning and memory areas. Bilateral ECT, the older form of the treatment, involves placing electrodes on both sides of the head and is associated with a higher risk of memory problems. Modern ECT devices have been designed to deliver electrical signals using brief or ultra-brief pulses, reducing the dose and the cognitive side effects, such as memory loss.
ECT has been found to be highly effective for the relief of major depression, with clinical evidence showing substantial improvement in approximately 80% of patients with severe major depression. It is also considered one of the least harmful treatments for severely depressed pregnant women in terms of fetal impact. However, the treatment does have some side effects, with confusion and transient memory loss being the most common adverse effects immediately following the procedure.
The use of ECT remains controversial, with varying public opinions, ethical concerns, and disputes within the medical community regarding its efficacy and adverse effects.
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Transcranial magnetic stimulation (TMS)
TMS relies on the principles of electricity and magnetism, and the interaction between a conductive item and a magnetic field. The magnetic field strength is similar to that of an MRI scanner, and the pulse generally reaches no more than 5 centimetres into the brain unless a modified coil and technique for deeper stimulation are used.
TMS can be used both diagnostically and therapeutically, with the effects varying based on the frequency and intensity of the magnetic pulses, as well as the length of treatment. It is approved by the FDA in the US and NICE in the UK for the treatment of depression, obsessive-compulsive disorder, and smoking cessation. It is also used to aid stroke recovery and treat chronic pain.
TMS is considered a safe treatment, with only very rare cases of significant side effects. It is particularly useful when other treatment approaches have been ineffective.
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Deep brain stimulation (DBS)
The history of DBS can be traced back to the 19th century when researchers first explored electrical brain stimulation to study brain localization of function. In the 20th century, the development of chronic electrode implants by neurophysiologists such as Walter Rudolf Hess and José Delgado allowed for the insertion of electrodes deep into the brains of animals, leading to the discovery of brain stimulation reward and the pleasure centre.
Today, DBS is a precise procedure that requires careful patient selection, electrode placement, and adjustment of the pulse generator. Microelectrode recording (MER) is a technique used to identify the optimal surgical site for DBS implantation. The patient needs to be awake during the MER procedure to provide accurate information about neuronal activity in different brain areas. The MER procedure itself is performed under general anaesthesia.
After the DBS leads and neurostimulator are implanted, the patient returns to the doctor for programming of the neurostimulator, which may take several appointments over weeks or months. During this time, medications and dosages are also adjusted to ensure their effectiveness in conjunction with the electrical stimulation. Even after the initial programming, patients need to return periodically for check-ups and adjustments.
While DBS does not fully resolve symptoms, it can reduce a patient's reliance on medications and improve their quality of life. However, it is important to consider the potential side effects, which may include cognitive impairment, memory deficits, speech difficulties, disequilibrium, and motor and sensory disturbances. Additionally, there is a risk of increased mortality, especially in cases of advanced disease or when targeting certain brain regions.
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History of electrical brain stimulation
Electrical brain stimulation (EBS) has been used since ancient times to modulate the nervous system and treat neurological disorders. Scribonius Largo, physician to the Roman emperor Claudius, suggested in his text "Compositiones Medicamentorum" (46 AD) that electric rays be applied to the cranial surface to treat headaches. Electric fish were used for this purpose until the 18th century.
In the 19th century, pioneering researchers such as Luigi Rolando (1773-1831) and Pierre Flourens (1794-1867) first used electrical brain stimulation to study brain localization of function, following the discovery by Luigi Galvani that nerves and muscles were electrically excitable. In 1804, Giovanni Aldini, Galvani's nephew, performed electrical stimulations on the exposed cerebral cortex of recently decapitated prisoners, noting that cortical stimulation evoked facial grimaces. This led him to conclude that electricity could have therapeutic effects in treating neuropsychiatric disorders.
In the mid-19th century, Eduard Hitzig, Gustav Fritsch, David Ferrier, and Friedrich Goltz used electrical stimulation to investigate the motor cortex in animals. In the late 19th century, Horsley stimulated the human cortex for the first time in epilepsy patients. Around the turn of the 20th century, the development of Electreat skin stimulation devices for pain opened the door for neurostimulation in modern medicine.
During the Victorian and Edwardian eras, TES machines that dispensed static, frictional, faradic, or battery electrical currents were widely available, with some claiming they could generate feelings of euphoria and improve mental performance. In the early 20th century, neurosurgeons and neurologists such as Robert Bartholow (1831-1904) and Fedor Krause (1857-1937) stimulated the human cortex electrically. In the mid-20th century, the advent of stereotactic procedures allowed for the development of deep brain stimulation (DBS), which has led to positive results in treating Parkinson's disease, essential tremors, and dystonia, among other conditions.
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Frequently asked questions
Electrical brain stimulation (EBS) is a form of electrotherapy and neurotherapy that uses electric currents to stimulate neurons or neural networks in the brain.
There are several types of electrical brain stimulation, including:
- Electroconvulsive therapy (ECT): A non-invasive procedure that uses electric currents to induce seizures in the brain.
- Transcranial magnetic stimulation (TMS): A non-invasive treatment that uses magnetic fields to stimulate nerve cells in the brain.
- Deep brain stimulation (DBS): A type of stimulation that involves surgically implanting electrodes in specific areas of the brain to generate electrical pulses.
- Transcranial direct current stimulation (tDCS): A form of brain stimulation that uses headgear to position electrodes against the scalp.
Electrical brain stimulation has been found to be beneficial in treating various mental and physical health conditions, including depression, OCD, migraines, anxiety, epilepsy, Parkinson's disease, and more. However, there are also potential risks and side effects associated with these treatments, such as memory problems, itching, irritation, and small burns at the electrode sites.
