Vincent Walsh TMS > tDCS & Migraine

Towards the end of the video (The Daily Telegraph 2008) Professor Vincent Walsh, (now of University of California Davis) discusses tDCS and its potential for therapeutic use. Especially of interest is the information on migraine headaches:

So, some migraines are caused by having too much activity in the visual brain area, and some are by having too little activity. And we hope that this can balance out, reverse that relative inactivity in the brain.

Could this imply that one person’s migraine could be mitigated with Cathodal (-) tdcs while another’s might benefit from Anodal (+) application of tDCS? And conversely, does it imply that improper stimulation would lead to MORE migraines?

If I suffered from migraines and wanted to test tDCS, here’s where I’d start:
Check the FisherWallace  Find A Doctor search page for an electrotherapist in your area.
If they will treat you for migraine, try a few sessions. If it works, and your doctor will authorize a purchase, you can buy your own unit (for $700). A FisherWallace device may qualify for insurance coverage.

Alternately, I would monitor the ClinicalTrials.gov site and keep an eye out for new studies testing tDCS for migraine. And lastly, I would contact manufacturers of other tDCS devices and ask if they knew of any electrotherapy practitioners in your area working with migraine. Here’s my short list of manufacturers to contact:

  • Soterix Medical: Are on the cutting edge of all things tDCS and in some of their literature I have seen them mention migraine.
  • MagStim: Another medical-level producer, although I’m not sure these devices are approved for use in the U.S. yet.
  • Alpha-Stim: While they don’t advertize the use of their device for migraine, they do offer many testimonials from people who state they found it beneficial. I have not seen this company associated with any scientific studies or papers.

CES (Cranial electrotherapy stimulation) Devices Currently (Ha!) Available

Turns out there are numerous ‘FDA Cleared’ CES (cranial electrotherapy stimulation AC) devices available for sale in the U.S. when recommended and prescribed by your doctor. Typically these devices are recommended for pain but also for depression. They also seem to be recommended for use in drug treatment. Cost of the device is sometimes covered by insurance.

[Video was removed from Youtube] That clip shows both the Fisher Wallace Stimulator and the Alpha-Stim devices.

More from Fisher Wallace. [Video was removed from Youtube]

Also for doctors: How to prescribe the device.

http://www.youtube.com/watch?feature=player_embedded&v=dOZ3Ktg04vY

A couple of other available devices: CES Ultra and European manufacturer Onko Cet offers the Transair series of transcranial electrostimulation (TES) devices.

 

tDCS and CES – A Little History

Is a way to think about the effects of tDCS then, that it increases neuronal ‘excitability’?
Interesting too, the possibility that AC stimulation might actually be affecting neurotransmitter production.

From: Noninvasive Brain Stimulation with Low-Intensity Electrical Currents: Putative Mechanisms of Action for Direct and Alternating Current Stimulation [PDF}

As early as 1794, Aldini had assessed the effect of galvanic head current on himself, and by 1804, he had reported the successful treatment of patients suffering from melancholia. Research continued through the early 20th century; yet because DC induced variable results, or sometime none at all, the use of low-intensity DC (i.e., tDCS) was progressively abandoned…

…between 1938 and 1945, subsequently led to an interest in the application of AC at lower intensities with the first study of “cranial electro-therapy stimulation” (also known as “electrosleep”) published by Anan’ev and others in 1957… Since the 1960s, a series of studies with low-intensity AC stimulation have been published, and cranial AC stimulation devices have become commercially available for personal use (e.g., Alpha-Stim, Fisher Wallace Cranial Stimulator, Transair Stimulator, etc.). However, research in this area has been inconsistent and there remains a lack of solid evidence showing the effects of weak transcranial stimulation with AC.

…During tDCS, low-amplitude direct currents penetrate the skull to enter the brain. Although there is substantial shunting of current at the scalp, sufficient current penetrates the brain to modify the transmembrane neuronal potential and, thus, influences the level of excitability and modulates the firing rate of individual neurons. DC currents do not induce action potentials; rather, the current appears to modulate the spontaneous neuronal activity in a polarity-dependent fashion: For example, anodal tDCS applied over the motor cortex increases the excitability of the underlying motor cortex, whereas cathodal tDCS applied over the same area decreases it. Similarly, anodal tDCS applied over the occipital cortex produces short-lasting increases in visual cortex excitability. Hence, tDCS is believed to deliver its effects by polarizing brain tissue, and although anodal stimulation generally increases excitability and cathodal stimulation generally reduces excitability, the direction of polarization depends strictly on the orientation of axons and dendrites in the indu- ced electrical field.

CES is a nonstandardized and often indistinct method of delivering cranial AC stimulation; indeed many studies cite the method of stimulation simply as “cranial electrotherapy stimulation” without identifying the specific site or other parameters of stimulation (e.g., duration, current density, intensity, electrode size) calling into question existing reviews of this method. Even so, CES has been suggested to be effective in the treatment of anxiety, depression, stress, and insomnia, and the following parameters of stimulation have been reported: frequency (0.5 Hz to 167 kHz), intensity (100 μA to 4 mA), and duration of stimulation (5 min to 6 consecutive days).

… Biochemical changes—neurotransmitter and endorphin release. Several studies suggest that AC stimulation may be associated with changes in neurotransmitters and endorphin release. In this context, subthreshold stimulation induced by AC stimulation would indeed cause significant changes in the nervous system electrical activity.

For further reading on CES (AC stimulation) the wikipedia page is quite good!