Prospects for the use of tDCS in clinical practice

Prospects for the use of tDCS in clinical practice. 30 years of clinical experience. Pinchuk D.Yu.

1. Definition of TCMP and tDCS (slide 2)

2. Interest in the methodology is growing (slide 3). This is ex-plained by the simplicity of the technique and the ease of use (slide 4), combined with the potentially high potential for appli-cation of the method both in the field of neurophysiology and cognitive sciences (approximately 65% of all studies) and in
clinical practice.

3. Increased interest in the methodology explains the emergence of a huge number of commercial firms that produce equipment for household use of tDCS (slide 5) for "improving cognitive abilities", all this is accompanied by aggressive advertising (slide 6).

4. Real and potential clinical effectiveness has been shown in a number of foreign works (slide 7). In a number of diseases, the effectiveness of tDCS is already shown, while in others it is considered to be potentially high.

5. The real clinical effectiveness is shown in an even greater num-ber of works by authors from the Russian Federation (mainly from St. Petersburg) and the countries of the former USSR. At the same time there is a sharp skew of the number of works performed in the Russian Federation, toward clinical application (slide 8), especially in the work done after 1990. In the Russian Federation, due to a number of organizational features, the method has been used since 1987, in the West and only experimentally since 2000, and therefore in clinical studies of developments in the Russian Federation is more. This is due to the fact that in the Russian Federation and the countries of the post-Soviet space the use of tDCS falls into the section of offi-cially permitted physiotherapeutic treatment, the so-called. "Galvanization of the brain," and does not require in principle a special permit. The situation in the West is different, galvanization there has long disappeared from textbooks. Therefore, anyDC transcranial exposure is considered to be a new method or a "new rediscovery of an old/known" method that is not on the list of approved methods.

6. BUT the galvanization of the brain and TCMP/ tDCS are not the same (slide 9). In Russia, however, the procedure, which is called TCMP, is often not. Unlike galvanization with 2-3 rigid regimens, the clinical efficacy in TCMP depends on a thorough clinical examination, and the results of this examination and taking into account the individual characteristics of the patient select the optimal zones of influence. Therefore, TCMP/ tDCS requires the use of a number of diagnostic procedures for its competent application (slide 10).

7. The real and potential capabilities of tDCS are based on the features of the mechanism of action of tDCS. "There is no more physiological method of influencing the nervous system than constant current". Bechterew. Mechanisms of tDCS action (slide 11,12).

8. Experiments by Paul Nietzsche and Walter Paulus (slide 13, 14). Change in excitability of the motor cortex during tDCS.

9. Clinical effects depend on the used localizations of the electrodes on the scalp (slide 15), changes are observed not only in the cortex, but also in the deep structures of the brain (thalamus, caudal nucleus, cingular gyrus, brain stem and even the possibilities the creation of physiologically significant densities in individual nuclei, for example n.accumbens, etc.) (slide 16). The position of both the anode and cathode is important.

10. The impact occurs both through the distribution of electric fields in the brain tissue (slide 17), both transsynaptic and along conductive paths (slide 18).

11. In tDCS there is not only a simple change in excitability, but also physiologically significant changes in the concentrations of neurotransmitters (slide 19, 20).

12. And also the blood flow (slide 21).

13. The results of tests showing potentially high efficacy of tDCS in psychoneurology are shown on the slides (slide 22-24).14. Possible complications during tDCS (slide 25).

15. And finally again about the need for a very careful attitude to the technique (slide 26).
16. Thank you for your attention (slide 27).