tDCS of the Cerebellum: Where Do We Stand in 2016? Technical Issues and Critical Review of the Literature

Kim van Dun, Florian C A A Bodranghien, Peter Mariën, Mario U Manto, Kim van Dun, Florian C A A Bodranghien, Peter Mariën, Mario U Manto

Abstract

Transcranial Direct Current Stimulation (tDCS) is an up-and-coming electrical neurostimulation technique increasingly used both in healthy subjects and in selected groups of patients. Due to the high density of neurons in the cerebellum, its peculiar anatomical organization with the cortex lying superficially below the skull and its diffuse connections with motor and associative areas of the cerebrum, the cerebellum is becoming a major target for neuromodulation of the cerebellocerebral networks. We discuss the recent studies based on cerebellar tDCS with a focus on the numerous technical and open issues which remain to be solved. Our current knowledge of the physiological impacts of tDCS on cerebellar circuitry is criticized. We provide a comparison with transcranial Alternating Current Stimulation (tACS), another promising transcranial electrical neurostimulation technique. Although both tDCS and tACS are becoming established techniques to modulate the cerebellocerebral networks, it is surprising that their impacts on cerebellar disorders remains unclear. A major reason is that the literature lacks large trials with a double-blind, sham-controlled, and cross-over experimental design in cerebellar patients.

Keywords: anodal vs. cathodal; cerebellum; electrode placement; intensity; offline vs. online; sham; tACS; tDCS.

Figures

Figure 1
Figure 1
Examples of set-ups to apply tDCS over the cerebellum. (A) bilateral setup aiming to stimulate simultaneously the two cerebellar hemispheres and the vermis, the flow of the current is indicated with arrows for anodal stimulation of the cerebellum (for cathodal stimulation, the flow of the current is reversed); (B–D) unilateral setups (the target is one cerebellar hemisphere) with the reference electrode over (B) the deltoid muscle, (C) the buccinator muscle, and (D) the forehead/supraorbital area. For simplicity, the wires and stimulator are only shown in (A).
Figure 2
Figure 2
Cerebellar folding influences polarization along the sulci. The principal axis of the Purkinje cells (indicated with blue arrows—the color code has no particular significance in the inset) along a trace of cerebellar gyri is subject to an electric field. The resulting polarization (maximal hyperpolarization or depolarization) is indicated in false color along the trace. Adapted from Rahman et al. (2014). With permission from Elsevier.

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