The effect of high-definition transcranial direct current stimulation intensity on motor performance in healthy adults: a randomized controlled trial

Ohad Lerner, Jason Friedman, Silvi Frenkel-Toledo, Ohad Lerner, Jason Friedman, Silvi Frenkel-Toledo

Abstract

Background: The results of transcranial direct current stimulation (tDCS) studies that seek to improve motor performance for people with neurological disorders, by targeting the primary motor cortex, have been inconsistent. One possible reason, among others, for this inconsistency, is that very little is known about the optimal protocols for enhancing motor performance in healthy individuals. The best way to optimize stimulation protocols for enhancing tDCS effects on motor performance by means of current intensity modulation has not yet been determined. We aimed to determine the effect of current intensity on motor performance using-for the first time-a montage optimized for maximal focal stimulation via anodal high-definition tDCS (HD-tDCS) on the right primary motor cortex in healthy subjects.

Methods: Sixty participants randomly received 20-min HD-tDCS at 1.5, 2 mA, or sham stimulation. Participants' reaching performance with the left hand on a tablet was tested before, during, and immediately following stimulation, and retested after 24 h.

Results: In the current montage of HD-tDCS, movement time did not differ between groups in each timepoint. However, only after HD-tDCS at 1.5 mA did movement time improve at posttest as compared to pretest. This reduction in movement time from pretest to posttest was significantly greater compared to HD-tDCS 2 mA. Following HD-tDCS at 1.5 mA and sham HD-tDCS, but not 2 mA, movement time improved at retest compared to pretest, and at posttest and retest compared to the movement time during stimulation. In HD-tDCS at 2 mA, the negligible reduction in movement time from the course of stimulation to posttest was significantly lower compared to sham HD-tDCS. Across all groups, reaction time improved in retest compared to pretest and to the reaction time during stimulation, and did not differ between groups in each timepoint.

Conclusions: It appears that 2 mA in this particular experimental setup inhibited the learning effects. These results suggest that excitatory effects induced by anodal stimulation do not hold for every stimulation intensity, information that should be taken into consideration when translating tDCS use from the realm of research into more optimal neurorehabilitation.

Trial registration: Clinical Trials Gov, NCT04577768. Registered 6 October 2019 -Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A9B3&selectaction=Edit&uid=U0005AKF&ts=8&cx=buucf0 .

Keywords: Current intensity; High-definition transcranial direct current stimulation; Motor performance.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
High-definition transcranial direct current stimulation (HD-tDCS) montage for maximal focal stimulation of the right Brodmann area 4 (primary motor cortex) using the HD-Targets modelling software (Soterix Medical, New York, NY). The location and current intensity value of each stimulating electrode are shown. Red denotes anodal stimulation while blue denotes cathodal stimulation
Fig. 2
Fig. 2
Current flow modeling during 2 mA High-definition transcranial direct current stimulation (HD-tDCS) using the HD-Target software (Soterix Medical, New York, NY). Current-flow models are shown on 2D and 3D reconstructions of the cortical surface. Skin, skull, and cerebrospinal fluid (CSF) masks are suppressed to reveal the underlying gray matter mask. The spatial profile of the current flow map is exactly the same as at 1.5 mA current injection but with induced electric field values scaled linearly. This is due to the linearity of the electric field solution [78]. A head model derived from the MNI 152 dataset was used
Fig. 3
Fig. 3
Experimental stimuli. (a) General setup of the motor task. (b) The participants started with the stylus at the starting point (the lower-middle target). After remaining there for 500 ms, (c) the center target turned red and one of the targets turned green, according to the current location in the sequence 4-1-3-2-5. After moving to and remaining at the target for 500 ms, the screen returned to (b), and the participants needed to lift the pen and return it to the starting point. Note that in this figure, for clarity, the targets and numbers are shown 3 times their relative size compared to those shown in the experiment. (d) Day 1 included pretest, test that started after two min of the appropriate stimulation and lasted six min, and posttest. Day 2 consisted of a retention test. Each of the tests (pretest, during stimulation, posttest and retention test) consisted of two blocks of 6 sequences (30 reaching movements within a block), with a 30 s break between blocks
Fig. 4
Fig. 4
Trial flowchart. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. *Tests were conducted in each group
Fig. 5
Fig. 5
Mean movement time (s) of reaching movements in each group at the different time points. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Error bars show standard deviation. Asterisks denote a significant difference (pBonferroni 

Fig. 6

Change in movement time (s)…

Fig. 6

Change in movement time (s) of reaching movements from pretest to posttest and…

Fig. 6
Change in movement time (s) of reaching movements from pretest to posttest and from the course of stimulation to posttest in each group. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Error bars show standard deviation. Asterisks denote a significant difference (pBonferroni 

Fig. 7

Individual movement time (s) in…

Fig. 7

Individual movement time (s) in each group at the different time points. HD-tDCS…

Fig. 7
Individual movement time (s) in each group at the different time points. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Black squares show mean movement time, and error bars show standard deviation

Fig. 8

Mean reaction time (s) of…

Fig. 8

Mean reaction time (s) of reaching movements at the different time points. HD-tDCS…

Fig. 8
Mean reaction time (s) of reaching movements at the different time points. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Error bars show standard deviation. Asterisks denote a significant difference (pBonferroni 
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References
    1. Stagg CJ, Antal A, Nitsche MA. Physiology of transcranial direct current stimulation. J ECT. 2018;34(3):144–152. doi: 10.1097/YCT.0000000000000510. - DOI - PubMed
    1. Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex weak transcranial direct current stimulation. J Physiol. 2000;527(3):633–639. doi: 10.1111/j.1469-7793.2000.t01-1-00633.x. - DOI - PMC - PubMed
    1. Broeder S, Nackaerts E, Heremans E, et al. Transcranial direct current stimulation in Parkinson's disease: neurophysiological mechanisms and behavioral effects. Neurosci Biobehav Rev. 2015;57:105–117. doi: 10.1016/j.neubiorev.2015.08.010. - DOI - PubMed
    1. Kang N, Summers JJ, Cauraugh JH. Transcranial direct current stimulation facilitates motor learning post-stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016;87(4):345–355. doi: 10.1136/jnnp-2015-311242. - DOI - PubMed
    1. Patel R, Ashcroft J, Patel A, et al. The impact of transcranial direct current stimulation on upper-limb motor performance in healthy adults: a systematic review and meta-analysis. Front Neurosci. 2019;13:1213. doi: 10.3389/fnins.2019.01213. - DOI - PMC - PubMed
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Fig. 6
Fig. 6
Change in movement time (s) of reaching movements from pretest to posttest and from the course of stimulation to posttest in each group. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Error bars show standard deviation. Asterisks denote a significant difference (pBonferroni 

Fig. 7

Individual movement time (s) in…

Fig. 7

Individual movement time (s) in each group at the different time points. HD-tDCS…

Fig. 7
Individual movement time (s) in each group at the different time points. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Black squares show mean movement time, and error bars show standard deviation

Fig. 8

Mean reaction time (s) of…

Fig. 8

Mean reaction time (s) of reaching movements at the different time points. HD-tDCS…

Fig. 8
Mean reaction time (s) of reaching movements at the different time points. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Error bars show standard deviation. Asterisks denote a significant difference (pBonferroni 
All figures (8)
Similar articles
Cited by
References
    1. Stagg CJ, Antal A, Nitsche MA. Physiology of transcranial direct current stimulation. J ECT. 2018;34(3):144–152. doi: 10.1097/YCT.0000000000000510. - DOI - PubMed
    1. Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex weak transcranial direct current stimulation. J Physiol. 2000;527(3):633–639. doi: 10.1111/j.1469-7793.2000.t01-1-00633.x. - DOI - PMC - PubMed
    1. Broeder S, Nackaerts E, Heremans E, et al. Transcranial direct current stimulation in Parkinson's disease: neurophysiological mechanisms and behavioral effects. Neurosci Biobehav Rev. 2015;57:105–117. doi: 10.1016/j.neubiorev.2015.08.010. - DOI - PubMed
    1. Kang N, Summers JJ, Cauraugh JH. Transcranial direct current stimulation facilitates motor learning post-stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016;87(4):345–355. doi: 10.1136/jnnp-2015-311242. - DOI - PubMed
    1. Patel R, Ashcroft J, Patel A, et al. The impact of transcranial direct current stimulation on upper-limb motor performance in healthy adults: a systematic review and meta-analysis. Front Neurosci. 2019;13:1213. doi: 10.3389/fnins.2019.01213. - DOI - PMC - PubMed
Show all 78 references
Publication types
Associated data
Related information
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Fig. 7
Fig. 7
Individual movement time (s) in each group at the different time points. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Black squares show mean movement time, and error bars show standard deviation
Fig. 8
Fig. 8
Mean reaction time (s) of reaching movements at the different time points. HD-tDCS 2 mA/1.5 mA = High-definition transcranial direct current stimulation with an intensity of 2 mA/1.5 mA. Error bars show standard deviation. Asterisks denote a significant difference (pBonferroni 
All figures (8)

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