Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS)

Jean Pascal Lefaucheur, Andrea Antal, Samar S. Ayache, David H. Benninger, Jérôme Brunelin, Filippo Cogiamanian, Maria Cotelli, Dirk De Ridder, Roberta Ferrucci, Berthold Langguth, Paola Marangolo, Veit Mylius, Michael A. Nitsche, Frank Padberg, Ulrich Palm, Emmanuel Poulet, Alberto Priori, Simone Rossi, Martin Schecklmann, Sven VannesteUlf Ziemann, Luis Garcia-Larrea, Walter Paulus

Research output: Contribution to journalReview article

Abstract

A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10–24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.

Original languageEnglish
Pages (from-to)56-92
Number of pages37
JournalClinical Neurophysiology
Volume128
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

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Therapeutic Uses
Guidelines
Electrodes
Prefrontal Cortex
Tinnitus
Transcranial Direct Current Stimulation
Consciousness Disorders
Pain
Professional Education
Neurophysiology
Fibromyalgia
Aphasia
Movement Disorders
Motor Cortex
Neuralgia
Patient Education
Temporal Lobe
Drug Resistance
Multiple Sclerosis
Parkinson Disease

Keywords

  • Cortex
  • Indication
  • Neurological disease
  • Neuromodulation
  • Noninvasive brain stimulation
  • Psychiatric disease
  • tDCS
  • Treatment

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). / Lefaucheur, Jean Pascal; Antal, Andrea; Ayache, Samar S.; Benninger, David H.; Brunelin, Jérôme; Cogiamanian, Filippo; Cotelli, Maria; De Ridder, Dirk; Ferrucci, Roberta; Langguth, Berthold; Marangolo, Paola; Mylius, Veit; Nitsche, Michael A.; Padberg, Frank; Palm, Ulrich; Poulet, Emmanuel; Priori, Alberto; Rossi, Simone; Schecklmann, Martin; Vanneste, Sven; Ziemann, Ulf; Garcia-Larrea, Luis; Paulus, Walter.

In: Clinical Neurophysiology, Vol. 128, No. 1, 01.01.2017, p. 56-92.

Research output: Contribution to journalReview article

Lefaucheur, JP, Antal, A, Ayache, SS, Benninger, DH, Brunelin, J, Cogiamanian, F, Cotelli, M, De Ridder, D, Ferrucci, R, Langguth, B, Marangolo, P, Mylius, V, Nitsche, MA, Padberg, F, Palm, U, Poulet, E, Priori, A, Rossi, S, Schecklmann, M, Vanneste, S, Ziemann, U, Garcia-Larrea, L & Paulus, W 2017, 'Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS)', Clinical Neurophysiology, vol. 128, no. 1, pp. 56-92. https://doi.org/10.1016/j.clinph.2016.10.087
Lefaucheur, Jean Pascal ; Antal, Andrea ; Ayache, Samar S. ; Benninger, David H. ; Brunelin, Jérôme ; Cogiamanian, Filippo ; Cotelli, Maria ; De Ridder, Dirk ; Ferrucci, Roberta ; Langguth, Berthold ; Marangolo, Paola ; Mylius, Veit ; Nitsche, Michael A. ; Padberg, Frank ; Palm, Ulrich ; Poulet, Emmanuel ; Priori, Alberto ; Rossi, Simone ; Schecklmann, Martin ; Vanneste, Sven ; Ziemann, Ulf ; Garcia-Larrea, Luis ; Paulus, Walter. / Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). In: Clinical Neurophysiology. 2017 ; Vol. 128, No. 1. pp. 56-92.
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