Fabiana Guarienti1,2, Wolnei Caumo2, Pedro Shiozawa1,3, Quirino Cordeiro3, Paulo S Boggio4, Isabela M Benseñor1, Paulo A Lotufo1, Marom Bikson5, André R Brunoni1. 1. Service of Interdisciplinary Neuromodulation & Interdisciplinary Center for Applied Neuromodulation, Department and Institute of Psychiatry, University Hospital, University of São Paulo, São Paulo, Brazil. 2. Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 3. Laboratory of Clinical Neuromodulation, Santa Casa Medical School, São Paulo, Brazil. 4. Laboratory of Cognitive and Social Neurosciences, Mackenzie Presbyterian University, São Paulo, Brazil. 5. Department of Biomedical Engineering, City College of New York, City University of New York, New York, NY, USA.
Abstract
OBJECTIVES: Transcranial direct current stimulation (tDCS)-induced erythema (skin reddening) has been described as an adverse effect that can harm blinding integrity in sham-controlled designs. To tackle this issue, we investigated whether the use of topical pretreatments could decrease erythema and other adverse effects associated with tDCS. MATERIALS AND METHODS: Thirty healthy volunteers were recruited, and four interventions were applied 30 min prior to tDCS in a Latin square design: placebo, ketoprofen 2%, hydroxyzine 1%, and lidocaine 5%. TDCS was applied for 30 min (2 mA, anode and cathode over F3 and F4, respectively) in two active sessions with a minimum 1-week interval. The Draize erythema scoring system scale was used to assess erythema intensity; a tDCS questionnaire was used to assess other adverse effects (e.g., tingling, itching, burning sensation, and pain). RESULTS: We found that ketoprofen (but not hydroxyzine or lidocaine) significantly attenuated tDCS-induced erythema regarding intensity and duration, with a medium effect compared with placebo. Erythema was overall mild, short-lived (lasting 18-24 min after tDCS ending), and more intense under the anode. Subjects with darker skin color also tended to present less intense tDCS-induced erythema. The prevalence of other adverse effects was low and did not differ between dermatological groups. CONCLUSIONS: Ketoprofen 2% topical pretreatment might be an interesting strategy to reduce tDCS-induced erythema and might be useful for blinding improvement in further sham-controlled tDCS trials.
OBJECTIVES: Transcranial direct current stimulation (tDCS)-induced erythema (skin reddening) has been described as an adverse effect that can harm blinding integrity in sham-controlled designs. To tackle this issue, we investigated whether the use of topical pretreatments could decrease erythema and other adverse effects associated with tDCS. MATERIALS AND METHODS: Thirty healthy volunteers were recruited, and four interventions were applied 30 min prior to tDCS in a Latin square design: placebo, ketoprofen 2%, hydroxyzine 1%, and lidocaine 5%. TDCS was applied for 30 min (2 mA, anode and cathode over F3 and F4, respectively) in two active sessions with a minimum 1-week interval. The Draize erythema scoring system scale was used to assess erythema intensity; a tDCS questionnaire was used to assess other adverse effects (e.g., tingling, itching, burning sensation, and pain). RESULTS: We found that ketoprofen (but not hydroxyzine or lidocaine) significantly attenuated tDCS-induced erythema regarding intensity and duration, with a medium effect compared with placebo. Erythema was overall mild, short-lived (lasting 18-24 min after tDCS ending), and more intense under the anode. Subjects with darker skin color also tended to present less intense tDCS-induced erythema. The prevalence of other adverse effects was low and did not differ between dermatological groups. CONCLUSIONS: Ketoprofen 2% topical pretreatment might be an interesting strategy to reduce tDCS-induced erythema and might be useful for blinding improvement in further sham-controlled tDCS trials.
Authors: A Antal; I Alekseichuk; M Bikson; J Brockmöller; A R Brunoni; R Chen; L G Cohen; G Dowthwaite; J Ellrich; A Flöel; F Fregni; M S George; R Hamilton; J Haueisen; C S Herrmann; F C Hummel; J P Lefaucheur; D Liebetanz; C K Loo; C D McCaig; C Miniussi; P C Miranda; V Moliadze; M A Nitsche; R Nowak; F Padberg; A Pascual-Leone; W Poppendieck; A Priori; S Rossi; P M Rossini; J Rothwell; M A Rueger; G Ruffini; K Schellhorn; H R Siebner; Y Ugawa; A Wexler; U Ziemann; M Hallett; W Paulus Journal: Clin Neurophysiol Date: 2017-06-19 Impact factor: 3.708
Authors: Gabriel Tortella; Roberta Casati; Luana V M Aparicio; Antonio Mantovani; Natasha Senço; Giordano D'Urso; Jerome Brunelin; Fabiana Guarienti; Priscila Mara Lorencini Selingardi; Débora Muszkat; Bernardo de Sampaio Pereira Junior; Leandro Valiengo; Adriano H Moffa; Marcel Simis; Lucas Borrione; André R Brunoni Journal: World J Psychiatry Date: 2015-03-22
Authors: Marom Bikson; Zeinab Esmaeilpour; Devin Adair; Greg Kronberg; William J Tyler; Andrea Antal; Abhishek Datta; Bernhard A Sabel; Michael A Nitsche; Colleen Loo; Dylan Edwards; Hamed Ekhtiari; Helena Knotkova; Adam J Woods; Benjamin M Hampstead; Bashar W Badran; Angel V Peterchev Journal: Brain Stimul Date: 2019-07-17 Impact factor: 8.955
Authors: Bernardo Sampaio-Junior; Gabriel Tortella; Lucas Borrione; Adriano H Moffa; Rodrigo Machado-Vieira; Eric Cretaz; Adriano Fernandes da Silva; Renério Fraguas; Luana V Aparício; Izio Klein; Beny Lafer; Stephan Goerigk; Isabela Martins Benseñor; Paulo Andrade Lotufo; Wagner F Gattaz; André Russowsky Brunoni Journal: JAMA Psychiatry Date: 2018-02-01 Impact factor: 21.596
Authors: Hamed Ekhtiari; Hosna Tavakoli; Giovanni Addolorato; Chris Baeken; Antonello Bonci; Salvatore Campanella; Luis Castelo-Branco; Gaëlle Challet-Bouju; Vincent P Clark; Eric Claus; Pinhas N Dannon; Alessandra Del Felice; Tess den Uyl; Marco Diana; Massimo di Giannantonio; John R Fedota; Paul Fitzgerald; Luigi Gallimberti; Marie Grall-Bronnec; Sarah C Herremans; Martin J Herrmann; Asif Jamil; Eman Khedr; Christos Kouimtsidis; Karolina Kozak; Evgeny Krupitsky; Claus Lamm; William V Lechner; Graziella Madeo; Nastaran Malmir; Giovanni Martinotti; William M McDonald; Chiara Montemitro; Ester M Nakamura-Palacios; Mohammad Nasehi; Xavier Noël; Masoud Nosratabadi; Martin Paulus; Mauro Pettorruso; Basant Pradhan; Samir K Praharaj; Haley Rafferty; Gregory Sahlem; Betty Jo Salmeron; Anne Sauvaget; Renée S Schluter; Carmen Sergiou; Alireza Shahbabaie; Christine Sheffer; Primavera A Spagnolo; Vaughn R Steele; Ti-Fei Yuan; Josanne D M van Dongen; Vincent Van Waes; Ganesan Venkatasubramanian; Antonio Verdejo-García; Ilse Verveer; Justine W Welsh; Michael J Wesley; Katie Witkiewitz; Fatemeh Yavari; Mohammad-Reza Zarrindast; Laurie Zawertailo; Xiaochu Zhang; Yoon-Hee Cha; Tony P George; Flavio Frohlich; Anna E Goudriaan; Shirley Fecteau; Stacey B Daughters; Elliot A Stein; Felipe Fregni; Michael A Nitsche; Abraham Zangen; Marom Bikson; Colleen A Hanlon Journal: Neurosci Biobehav Rev Date: 2019-07-02 Impact factor: 8.989
Authors: F Fregni; M A Nitsche; C K Loo; A R Brunoni; P Marangolo; J Leite; S Carvalho; N Bolognini; W Caumo; N J Paik; M Simis; K Ueda; H Ekhitari; P Luu; D M Tucker; W J Tyler; J Brunelin; A Datta; C H Juan; G Venkatasubramanian; P S Boggio; M Bikson Journal: Clin Res Regul Aff Date: 2015-03-01
Authors: A J Woods; A Antal; M Bikson; P S Boggio; A R Brunoni; P Celnik; L G Cohen; F Fregni; C S Herrmann; E S Kappenman; H Knotkova; D Liebetanz; C Miniussi; P C Miranda; W Paulus; A Priori; D Reato; C Stagg; N Wenderoth; M A Nitsche Journal: Clin Neurophysiol Date: 2015-11-22 Impact factor: 3.708
Authors: Marom Bikson; Pnina Grossman; Chris Thomas; Adantchede Louis Zannou; Jimmy Jiang; Tatheer Adnan; Antonios P Mourdoukoutas; Greg Kronberg; Dennis Truong; Paulo Boggio; André R Brunoni; Leigh Charvet; Felipe Fregni; Brita Fritsch; Bernadette Gillick; Roy H Hamilton; Benjamin M Hampstead; Ryan Jankord; Adam Kirton; Helena Knotkova; David Liebetanz; Anli Liu; Colleen Loo; Michael A Nitsche; Janine Reis; Jessica D Richardson; Alexander Rotenberg; Peter E Turkeltaub; Adam J Woods Journal: Brain Stimul Date: 2016-06-15 Impact factor: 8.955