Neurostimulation

Head of the department
MUDr. Monika Klírová, Ph.D.
Contact
e-mail:monika.klirova@nudz.cz


Profile

About us

The neurostimulation lab was developed in conjunction with the repetitive transcranial magnetic stimulation laboratory, which began its work in 2002 at the Prague Psychiatric Center (PCP).
Following the transformation of the Prague Psychiatric Center into the National Institute of Mental Health (NÚDZ) in 2015, the current Laboratory of Neurostimulation was established, which gradually expanded its research schedule to other neuromodulation technologies such as transcranial direct current stimulation (tDCS) and theta burst stimulation (TBS). In 2018, the Geodesic Transcranial Electrical Neuromodulation System (GTEN) was acquired in cooperation with
the RP6 research program and co-financed by the 3rd Medical Faculty of Charles University. This technology allows high-definition electrical stimulation with alternating current (HD-tACS), direct current (HD-tDCS) and pulsed electric current stimulation (tPCS). Our workplace is one of the first workplaces to work with this unique technology.

 

 

Laboratory equipment

MagPro R30 Stimulator (Magventure Tonika Elektronic, Denmark)
BrainSight Frameless Navigation System (Rogue Research Inc., Canada)
tDCS Stimulator HDCStim (Newronica, Italy)
NeuroAD (Neuronix, Israel)
Geodesic Transcranial Electrical Neuromodulatory System GTEN 100 (Electrical Geodesics, Inc., USA) 

 

 

About methods

Repetitive Transcranial Magnetic Stimulation (rTMS)

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive treatment method that has been used since the 1990s to treat specific neuropsychiatric disorders which were often resistant to prior therapy. In the field of psychiatry, this method has been used in the treatment of depression (unipolar and bipolar), some anxiety disorders and chronic hallucinations. This type of treatment is well tolerated by patients and does not require any specific preparation. The effect of the method is given by the repeated action of short pulses of a strong magnetic field (2 T) focused on a defined area of the brain. The pulses of the magnetic field affect nerve cell activity in a given cortical area: low-frequency (1 Hz) rTMS weakens cortical activity in the targeted area, while conversely high-frequency rTMS activates the region being focused on. Low-frequency rTMS is used in the treatment of mental disorders associated with increased brain activity (such as auditory hallucinations and tinnitus), in which strong pulses of the low-frequency rTMS reduce increased activity in a defined cortical area. High-frequency rTMS is used for the treatment of mental disorders which are associated with decreased brain activity (such as depression and OCD), where high-frequency rTMS induces an increase in the activity of hypoactive cortical areas. Up to several hundred pulses are applied during one session; repeated sessions are required to achieve the desired effect. Our facility currently has more than fifteen years of experience with rTMS applications in the therapy of mental disorders.
The lab is equipped with the Brainsight Frameless Neural Network, which is experimentally used for the individual targeting of the area of the brain that is being stimulated according to a structural (MRI) or functional (fMRI) patient examination. This method makes it possible to target the cortical area with high precision (in millimeters), increasing the efficiency of the treatment itself.
rTMS is a medical treatment that is covered by health insurance. 

 

 

Transcranial Direct Current Stimulation (tDCS)

Transcranial Direct Current Stimulation (tDCS) is a non-invasive and well-tolerated method which consists of the administration of direct current (1-2mA). A direct current acting between two or more electrodes (anode and cathode) attached to the head results in a change in neuronal activity in the region of the brain that is being stimulated, namely a change in synaptic transmission in a given area. We distinguish two basic types of tDCS: 1) anodal (positive) neuromodulation, which is applied to cortical regions with reduced activity (such as the left prefrontal cortex in depression), and 2) cathodal (negative) neuromodulation, suitable for application in areas with increased cerebral activity (such as the left temporoparietal cortex in auditory hallucinations). The effect of the method is due to long-term synaptic potentiation (anodal neuromodulation) or long-term synaptic depression (cathodal neuromodulation). Long-term synaptic potentiation strengthens the linkage between two neurons, whereas long-term synaptic depression weakens this bond. The existing meta-analyses have confirmed the effect of this method in the treatment of non-resistant depression and craving in alcoholism and nicotine and cocaine dependency. For neurological diagnoses, tDCS appears to be successful in the treatment of fibromyalgia.
This method is currently used for research purposes only; it is not a procedure covered by insurance.

Transcranial Alternating Current Stimulation (tACS)

Transcranial Alternating Current Stimulation (tACS) is a non-invasive neuromodulation method that works on the principle of modulation of endogenous oscillations leading to frequency-specific changes of activity in the targeted area of the brain. As with tDCS, alternating current between two or more electrodes leads to specific changes in neuronal activity in the region of the brain that is being stimulated.The effect of tACS is to directly influence the endogenous oscillations by the frequencies of the stimulation used and the consequent induction of synaptic changes through neuronal plasticity, which is why tACS has a persisting effect on brain oscillation activity. In our workplace we apply tACS using the Geodesic Transcranial Electrical Neuromodulation equipment (GTEN).
Our current tACS projects are focused on research on healthy volunteers in which we examine the effect of theta-frequency high-definition tACS on 1] control inhibition processes in the adult population and 2] working memory in seniors. This method is currently used for research purposes only.

High Definition (HD) Transcranial Electrical Neuromodulation (TEN)

The Geodesic Transcranial Electrical Neuromodulation System (GTEN 100) is a neuromodulatory device with flexibility to choose from as many as 256 hybrid neuromodulatory electrodes for HD-tDCS, HD-tACS and HD-tPCS, which allow a selected region of the brain to be targeted with high precision, while targeting areas of the brain that are difficult to target by standard neuromodulatory methods. GTEN works on the principle of Multielectric Transcranial Electrical Neuromodulation (MTEN), which allows the required current density to the targeted area of the brain to be optimized while being minimized in the rest of the brain. MTEN analyses have shown that by using higher electrode densities, the focusing and directivity of the electrical current are improved, allowing penetration into deeper areas of the brain. Additionally, the device offers MTEN with simultaneous EEG monitoring.
The area of the brain selected for neuromodulation is individually focused on the basis of the coregistration of magnetic resonance imaging (MRI) with the individual GPS position of head-mounted neuromodulatory electrodes and possibly co-registration with high-definition EEG examination, where the region for neuromodulation is registered according to event-related potentials (ERPs) changes.
At present, our GTEN projects are focused on research on healthy volunteers in which we examine the effect of theta-frequency high-definition tACS on 1] control inhibition processes in the adult population and 2] working memory in seniors. GTEN research enables the mutual integration of the results, leading to the clarifying and understanding of the dynamics of complex brain processes in normal and pathological states. This technology is used for research purposes only.

 

 


Stimulation methods


Actual inpatient staff

 


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