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 dirrect curent stimulation (tDCS), theta burst stimulation (TBS). In 2018, the Geodesic Transcranial Electrical Neuromodulation System (GTEN) was acquired in cooperation with the RP6 research program and co-financing 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 wokplaces which 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 a specific neuropsychiatric disorders, 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 the 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 brain area. Pulses of magnetic field affect nerve cell activity in a given cortical area: low-frequency (1 Hz) rTMS weakens cortical activity in targeted area, conversely high frequency rTMS activate focused region. Low-frequency rTMS is used in the treatment mental disorders associated with increased brain activity (such as auditory hallucinations and tinnitus), where strong pulses of the low frequency rTMS lead to decrease increased activity in defined cortical area. High frequency rTMS is used for the treatment of mental disorder, which are associated with decreased brain activity (such as depression and OCD), where high frequency rTMS lead to increase the 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 equiped by the Brainsight Frameless Neural Network, which is experimentally used for the individual targeting of the stimulated brain area according to 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 in the administration of direct current (1-2mA). A direct current acting between two and more electrodes (anode and cathode) attached to the head results in a change of neuronal activity in the stimulated brain region, namely a change of synaptic transmission at a given area. We distinguish two basic types of tDCS: 1) anodal (positive) neuromodulation that is applied to cortical regions with reduced activity (such as left prefrontal cortex in depression), 2) cathodal (negative) neuromodulation, suitable for application in areas where increased cerebral activity (such as 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-analyzes have confirmed the effect of this method in the treatment of non-resistant depression, craving in alcoholism, nicotine and cocaine. 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 an insurance-covered procedure.

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 targeted brain area. As with tDCS, alternating current between two and more electrodes leads to specific changes of neuronal activity in the stimulated brain region.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. At our workplace we apply tACS using the Geodesic Transcranial Electrical Neuromodulation equipment (GTEN).
Our current tACS projects are focused on the research of healthy volunteers where 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)

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 to target selected brain region with high precision, while targeting brain areas that are difficult to target by standard neuromodulatory methods. GTEN works on the principle of Multielectric Transcranial Electrical Neuromodulation (MTEN), which allows to optimize the required current density to the targeted brain area and minimize it in the rest of the brain. MTEN analyzes have shown that by using higher electrode densities, the focusing and directivity of electrical current are improved, allowing the penetration into deeper brain areas. Additionally, the device offers MTEN with simultaneous EEG monitoring.
Selected brain area for neuromodulation is individually focused on the basis of coregistration of the 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 the evoked potentials changes.
At present, our GTEN projects are focused on research of healthy volunteers, where 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 enable 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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