Transcranial direct current stimulation (tDCS) in the management of epilepsy: A systematic review

Pedro Sudbrack-Oliveira; Marina Zanichelli Barbosa; Sigride Thome-Souza; Lais Boralli Razza; Jose Gallucci-Neto; Leandro da Costa Lane Valiengo; Andre Russowsky Brunoni

doi:10.1016/j.seizure.2021.01.020

Transcranial direct current stimulation (tDCS) in the management of epilepsy: A systematic review

Seizure. 2021 Mar:86:85-95. doi: 10.1016/j.seizure.2021.01.020. Epub 2021 Feb 5.

Authors

Pedro Sudbrack-Oliveira¹, Marina Zanichelli Barbosa¹, Sigride Thome-Souza², Lais Boralli Razza¹, Jose Gallucci-Neto³, Leandro da Costa Lane Valiengo⁴, Andre Russowsky Brunoni⁵

Affiliations

¹ Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
² Video-EEG Unit, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
³ Neuropsychiatry Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
⁴ Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Experimental Physiopathology Program, University of São Paulo Medical School, São Paulo, Brazil.
⁵ Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil. Electronic address: brunoni@usp.br.

PMID: 33582584
DOI: 10.1016/j.seizure.2021.01.020

Abstract

Purpose: Current therapies for the management of epilepsy are still suboptimal for several patients due to inefficacy, major adverse events, and unavailability. Transcranial direct current stimulation (tDCS), an emergent non-invasive neuromodulation technique, has been tested in epilepsy samples over the past two decades to reduce either seizure frequency or electroencephalogram (EEG) epileptiform discharges.

Methods: A systematic review was performed in accordance with PRISMA guidelines (PROSPERO record CRD42020160292). A thorough electronic search was completed in MEDLINE, EMBASE, CENTRAL and Scopus databases for trials that applied tDCS interventions to children and adults with epilepsy of any cause, from inception to April 30, 2020.

Results: Twenty-seven studies fulfilled eligibility criteria, including nine sham-controlled and 18 uncontrolled trials or case reports/series. Samples consisted mainly of drug-resistant focal epilepsy patients that received cathodal tDCS stimulation targeted at the site with maximal EEG abnormalities. At follow-up, 84 % (21/25) of the included studies reported a reduction in seizure frequency and in 43 % (6/14) a decline in EEG epileptiform discharge rate was observed. No serious adverse events were reported.

Conclusions: Cathodal tDCS is both a safe and probably effective technique for seizure control in patients with drug-resistant focal epilepsy. However, published trials are heterogeneous regarding samples and methodology. More and larger sham-controlled randomized trials are needed, preferably with mechanistic informed stimulation protocols, to further advance tDCS therapy in the management of epilepsy.

Keywords: Brain polarization; Brain stimulation; Galvanic stimulation; Seizure; Transcranial electric stimulation.

Publication types

Review
Systematic Review

MeSH terms

Electroencephalography
Epilepsy* / therapy
Humans
Seizures
Transcranial Direct Current Stimulation*