scholarly journals Remotely Monitored Home-Based Neuromodulation With Transcranial Alternating Current Stimulation (tACS) for Mal de Débarquement Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Yoon-Hee Cha ◽  
Jeff Riley ◽  
Diamond Gleghorn ◽  
Benjamin Doudican
Keyword(s):  
Treatment Option ◽  
Treatment Options ◽  
Alternating Current ◽  
Open Label ◽  
Double Blind ◽  
Entire Study ◽  
Safe Treatment ◽  
Mal De Debarquement Syndrome ◽  
Transcranial Alternating Current Stimulation ◽  
Safe Treatment Option

Objective: To determine whether remotely-monitored transcranial alternating current stimulation (tACS) may be a viable and safe treatment option for Mal de Débarquement Syndrome (MdDS).Background: Mal de Débarquement Syndrome is a neurotological disorder characterized by persistent oscillating vertigo that is triggered by entrainment to passive oscillatory motion such as occurs during water-based travel. Treatment options for MdDS are limited, variably effective, and can be undone by further travel.Design and Methods: This was a remotely-monitored open-label optional extension phase of a double-blind randomized onsite study of tACS for medically refractory MdDS. The primary goal was to determine safety, feasibility, and blinded participant feedback. The secondary goal was to determine efficacy. Thirteen participants (all women), aged 22–67 years, experiencing a duration of illness of 11–72 months, were a subset of 24 individuals who participated in an on-site study of tACS. They had either not responded to the on-site protocol or had relapsed after travel home. Treatment accessories and a tablet controlled tACS stimulator (Pulvinar XCSITE-100) were mailed to participants. Three teaching sessions were performed via webcam followed by on-going remote monitoring of treatment logs and participants' reports through a daily on-line diary and weekly questionnaires. Treatment continued until an effective protocol was administered for 4 weeks and then tapered over 4 weeks. Participants completed a blinded feedback survey and a debriefing interview at the completion of the entire study.Results: Treatment duration ranged from 4 to 31 weeks followed by a 4-week taper accounting for 578 verified sessions. Of the 13 total participants, seven agreed or agreed strongly in the blinded survey that tACS treatment was beneficial; 2) Twelve were comfortable utilizing tACS on their own; 3) Eleven preferred stimulation above their individual alpha frequency; 4) Side effects were generally mild and typical of tACS. In the debriefing interview completed 2–9 months after the last stimulation, five participants reported doing “great,” with no to minimal symptoms, four reported doing “good,” with moderate symptoms, and four reported no change compared to pre-study baseline.Conclusion: Remotely-monitored tACS may be a safe treatment option for MdDS with the potential for lasting outcomes, increased accessibility, and reduction in travel-related treatment reversal.

Zonisamide as treatment option in persistent migraine aura

2021 ◽  
Vol 14 (4) ◽  
pp. e240783
Author(s):  
Katharina Kaltseis ◽  
Florian Frank ◽  
Gregor Broessner
Keyword(s):  
Side Effects ◽  
Female Patient ◽  
Treatment Option ◽  
Treatment Options ◽  
Migraine Aura ◽  
Safe Treatment ◽  
Ongoing Treatment ◽  
Triple X Syndrome ◽  
Persistent Aura ◽  
Safe Treatment Option

Persistent migraine aura without infarction is a rare but debilitating condition. Treatment options are mostly anecdotal and limited due to inefficacy and side effects. We present a 16-year-old female patient with triple X syndrome, having persistent aura symptoms for over 2 years, consisting of continuous visual and sensory sensations. Previous treatments with seven different migraine preventatives were not successful. The patient successfully responded to zonisamide against refractory prolonged aura and remained symptom-free under the ongoing treatment without any relevant side effects. Zonisamide may be considered a new and safe treatment option for patients with persistent migraine aura.

scholarly journals Conducting double-blind placebo-controlled clinical trials of transcranial alternating current stimulation (tACS)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Flavio Frohlich ◽  
Justin Riddle
Keyword(s):  
Rational Design ◽  
Target Identification ◽  
Alternating Current ◽  
Sine Wave ◽  
Brain Network ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Cortical Oscillations ◽  
Transcranial Alternating Current Stimulation ◽  
Therapeutic Platform

AbstractMany psychiatric and neurological illnesses can be conceptualized as oscillopathies defined as pathological changes in brain network oscillations. We previously proposed the application of rational design for the development of non-invasive brain stimulation for the modulation and restoration of cortical oscillations as a network therapeutic. Here, we show how transcranial alternating current stimulation (tACS), which applies a weak sine-wave electric current to the scalp, may serve as a therapeutic platform for the treatment of CNS illnesses. Recently, an initial series of double-blind, placebo-controlled treatment trials of tACS have been published. Here, we first map out the conceptual underpinnings of such trials with focus on target identification, engagement, and validation. Then, we discuss practical aspects that need to be considered for successful trial execution, with particular regards to ensuring successful study blind. Finally, we briefly review the few published double-blind tACS trials and conclude with a proposed roadmap to move the field forward with the goal of moving from pilot trials to convincing efficacy studies of tACS.

scholarly journals A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy

Blood ◽  
2017 ◽  
Vol 130 (9) ◽  
pp. 1097-1103 ◽  
Author(s):  
Zhangyuan Kong ◽  
Ping Qin ◽  
Shan Xiao ◽  
Hai Zhou ◽  
Hong Li ◽  
...  
Keyword(s):  
Treatment Option ◽  
Immune Thrombocytopenia ◽  
Safe Treatment ◽  
Key Points ◽  
Safe Treatment Option ◽  
Recombinant Human Thrombopoietin ◽  
In Pregnancy

Key Points rhTPO is a potentially effective and safe treatment option for ITP during pregnancy.

scholarly journals Theta-gamma cross-frequency transcranial alternating current stimulation over the trough impairs cognitive control

2020 ◽  
Author(s):  
Zsolt Turi ◽  
Matthias Mittner ◽  
Albert Lehr ◽  
Hannah Bürger ◽  
Andrea Antal ◽  
...  
Keyword(s):  
Cognitive Control ◽  
Repeated Measures ◽  
Instrumental Learning ◽  
Learning Task ◽  
Alternating Current ◽  
Double Blind ◽  
Bayesian Hierarchical ◽  
Theta Wave ◽  
Gamma Frequency ◽  
Transcranial Alternating Current Stimulation

Cognitive control is a hypothetical mental process, which underlies adaptive goal-directed decisions. Previous studies have linked cognitive control to electrophysiological fluctuations in the theta band and theta-gamma cross-frequency coupling (CFC) arising from the cingulate and frontal cortices. Yet, to date the behavioral consequences of different forms of theta-gamma CFC remain elusive. Here, we studied the behavioral effects of the theta-gamma CFC via transcranial alternating current stimulation (tACS) designed to stimulate the frontal and cingulate cortices. Using a double-blind, randomized, repeated measures study design, 24 healthy participants were subjected to three main, active CFC-tACS protocols: Short gamma frequency bursts (80 Hz) were coupled to an ongoing theta cycle (4 Hz) to coincide with either the peaks or the troughs of the theta wave. In a third condition, the amplitude of the gamma oscillation was modulated by the phase of a theta cycle. In the fourth, control protocol, gamma was continuously superimposed over the theta cycle, therefore lacking any phase-specificity in the CFC. During the 20-minute stimulations, the participants performed a Go/NoGo monetary reward- and punishment-based instrumental learning task. A Bayesian hierarchical logistic regression analysis revealed that CFC-tACS over peak had no effects on the behavioral performance, whereas CFC-tACS over trough and, to a lesser extent, amplitude-modulated tACS reduced performance in conflicting trials. Our results suggest that cognitive control depends on the phase-specificity of the theta-gamma CFC.

The Effect of Oral Niacinamide on Plasma Phosphorus Levels in Peritoneal Dialysis Patients

2009 ◽  
Vol 29 (5) ◽  
pp. 562-567 ◽  
Author(s):  
Daniel O. Young ◽  
Steven C. Cheng ◽  
James A. Delmez ◽  
Daniel W. Coyne
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Effects ◽  
Controlled Trial ◽  
Treatment Options ◽  
Study Drug ◽  
Phosphate Binders ◽  
Open Label ◽  
Double Blind ◽  
Phosphorus Levels ◽  
Plasma Phosphorus

Background Hyperphosphatemia remains a significant problem for patients requiring dialysis and is associated with increased mortality. Current treatment options include dietary restriction, dialysis, and phosphate binders. Treatment using the latter is frequently limited by cost, tolerability, and calcium loading. One open-label trial found niacinamide to be effective at decreasing serum phosphorus values in hemodialysis patients. Niacinamide may effectively reduce phosphorus levels in peritoneal dialysis (PD) patients already receiving standard phosphorus-lowering therapies. Methods An 8 week, randomized, double blind, placebo-controlled trial to evaluate the effectiveness of niacinamide to reduce plasma phosphorus levels in PD patients. Patients had to demonstrate a baseline phosphorus value > 4.9 mg/dL. Patients were randomized to niacinamide or placebo and prescribed 250 mg twice daily, with titration to 750 mg twice daily, as long as safety parameters were not violated. Phosphate binders, active vitamin D, and cinacalcet were kept constant during the study. The primary end point was change in plasma phosphorus. Secondary end points included changes in lipid parameters. Results 15 patients started on the study drug (8 niacinamide, 7 placebo) and 7 in each arm had at least one on-study phosphorus measurement. The niacinamide treatment group experienced an average 0.7 ± 0.9 mg/dL decrease in plasma phosphorus and the placebo-treated group experienced an average 0.4 ± 0.8 mg/dL increase. The treatment effect difference (1.1 mg/dL) was significant ( p = 0.037). No significant changes in high- or low-density lipoproteins or triglycerides were demonstrated. Two of the 8 patients randomized to the niacinamide treatment arm had to withdraw from the study due to drug-related adverse effects. Adverse effects may limit the use of niacinamide in PD patients. Conclusion Niacinamide, when added to standard phosphorus-lowering therapies, resulted in a modest yet statistically significant reduction in plasma phosphorus levels at 8 weeks. [ClinicalTrials.gov number NCT00508885 (ClinicalTrials.gov)]

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