A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation
Transcranial direct current stimulation (tDCS) is a non-invasive method of brain stimulation that has been intensively investigated in clinical and cognitive neuroscience. Although the general impression is that tDCS is a safe technique with mild and transient adverse effects (AEs), human data on sa...
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Veröffentlicht in: | The international journal of neuropsychopharmacology 2011-09, Vol.14 (8), p.1133-1145 |
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description | Transcranial direct current stimulation (tDCS) is a non-invasive method of brain stimulation that has been intensively investigated in clinical and cognitive neuroscience. Although the general impression is that tDCS is a safe technique with mild and transient adverse effects (AEs), human data on safety and tolerability are largely provided from single-session studies in healthy volunteers. In addition the frequency of AEs and its relationship with clinical variables is unknown. With the aim of assessing tDCS safety in different conditions and study designs, we performed a systematic review and meta-analysis of tDCS clinical trials. We assessed Medline and other databases and reference lists from retrieved articles, searching for articles from 1998 (first trial with contemporary tDCS parameters) to August 2010. Animal studies, review articles and studies assessing other neuromodulatory techniques were excluded. According to our eligibility criteria, 209 studies (from 172 articles) were identified. One hundred and seventeen studies (56%) mentioned AEs in the report. Of these studies, 74 (63%) reported at least one AE and only eight studies quantified AEs systematically. In the subsample reporting AEs, the most common were, for active vs. sham tDCS group, itching (39.3% vs. 32.9%, p>0.05), tingling (22.2% vs. 18.3%, p>0.05), headache (14.8% vs. 16.2%, p>0.05), burning sensation (8.7% vs. 10%, p>0.05) and discomfort (10.4% vs. 13.4%, p>0.05). Meta-analytical techniques could be applied in only eight studies for itching, but no definite results could be obtained due to between-study heterogeneity and low number of studies. Our results suggested that some AEs such as itching and tingling were more frequent in the tDCS active group, although this was not statistically significant. Although results suggest that tDCS is associated with mild AEs only, we identified a selective reporting bias for reporting, assessing and publishing AEs of tDCS that hinders further conclusions. Based on our findings, we propose a revised adverse effects questionnaire to be applied in tDCS studies in order to improve systematic reporting of tDCS-related AEs. |
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Although the general impression is that tDCS is a safe technique with mild and transient adverse effects (AEs), human data on safety and tolerability are largely provided from single-session studies in healthy volunteers. In addition the frequency of AEs and its relationship with clinical variables is unknown. With the aim of assessing tDCS safety in different conditions and study designs, we performed a systematic review and meta-analysis of tDCS clinical trials. We assessed Medline and other databases and reference lists from retrieved articles, searching for articles from 1998 (first trial with contemporary tDCS parameters) to August 2010. Animal studies, review articles and studies assessing other neuromodulatory techniques were excluded. According to our eligibility criteria, 209 studies (from 172 articles) were identified. One hundred and seventeen studies (56%) mentioned AEs in the report. Of these studies, 74 (63%) reported at least one AE and only eight studies quantified AEs systematically. In the subsample reporting AEs, the most common were, for active vs. sham tDCS group, itching (39.3% vs. 32.9%, p>0.05), tingling (22.2% vs. 18.3%, p>0.05), headache (14.8% vs. 16.2%, p>0.05), burning sensation (8.7% vs. 10%, p>0.05) and discomfort (10.4% vs. 13.4%, p>0.05). Meta-analytical techniques could be applied in only eight studies for itching, but no definite results could be obtained due to between-study heterogeneity and low number of studies. Our results suggested that some AEs such as itching and tingling were more frequent in the tDCS active group, although this was not statistically significant. Although results suggest that tDCS is associated with mild AEs only, we identified a selective reporting bias for reporting, assessing and publishing AEs of tDCS that hinders further conclusions. Based on our findings, we propose a revised adverse effects questionnaire to be applied in tDCS studies in order to improve systematic reporting of tDCS-related AEs.</description><identifier>ISSN: 1461-1457</identifier><identifier>EISSN: 1469-5111</identifier><identifier>DOI: 10.1017/S1461145710001690</identifier><identifier>PMID: 21320389</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Bias ; Data Collection ; Deep Brain Stimulation - adverse effects ; Deep Brain Stimulation - methods ; Electric Stimulation Therapy - adverse effects ; Electric Stimulation Therapy - methods ; Female ; Humans ; Male ; Medical research ; Methods ; Randomized Controlled Trials as Topic ; Skull ; Studies ; Surveys and Questionnaires ; Systematic review</subject><ispartof>The international journal of neuropsychopharmacology, 2011-09, Vol.14 (8), p.1133-1145</ispartof><rights>CINP 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-d65bc6488ee51bee140759cca66aafb20322d5cd66ea2f9507876686715ff6fe3</citedby><cites>FETCH-LOGICAL-c447t-d65bc6488ee51bee140759cca66aafb20322d5cd66ea2f9507876686715ff6fe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21320389$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brunoni, Andre Russowsky</creatorcontrib><creatorcontrib>Amadera, Joao</creatorcontrib><creatorcontrib>Berbel, Bruna</creatorcontrib><creatorcontrib>Volz, Magdalena Sarah</creatorcontrib><creatorcontrib>Rizzerio, Brenno Gomes</creatorcontrib><creatorcontrib>Fregni, Felipe</creatorcontrib><title>A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation</title><title>The international journal of neuropsychopharmacology</title><addtitle>Int J Neuropsychopharmacol</addtitle><description>Transcranial direct current stimulation (tDCS) is a non-invasive method of brain stimulation that has been intensively investigated in clinical and cognitive neuroscience. Although the general impression is that tDCS is a safe technique with mild and transient adverse effects (AEs), human data on safety and tolerability are largely provided from single-session studies in healthy volunteers. In addition the frequency of AEs and its relationship with clinical variables is unknown. With the aim of assessing tDCS safety in different conditions and study designs, we performed a systematic review and meta-analysis of tDCS clinical trials. We assessed Medline and other databases and reference lists from retrieved articles, searching for articles from 1998 (first trial with contemporary tDCS parameters) to August 2010. Animal studies, review articles and studies assessing other neuromodulatory techniques were excluded. According to our eligibility criteria, 209 studies (from 172 articles) were identified. One hundred and seventeen studies (56%) mentioned AEs in the report. Of these studies, 74 (63%) reported at least one AE and only eight studies quantified AEs systematically. In the subsample reporting AEs, the most common were, for active vs. sham tDCS group, itching (39.3% vs. 32.9%, p>0.05), tingling (22.2% vs. 18.3%, p>0.05), headache (14.8% vs. 16.2%, p>0.05), burning sensation (8.7% vs. 10%, p>0.05) and discomfort (10.4% vs. 13.4%, p>0.05). Meta-analytical techniques could be applied in only eight studies for itching, but no definite results could be obtained due to between-study heterogeneity and low number of studies. Our results suggested that some AEs such as itching and tingling were more frequent in the tDCS active group, although this was not statistically significant. Although results suggest that tDCS is associated with mild AEs only, we identified a selective reporting bias for reporting, assessing and publishing AEs of tDCS that hinders further conclusions. Based on our findings, we propose a revised adverse effects questionnaire to be applied in tDCS studies in order to improve systematic reporting of tDCS-related AEs.</description><subject>Bias</subject><subject>Data Collection</subject><subject>Deep Brain Stimulation - adverse effects</subject><subject>Deep Brain Stimulation - methods</subject><subject>Electric Stimulation Therapy - adverse effects</subject><subject>Electric Stimulation Therapy - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical research</subject><subject>Methods</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Skull</subject><subject>Studies</subject><subject>Surveys and Questionnaires</subject><subject>Systematic review</subject><issn>1461-1457</issn><issn>1469-5111</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kc1u1TAQhS0Eou2FB2CDLDawCXgS_2VZVYUiVWIBrCPHHhdXSXyxnVbl6XHoBSQQbOzRzDdnNHMIeQbsNTBQbz4ClwBcKGCMgezZA3JcU30jAODhjxiarX5ETnK-ZqzlopOPyVELXcs63R-Tb6c03-WCsynB0oQ3AW9pXGq0j6mE5YqaxVGTM-Y841Jo9NS4G0wZKXqPtuStGm0wBR29DeULLcks2dYnmIm6kCpE7ZrS1p5LmNepDovLE_LImynj08O_I5_fnn86u2guP7x7f3Z62VjOVWmcFKOVXGtEASMicKZEb62R0hg_1j3a1gnrpETT-l4wpZWUWioQ3kuP3Y68vNfdp_h1xVyGOWSL02QWjGsetOql0ttBduTVf8l6NS2Y7roNffEHeh3XtNQ9hp5xwVuhdYXgHrIp5pzQD_sUZpPuBmDD5uDwl4O15_lBeB1ndL86flpWge4gauYxBXeFv0f_W_Y77qmnAg</recordid><startdate>201109</startdate><enddate>201109</enddate><creator>Brunoni, Andre Russowsky</creator><creator>Amadera, Joao</creator><creator>Berbel, Bruna</creator><creator>Volz, Magdalena Sarah</creator><creator>Rizzerio, Brenno Gomes</creator><creator>Fregni, Felipe</creator><general>Cambridge University Press</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7TK</scope><scope>7X8</scope></search><sort><creationdate>201109</creationdate><title>A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation</title><author>Brunoni, Andre Russowsky ; 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Although the general impression is that tDCS is a safe technique with mild and transient adverse effects (AEs), human data on safety and tolerability are largely provided from single-session studies in healthy volunteers. In addition the frequency of AEs and its relationship with clinical variables is unknown. With the aim of assessing tDCS safety in different conditions and study designs, we performed a systematic review and meta-analysis of tDCS clinical trials. We assessed Medline and other databases and reference lists from retrieved articles, searching for articles from 1998 (first trial with contemporary tDCS parameters) to August 2010. Animal studies, review articles and studies assessing other neuromodulatory techniques were excluded. According to our eligibility criteria, 209 studies (from 172 articles) were identified. One hundred and seventeen studies (56%) mentioned AEs in the report. Of these studies, 74 (63%) reported at least one AE and only eight studies quantified AEs systematically. In the subsample reporting AEs, the most common were, for active vs. sham tDCS group, itching (39.3% vs. 32.9%, p>0.05), tingling (22.2% vs. 18.3%, p>0.05), headache (14.8% vs. 16.2%, p>0.05), burning sensation (8.7% vs. 10%, p>0.05) and discomfort (10.4% vs. 13.4%, p>0.05). Meta-analytical techniques could be applied in only eight studies for itching, but no definite results could be obtained due to between-study heterogeneity and low number of studies. Our results suggested that some AEs such as itching and tingling were more frequent in the tDCS active group, although this was not statistically significant. Although results suggest that tDCS is associated with mild AEs only, we identified a selective reporting bias for reporting, assessing and publishing AEs of tDCS that hinders further conclusions. Based on our findings, we propose a revised adverse effects questionnaire to be applied in tDCS studies in order to improve systematic reporting of tDCS-related AEs.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>21320389</pmid><doi>10.1017/S1461145710001690</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Bias Data Collection Deep Brain Stimulation - adverse effects Deep Brain Stimulation - methods Electric Stimulation Therapy - adverse effects Electric Stimulation Therapy - methods Female Humans Male Medical research Methods Randomized Controlled Trials as Topic Skull Studies Surveys and Questionnaires Systematic review |
title | A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation |
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