High-definition transcranial direct current stimulation desynchronizes refractory status epilepticus

Darion B Toutant; Hussam El-Alawi; Eun Hyung Choi; Natalie Wright; Manzuma Khanam; Bojan Paunovic; Ji Hyun Ko; Marcus C Ng

doi:10.1016/j.neurot.2024.e00343

High-definition transcranial direct current stimulation desynchronizes refractory status epilepticus

Neurotherapeutics. 2024 Apr 4;21(4):e00343. doi: 10.1016/j.neurot.2024.e00343. Online ahead of print.

Authors

Darion B Toutant¹, Hussam El-Alawi², Eun Hyung Choi³, Natalie Wright³, Manzuma Khanam³, Bojan Paunovic⁴, Ji Hyun Ko⁵, Marcus C Ng⁶

Affiliations

¹ Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, Canada. Electronic address: toutant3@myumanitoba.ca.
² Undergraduate Medical Education, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
³ Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada.
⁴ Undergraduate Medical Education, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
⁵ Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, Canada; Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada.
⁶ Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, Canada; Undergraduate Medical Education, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.

Abstract

Recently, we showed that high-definition transcranial direct current stimulation (hd-tDCS) can acutely reduce epileptic spike rates during and after stimulation in refractory status epilepticus (RSE), with a greater likelihood of patient discharge from the intensive care unit compared to historical controls. We investigate whether electroencephalographic (EEG) desynchronization during hd-tDCS can help account for observed anti-epileptic effects. Defining desynchronization as greater power in higher frequencies such as above 30 Hz ("gamma") and lesser power in frequency bands lower than 30 Hz, we analyzed 27 EEG sessions from 10 RSE patients who had received 20-minute session(s) of 2-milliamperes of transcranial direct current custom-targeted at the epileptic focus as previously determined by a clinical EEGer monitoring the EEG in real-time. During hd-tDCS, median relative power change over the EEG electrode chains in which power changes were maximal was +4.84%, -5.25%, -1.88%, -1.94%, and +4.99% for respective delta, theta, alpha, beta, and gamma frequency bands in the bipolar longitudinal montage (p = 0.0001); and +4.13%, -5.44%, -1.81%, -3.23%, and +5.41% in the referential Laplacian montage (p = 0.0012). After hd-tDCS, median relative power changes reversed over the EEG electrode chains in which power changes were maximal: -2.74%, +4.20%, +1.74%, +1.75%, and -4.68% for the respective delta, theta, alpha, beta, and gamma frequency bands in the bipolar longitudinal montage (p = 0.0001); and +1.59%, +5.07%, +1.74%, +2.40%, and -5.12% in the referential Laplacian montage (p = 0.0004). These findings are consistent with EEG desynchronization through theta-alpha-beta-gamma bands during hd-tDCS, helping account for the efficacy of hd-tDCS as an emerging novel anti-epileptic therapy against RSE.

Keywords: Desynchronization; Electroencephalography (EEG); High-definition transcranial direct current stimulation (hd-tDCS); Neuromodulation; Refractory status epilepticus (RSE); Relative power.