Transcranial brain stimulation: potential and limitations

Abstract

The brain adapts to new requirements in response to activity, learning or reactions to environmental stimuli by continuous reorgani­zation. These reorganization processes can be facilitated and augmented, or also inhibit­ed and prevented, by transcranial neurostim­ulation. The most common methods are electrical or magnetic stimulation. However, few studies have dealt with the newer methods using near infrared or ultrasound stimulation.Transcranial magnetic stimulation (TMS) allows the pain-free transfer of very short bursts of high intensity electrical energy through the skull and can induce action po­tentials. By varying the number and intensity of the stimuli, and the stimulus sequence, repetitive TMS (rTMS) can induce either inhib­itory or facilitatory effects in the brain. A differentiation is made between short-lived interference with ongoing brain activity, and plastic changes that persist for a longer period beyond the end of the stimulation.Weaker electric fields in the 1 mA range can be applied painlessly through the skull. These probably exert their effects by modulating neuronal membranes and influencing the spontaneous firing rate of cortical neu­rons. They encompass the range from tran­scranial direct current stimulation (tDCS) to high frequency alternating current stimulation (tACS) in the kilohertz range. In view of the multitude of physically possible stimulation algorithms, hypothesis-driven protocols based on cellular or neuronal network characteristics are particularly popular, in the effort to narrow the choices in a meaningful manner. Examples are theta burst stimulation or tACS in the so-called “ripple” frequen­cy range. It is, of course, not possible to selectively stimulate individual neurons using transcranial stimulation techniques; however selective after-effects can be achieved when used in combination with neuropharmacologically active drugs. The use of these methods for neuroenhancement is now a topic of intense discussion.