Phantom Limb -tDCS Scalp Stimulation Reduced it 40% -Immediate and Sustained

A sustained 40% improvement was obtained from direct current 1.5 milliamp voltage – about what a 9 volt battery hooked up with a 10 k potentiometer resistor could furnish.

J Pain. 2015 Apr 8. pii: S1526-5900(15)00606-9. doi: 10.1016/j.jpain.2015.03.013.[Epub ahead of print]
Immediate and sustained effects of 5-day transcranial direct current stimulation of the motor cortex in phantom limb pain.
Bolognini N(1), Spandri V(2), Ferraro F(3), Salmaggi A(4), Molinari AC(5), Fregni F(6), Maravita A(7).
http://www.ncbi.nlm.nih.gov/pubmed/25863170

Direct Current Transcranial Stimulation (tDCS) is not pulse therapy it is simple direct current running from positive anode in this case, near midline, to controlateral negative cathode on lower forehead above eye.

  • 8 cases –   cross-over, double-blind, sham-controlled design
  • pair  of  surface  saline-soaked  sponge  electrodes.
  • “anodal electrode was placed over C3 or C4 (EEG 10/20 system) in order to stimulate M1 contralateral to the amputation, while the cathode electrode over the contralateral supraorbital area.” C3/4 is at ear level near midline for leg
    c4

 

  • 30 minutes tDCS 1.5 milliamps for 15 min quickly ramped up and down at ends
  • “The electrodes (35 cm X 2) were firmly attached by elastic bands, and an electro-conductive gel”. Using pi R square  gives me a radius of 3.3 cm or diameter of 6.7 cm.
  • 5 days of treatment

Some bits of wisdom:

  • “massive  sensorimotor   cortical   reorganization   occurs   in   the   cerebral   hemisphere   contralateral   to   the  amputation”
  •   “in  order  to  produce  analgesic  effects,  brain  stimulation  should  be  applied  to  the  motor  cortex  contralateral  to  the  side  of  pain 
  • ” in  the  treatment  of  chronic pain, motor cortex stimulation with rTMS may be more effective when the stimulation site  is  adjacent  to  the  cortical  representation  of  the  painful  zone,  rather  than  within  the  painful  zone  itself.”

RESULTS: – intensity of pain dropped from 5.6 to 3.1. Frequency of spasms dropped 40% as well. These benefit persisted….

phantom_tdcs

 

 

 

 

 

 

 

 

 

 

Comment –

well according to homunculus, the leg would be near the midline:

homunculus1

 

 

 

 

 

 

 

 

 

For the contralateral supraorbital cathode, an ECG pad should suffice: – clean area with alcohol first.

ecg_pad

 

 

 

 

I rigged up a welders head gear to hold the saline pad (hint- put soap in electrolyte- conducts much better).

headgear

 

 

 

 

A 9 volt battery connected to a 10 K potentiometer would be all you would need for electronics.  They used to use 2 ma and that was some robust sensation so suspect 1.5 ma is a milder sensation – just turn it up until nicely tolerable.

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