title: Prefronto-cerebellar transcranial direct current stimulation improves sleep quality in euthymic bipolar patients: a brief report.
abstract: BACKGROUND
  Sleep problems are common in bipolar disorder (BD) and may persist during the euthymic phase of the disease. The aim of the study was to improve sleep quality of euthymic BD patients through the administration of prefronto-cerebellar transcranial direct current stimulation (tDCS).
  
  
  METHODS
  25 euthymic outpatients with a diagnosis of BD Type I or II have been enrolled in the study. tDCS montage was as follows: cathode on the right cerebellar cortex and anode over the left dorsolateral prefrontal cortex (DLPFC); the intensity of stimulation was set at 2 mA and delivered for 20 min/die for 3 consecutive weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality at baseline and after the tDCS treatment.
  
  
  RESULTS
  PSQI total score and all PSQI subdomains, with the exception of "sleep medication," significantly improved after treatment.
  
  
  CONCLUSIONS
  This is the first study where a positive effect of tDCS on the quality of sleep in euthymic BD patients has been reported. As both prefrontal cortex and cerebellum may play a role in regulating sleep processes, concomitant cathodal (inhibitory) stimulation of cerebellum and anodal (excitatory) stimulation of DLPFC may have the potential to modulate prefrontal-thalamic-cerebellar circuits leading to improvements of sleep quality.
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Minichino
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Bersani
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Spagnoli
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Corrado
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Michele
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Wanda Katharina
authors.initials: WK
authors.lastname: Calò
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Primavera
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Baoran
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bernabei
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Macrì
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Lucilla
authors.initials: L
authors.lastname: Vergnani
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Biondi
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Delle Chiaie
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications* / Q000628:therapy; D002531:Cerebellum / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D017397:Prefrontal Cortex / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation; D055815:Young Adult