title: Transcranial Direct Current Stimulation in Epilepsy.
abstract: BACKGROUND
  Transcranial direct current stimulation (tDCS) is an emerging non-invasive neuromodulation therapy in epilepsy with conflicting results in terms of efficacy and safety.
  
  
  OBJECTIVE
  Review the literature about the efficacy and safety of tDCS in epilepsy in humans and animals.
  
  
  METHODS
  We searched studies in PubMed, MedLine, Scopus, Web of Science and Google Scholar (January 1969 to October 2013) using the keywords 'transcranial direct current stimulation' or 'tDCS' or 'brain polarization' or 'galvanic stimulation' and 'epilepsy' in animals and humans. Original articles that reported tDCS safety and efficacy in epileptic animals or humans were included. Four review authors independently selected the studies, extracted data and assessed the methodological quality of the studies using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines and Jadad Scale. A meta-analysis was not possible due to methodological, clinical and statistical heterogeneity of included studies.
  
  
  RESULTS
  We analyzed 9 articles with different methodologies (3 animals/6 humans) with a total of 174 stimulated individuals; 109 animals and 65 humans. In vivo and in vitro animal studies showed that direct current stimulation can successfully induce suppression of epileptiform activity without neurological injury and 4/6 (67%) clinical studies showed an effective decrease in epileptic seizures and 5/6 (83%) reduction of inter-ictal epileptiform activity. All patients tolerated tDCS well.
  
  
  CONCLUSIONS
  tDCS trials have demonstrated preliminary safety and efficacy in animals and patients with epilepsy. Further larger studies are needed to define the best stimulation protocols and long-term follow-up.
authors.affiliation: Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico. Electronic address: pegaso31@yahoo.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: San-Juan
authors.affiliation: Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 300 1st Ave, Charlestown, MA 02129, USA.
authors.forename: León
authors.initials: L
authors.lastname: Morales-Quezada
authors.affiliation: Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico.
authors.forename: Adolfo Josué
authors.initials: AJ
authors.lastname: Orozco Garduño
authors.affiliation: Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico.
authors.forename: Mario
authors.initials: M
authors.lastname: Alonso-Vanegas
authors.affiliation: Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico.
authors.forename: Maricarmen Fernández
authors.initials: MF
authors.lastname: González-Aragón
authors.affiliation: Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico.
authors.forename: Dulce Anabel
authors.initials: DA
authors.lastname: Espinoza López
authors.affiliation: Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico.
authors.forename: Rafael
authors.initials: R
authors.lastname: Vázquez Gregorio
authors.affiliation: Comprehensive Epilepsy Center of Long Island, St. Charles Hospital, 200 Belle Terre Rd., Port Jefferson, NY 11777, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Anschel
authors.affiliation: Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 300 1st Ave, Charlestown, MA 02129, USA.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult
keywords: Brain polarization; Epilepsy; Galvanic stimulation; Transcranial direct current stimulation; tDCS