title: Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).
abstract: A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
authors.affiliation: Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team (ENT), Faculty of Medicine, Paris Est Créteil University, Créteil, France. Electronic address: jean-pascal.lefaucheur@hmn.aphp.fr.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, Göttingen, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Antal
authors.affiliation: Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team (ENT), Faculty of Medicine, Paris Est Créteil University, Créteil, France.
authors.forename: Samar S
authors.initials: SS
authors.lastname: Ayache
authors.affiliation: Department of Clinical Neurosciences, Section of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: David H
authors.initials: DH
authors.lastname: Benninger
authors.affiliation: PsyR2 Team, U 1028, INSERM and UMR 5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), CH Le Vinatier, Lyon-1 University, Bron, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Brunelin
authors.affiliation: Clinica Neurologica III, Dipartimento di Scienze della Salute, Azienda Ospedaliera Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy; IRCCS Fondazione Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cogiamanian
authors.affiliation: Neuropsychology Unit, IRCCS Fondazione Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Cotelli
authors.affiliation: Brai(2)n, Tinnitus Research Initiative Clinic of Antwerp, Sint Augustinus Hospital, Wilrijk, Belgium; Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ridder
authors.affiliation: Clinica Neurologica III, Dipartimento di Scienze della Salute, Azienda Ospedaliera Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy; IRCCS Fondazione Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ferrucci
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Langguth
authors.affiliation: Dipartimento di Studi Umanistici, University Federico II, Naples, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Marangolo
authors.affiliation: Department of Neurology, Section Pain and Neuromodulation, University of Marburg, Marburg, Germany; Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland.
authors.forename: Veit
authors.initials: V
authors.lastname: Mylius
authors.affiliation: Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nitsche
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Padberg
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Palm
authors.affiliation: PsyR2 Team, U 1028, INSERM and UMR 5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), CH Le Vinatier, Lyon-1 University, Bron, France; Department of Emergency Psychiatry, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Poulet
authors.affiliation: Clinica Neurologica III, Dipartimento di Scienze della Salute, Azienda Ospedaliera Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy; IRCCS Fondazione Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Priori
authors.affiliation: Unit of Neurology and Clinical Neurophysiology, Brain Investigation & Neuromodulation Lab, Department of Neuroscience, and Human Physiology Section, Siena University, Siena, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schecklmann
authors.affiliation: Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Edegem, Belgium; Laboratory for Auditory and Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas, Dallas, TX, USA.
authors.forename: Sven
authors.initials: S
authors.lastname: Vanneste
authors.affiliation: Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Ziemann
authors.affiliation: NeuroPain Team, U 1028, INSERM, Center for Neuroscience Research of Lyon (CRNL), Lyon-1 University, Bron, France.
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia-Larrea
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, Göttingen, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Paulus
mesh_terms: D001921:Brain / Q000503:physiopathology; D005060:Europe / Q000453:epidemiology; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards*; D006801:Humans; D009422:Nervous System Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D065908:Transcranial Direct Current Stimulation / Q000379:methods / Q000592:standards*
keywords: Cortex; Indication; Neurological disease; Neuromodulation; Noninvasive brain stimulation; Psychiatric disease; Treatment; tDCS