Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016

Marom Bikson, Pnina Grossman, Chris Thomas, Adantchede Louis Zannou, Jimmy Jiang, Tatheer Adnan, Antonios P. Mourdoukoutas, Greg Kronberg, Dennis Truong, Paulo Boggio, André R. Brunoni, Leigh Charvet, Felipe Fregni, Brita Fritsch, Bernadette Gillick, Roy H. Hamilton, Benjamin M. Hampstead, Ryan Jankord, Adam Kirton, Helena KnotkovaDavid Liebetanz, Anli Liu, Colleen Loo, Michael A. Nitsche, Janine Reis, Jessica D. Richardson, Alexander Rotenberg, Peter E. Turkeltaub, Adam J. Woods

Research output: Contribution to journalReview articlepeer-review

447 Scopus citations

Abstract

This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose–response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3–13 A/m2) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.

Original languageEnglish (US)
Pages (from-to)641-661
Number of pages21
JournalBrain Stimulation
Volume9
Issue number5
DOIs
StatePublished - Sep 1 2016

Keywords

  • Electrical stimulation
  • Mood disorders
  • Safety
  • Transcranial Direct Current Stimulation
  • tDCS
  • tDCS safety

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