Friday, August 5, 2016

Zapping Their Brains at Home

A couple weeks ago, Anna Wexler published an article in the New York Times titled “Zapping Their Brains at Home.”
“Earlier this month, in the journal Annals of Neurology, four neuroscientists published an open letter to practitioners of do-it-yourself brain stimulation. These are people who stimulate their own brains with low levels of electricity, largely for purposes like improved memory or learning ability. The letter, which was signed by 39 other researchers, outlined what is known and unknown about the safety of such noninvasive brain stimulation, and asked users to give careful consideration to the risks.”
I worked on brain stimulation when at the National Institutes of Health, and Russ Hobbie and I analyze neural stimulation in Intermediate Physics for Medicine and Biology. So what is my reaction to these do-it-yourselfers? My first thought was “Yikes…this sounds like trouble!” But the more I think about it, the less worried I am.

We are talking about transcranial direct current stimulation, which uses weak currents applied to the scalp. I have always been surprised that such tiny currents have any effect at all; see my editorial “What Does the Ratio of Injected Current to Electrode Area Not Tell Us About tDCS?” (Clinical Neurophysiology, Volume 120, Pages 1037-1038, 2009). My advice to the do-it-yourselfers is not so much “be careful” but rather “don’t get your hopes up.”

Of the four coauthors on the letter in Annals of Neurology, the only one I know is Alvaro Pascual-Leone, who I worked with while at NIH and who we cite several times in IPMB. Below I list the main points raised in the letter:
  • Stimulation affects more of the brain than a user may think 
  • Stimulation interacts with ongoing brain activity, so what a user does during tDCS changes tDCS effects 
  • Enhancement of some cognitive abilities may come at the cost of others 
  • Changes in brain activity (intended or not) may last longer than a user may think 
  • Small differences in tDCS parameters can have a big effect 
  • tDCS effects are highly variable across different people 
  • The risk/benefit ratio is different for treating diseases versus enhancing function
What do I think of do-it-yourselfers in general? I have mixed feelings. Heaven help us if they start fooling around with heart defibrillators, which could be suicidal. For transcranial magnetic stimulation, I think the biggest risk would be the construction of a device that sends kiloamps of current through a coil. I have always thought that TMS is more dangerous for the physician (who often holds the coil) than for the patient. Moreover, the induced current in the brain is larger for TMS than for tDCS. I would be wary of do-it-yourself magnetic stimulation. But for D.I.Y.ers using relatively low-level electrical current applied to the scalp, if someone educates themself on the technique and follows reasonable safety recommendations, then I don’t see it as a problem.

Wexler ends her letter
“The open letter this month is about safety. But it also a recognition that these D.I.Y. practitioners are here to stay, at least for the time being. While the letter does not condone, neither does it condemn. It sticks to the facts and eschews paternalistic tones in favor of measured ones. The letter is the first instance I’m aware of in which scientists have directly addressed these D.I.Y. users. Though not quite an olive branch, it is a commendable step forward, one that demonstrates an awareness of a community of scientifically involved citizens.”
If you want to read more by Wexler, look here and here.

My final, and admittedly self-serving, advice to the D.I.Y.ers: go buy a copy of Intermediate Physics for Medicine and Biology, so you can learn the scientific principles behind this and other techniques.

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