Marom Bikson speaks at the BrainSTIM2015 - Targeting transcranial Electrical Stimulation (tES) using EEG. Includes how to use EEG to inform transcranial Direct Current Stimulation (tDCS) montages. And critical pitfalls in concurrent recording. Stay tuned for our upcoming paper on reciprocity. The complete video can be found here: https://www.youtube.com/watch?v=yYmDQB7qSCE The first publication on the topic can be found here http://neuralengr.com/wp-content/uploads/2016/05/2016-Cancelli-A-simple-method.pdf Related technology can be found here http://soterixmedical.com/research/monitoring/eeg

1. July 11, 2015, BrainSTIM 2015 Conference
Targeting transcranial Electrical Stimulation using
EEG: The scalp space approach
Modeling: Lucas Parra, Asif Rahman, Dennis Truong, Jacek
Dmochowski, Abhi Datta, Mahtab Alam, Alexander David,
Asif Rahman, Maged Elwassif, Salman Shahid, Mohammed
Aboseria, Ole Seibt, Andoni Mourdoukoutas
Marom Bikson, The City College of New York
Electrode Design: Preet Minhas, Johnson Ho, Abhi Datta,
Chris Thomas, Varun Bansal, Jinal Patel, Justin Rice, Niranjan
Khadka, Vaishali Patel
Scalp-Space EEG inversion: Franca Tecchio, Andrea
Cancelli, Carlo Cottone
“The problem with EEG + TES”: Emily Kappenman,
Vladimir Miskovic, Karl Kuntzelman

2. Disclosure:
Soterix Medical Inc. produces tDCS and High-Definition
tDCS. Marom Bikson is founder and has shares in Soterix
Medical. Some of the clinical data presented may be
supported by Soterix Medical Marom Bikson serves on the
scientific advisory board of Boston Scientific Inc.
Support:
NIH (NINDS, NCI, NIBIB), NSF, Epilepsy Foundation, Wallace
Coulter Foundation, DoD (USAF, AFOSR)

3. Transcranial Direct Current Stimulation (tDCS)
• Non-invasive, portable, well-tolerated
neuromodulation.
• Low-intensity (mA) current passed
between scalp electrodes.
• Tested for cognitive neuroscience and
neuropsychiatric treatment.
tDCS Publications
+-

4. Transcranial Direct Current Stimulation (tDCS)
• Non-invasive, portable, well-tolerated
neuromodulation.
• Low-intensity (mA) current passed
between scalp electrodes.
• Tested for cognitive neuroscience and
neuropsychiatric treatment.
tDCS Publications
+-
Depression, Pain, Migraine, Epilepsy, PTSD, Schizophrenia,
Tinnitus, Neglect, Rehabilitation (motor, aphasia), TBI,
OCD, Attention / Vigilance, Accelerated learning (reading,
motor skills, math, threat detection), Memory, Creativity,
Sleep (SW, Lucid dreaming, Threat detection, Impulsivity,
Compassion, Jelousy, Reality Filtering, IQ, Prejudice…

5. Transcranial Direct Current Stimulation (tDCS)
• Non-invasive, portable, well-tolerated
neuromodulation.
• Low-intensity (mA) current passed
between scalp electrodes.
• Tested for cognitive neuroscience and
neuropsychiatric treatment.
tDCS Publications
+-
Depression, Pain, Migraine, Epilepsy, PTSD, Schizophrenia,
Tinnitus, Neglect, Rehabilitation (motor, aphasia), TBI,
OCD, Attention / Vigilance, Accelerated learning (reading,
motor skills, math, threat detection), Memory, Creativity,
Sleep (SW, Lucid dreaming, Threat detection, Impulsivity,
Compassion, Jelousy, Reality Filtering, IQ, Prejudice…
How do we optimize tDCS for a specific indication and individual

6. tDCS electrode position on the head
determines which regions are stimulated
 Current flows from one electrode to the other
Truong et al. Clinician accessible tools for GUI computational
models. “BONSAI” and “SPHERES”. Brain Stimulation 2014
Zero
Max

7. Extra-cephalic electrode won’t solve
the issue of diffuse bi-directional flow
 tDCS is deep
Datta et al. Electrode montage for tDCS: Role of return electrode.
Clinical Neurophysiology 2010

8. Datta et al. Electrode montage for tDCS: Role of return electrode.
Clinical Neurophysiology 2010
Extra-cephalic electrode won’t solve
the issue of diffuse bi-directional flow
 tDCS is deep

9. “4x1” montage of High-Definition tDCS
Zero
Max
 Allows targeting of selected cortical regions
Datta et al. Gyri-precise model of tDCS: Improved spatial focality
using a ring versus conventional pad. Brain Stimulation 2009

10. Center electrode: CATHODE Center electrode: ANODE
Outward current
(inhibitory)
Inward current
(excitatory)
 Total of 5 small “HD” electrodes (4+1)
 Center electrode over target determines polarity 4
return electrodes - Ring radius determines
modulation area
“4x1” montage of High-Definition tDCS

11. “4x1” montage of High-Definition tDCS
 2006-2008 Gyri-precise brain models
 2008 3rd International Brain Stimulation
Conference
 2008-09 Publications on Theory
 2008-10 Safety (Wassermann et al.)
 2012: Experimental Pain (George et al.)
 2012 Fibromyalgia (Fregni et al.)
 2013 Neuro-plasticity (Nitsche et al.)
 2013 Focality Physiology (Edwards et al.)
 2015 Cognitive Performance (Loo et al.)
Datta et al. Gyri-precise model of tDCS: Improved spatial focality
using a ring versus conventional pad. Brain Stimulation 2009

12. It won’t work because:
 The skull is resistive
 Current is diffused in the skin and CSF, not
skull, and can be controlled inside ring
 Prior efforts limited by use of large pads,
not by physics
Minhas et al. Electrodes for High-Definition transcutaneous DC.
J Neuroscience Methods 2010

13. It won’t work because:
 The skull is resistive
 Current is diffused in the skin and CSF, not
skull, and can be controlled inside ring
 Prior efforts limited by use of large pads,
not by physics
 DC can’t be applied through little electrodes
 2008-10 design of High-Definition Electrodes
 3cm2 electrode-electrolyte contact area,
Ag/AgCl electrodes, high-capacity gel (e.g.
Signa), rated 2 mA + 22 minutes
Minhas et al. Electrodes for High-Definition transcutaneous DC.
J Neuroscience Methods 2010

14. High-Definition tDCS uses arrays of
electrodes to focus current to targets
 Without need for “search” there is a single
solution given a target (2009-11)
Dmochowksi et al. Optimized multi-electrodes stimulation increases
focality and intensity at target. J Neural Engr 2011

15. What target?

16. Use EEG to guide HD-tDCS
targeting (~1978)
 Easy – HD easily integrated with any EEG
 Individualized – Sure
 Automatic – But how? Still Easy?
 Real time – Beware

17. Model driven EEG to HD-tDCS. Easy?
1) Get and process high resolution MRI
2) Conduct high-density EEG
3) Localize sources (assumptions)
4) Run full HD-tDCS optimization using all
electrodes

18. Model driven EEG to HD-tDCS. Easy?
1) Get and process high resolution MRI
2) Conduct high-density EEG
3) Localize sources (assumptions)
4) Run full HD-tDCS optimization using all
electrodes
Scalp Space EEG to HD-tDCS. Easy.
1) Conduct EEG
2) Scalp Space Inversion with no scans, no
source assumptions, easy math
3) HD-tDCS with minimal electrodes

19. Single dipole – Basic scalp-space inversion
Scalp
Potential(v)
BrainElectric
Field(v/m)
Local
dipole
Source

20. Single dipole – Basic scalp-space inversion
Scalp
Potential(v)
BrainElectric
Field(v/m)
Local
dipole
Source Voltage
inversion
Voltage to
current

21. Single dipole – Laplacian inversionVoltage
tocurrentLaplacian
Current source density at each electrode,
apply that current (exclude borders)
256 128 64 32 16 8
Number electrodes

22. Single dipole – Two HD electrodes
Scalp
Potential(v)
BrainElectric
Field(v/m)
Local
dipole
Source Ad hoc
position

23. Single dipole – Two HD electrodes
Scalp
Potential(v)
BrainElectric
Field(v/m)
Local
dipole
Source Ad hoc
position
At laplacian
peaks

24. 2 Electrode: Ad-Hoc / Model-Based Placement
Close
Electrodes
Distant
Electrodes
Off-angle
Electrodes
Targeted
(focused current
flow) but low
intensity in brain
Diffuse across
brain but high
intensity
Current flow
orientation along
target key
Dmochowksi et al. Optimized multi-electrodes stimulation increases
focality and intensity at target. J Neural Engr 2011

25. Scalp-Space EEG to HD-tDCS
Method
1) Collect EEG
2) Laplacian at all channels
3) 2 HD electrodes at MAX and MIN
Outcome
1) Direction of current flow at source matched
2) Balance between targeting and intensity
3) Simple

26. Scalp-Space EEG to HD-tDCS
Method
1) Collect EEG
2) Laplacian at all channels
3a) If bipolar: 2 HD electrodes at MAX and MIN
3b) If unipolar: 4x1 HD-tDCS over MAX/MIN
Outcome
1) Direction of current flow at source matched
2) Balance between targeting and intensity
3) Simple

27. The problem with concurrent tDCS and EEG
• No stimulation source is perfect. Noise limits
signal change size detectable. Must be reported.
• Stimulation alters tissue conductivity, most
evident in scalp erythema. Will alter detection of
EEG in a montage + time specific fashion.
• Stimulation effects amplifiers. Volts can drive
non-linear performance (e.g. filtering) in a montage
+ time specific fashion. Active head-stages, DRL…
• Physiologic artifacts. Eye-blink artifact, retinal
sensitivity, EKG…
• Electrode distortion. Electrochemical change in
impedance. When same one used.
Kappenman et al. The problem with concurrent tES and EEG.

28. The problem with concurrent tDCS and EEG
Kappenman et al. The problem with concurrent tES and EEG.
• No stimulation source is perfect. Noise limits
signal change size detectable. Must be reported.
• Stimulation alters tissue conductivity, most
evident in scalp erythema. Will alter detection of
EEG in a montage + time specific fashion.
• Stimulation effects amplifiers. Volts can drive
non-linear performance (e.g. filtering) in a montage
+ time specific fashion. Active head-stages, DRL…
• Physiologic artifacts. Eye-blink artifact, retinal
sensitivity, EKG…
• Electrode distortion. Electrochemical change in
impedance. When same one used.
Not systematically addressing all these issues, in
a trial specific fashion, leads to meaningless data

29. Take home messages
1) tDCS can be focal at cortex using 4x1 (2008).
2) HD electrodes needed for tolerability (2008).
3) Given MRI + target: optimization “solved” (2011).
4) Simple inversion of EEG to HD-tDCS fails.
5) Scalp Space-Inversion provides simple targeting
without need for MRI.
6) Limited EEG and only few
HD electrodes needed:
Bipolar or 4x1 montage.
7) Concurrent EEG + tDCS
problematic.

30. “Functional Sets” of HD electrodes
 Set of HD electrodes that share a total current
 Bain current flow does not depend on the
relative current split of between electrode within
function set
 Skin current density is reduced

31. July 11, 2015, BrainSTIM 2015 Conference
Targeting transcranial Electrical Stimulation using
EEG: The scalp space approach
Modeling: Lucas Parra, Asif Rahman, Dennis Truong, Jacek
Dmochowski, Abhi Datta, Mahtab Alam, Alexander David,
Asif Rahman, Maged Elwassif, Salman Shahid, Mohammed
Aboseria, Ole Seibt, Andoni Mourdoukoutas
Marom Bikson, The City College of New York
Electrode Design: Preet Minhas, Johnson Ho, Abhi Datta,
Chris Thomas, Varun Bansal, Jinal Patel, Justin Rice, Niranjan
Khadka, Vaishali Patel
Scalp-Space EEG inversion: Franca Tecchio, Andrea
Cancelli, Carlo Cottone
“The problem with EEG + TES”: Emily Kappenman,
Vladimir Miskovic, Karl Kuntzelman