Journal of Sleep Medicine

Korean Sleep Research Society (대한수면연구학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Transcranial Direct-Current Stimulation Therapy on Primary Chronic Insomnia: A Proof-of Concept Clinical Trial

일차성 만성불면증 환자에서 경두개 직류전기자극법 치료 효과: 개념 증명 연구

  • Jun, Jin-Sun (Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital) ;
  • Kim, Tae-Joon (Department of Neurology, National Center for Mental Health) ;
  • Koo, Sun A (Department of Neurology, Seoul National University Hosipital) ;
  • Park, Ji-Sook (Department of Neurology, Seoul National University Hosipital) ;
  • Kim, Keun Tae (Department of Neurology, Keimyung University Dongsan Medical Center) ;
  • Yang, Tae-Won (Department of Neurology, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital) ;
  • Lim, Jung-Ah (Department of Neurology, Hallym University College of Medicine, Gangnam Sacred Heart Hospital) ;
  • Byun, Jung-Ick (Department of Neurology, Kyung Hee University Gangdong Hospital) ;
  • Sunwoo, Jun-Sang (Department of Neurology, Soonchunhyang University Seoul Hospital) ;
  • Jung, Ki-Young (Department of Neurology, Seoul National University Hosipital)
  • 전진선 (경북대학교 의과대학 칠곡경북대학교병원 신경과) ;
  • 김태준 (국립정신건강센터 신경과) ;
  • 구선아 (서울대학교병원 신경과) ;
  • 박지숙 (서울대학교병원 신경과) ;
  • 김근태 (계명대학교 동산의료원 신경과) ;
  • 양태원 (경상대학교 의과대학 창원경상대학교병원 신경과) ;
  • 임정아 (한림대학교 의과대학 강남성심병원 신경과) ;
  • 변정익 (강동경희대학교병원 신경과) ;
  • 선우준상 (순천향대학교서울병원 신경과) ;
  • 정기영 (서울대학교병원 신경과)
  • Received : 2018.01.21
  • Accepted : 2018.07.09
  • Published : 2018.12.31
⟨ Previous Next ⟩

Abstract

Objectives: To assess the effect and safety of transcranial direct-current stimulation (tDCS) in primary chronic insomnia. Methods: A one-month, double-blind, randomized, sham-controlled trial was performed. A total of 7 patients with primary chronic insomnia received tDCS using anodal (n=3), cathodal (n=2), or sham stimulation (n=2). They were followed up at 1 week and 1 month after treatment. The primary outcome measures included improvement in total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) at 1 month follow-up. Results: TST and SE were improved with tDCS at 1 month follow-up in all patients (100%) of the anodal group, one (50%) of the cathodal group, and one (50%) of the sham group. tDCS improved SL at 1 month follow-up in two patients (67%) of the anodal group, one (50%) of the cathodal group, and none (0%) of the sham group. With respect to adverse events, transient itching sensation occurred in one patient of the anodal group. None of the other groups reported adverse events. Conclusions: Our results suggest that tDCS may be effective and safe for treatment of primary chronic insomnia. A larger controlled study needs to be further investigated.

Keywords

Acknowledgement

Supported by : Seoul National University Hospital

References

  1. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4:487-504.
  2. Silber MH. Clinical practice. Chronic insomnia. N Engl J Med 2005;353:803-810. https://doi.org/10.1056/NEJMcp043762
  3. Kwon YN, Sung MJ, Cho HA, et al. Effects of an indigo blanket on insomnia symptoms: double blind, placebo-controlled, randomized pilot study. J Korean Sleep Res Soc 2014;11:33-37. https://doi.org/10.13078/jksrs.14006
  4. Wilt TJ, MacDonald R, Brasure M, et al. Pharmacologic treatment of insomnia disorder: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med 2016;165:103-112. https://doi.org/10.7326/M15-1781
  5. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2017;13:307-349. https://doi.org/10.5664/jcsm.6470
  6. Gray SL, LaCroix AZ, Hanlon JT, et al. Benzodiazepine use and physical disability in community-dwelling older adults. J Am Geriatr Soc 2006;54:224-230. https://doi.org/10.1111/j.1532-5415.2005.00571.x
  7. Cumming RG, Le Couteur DG. Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs 2003;17:825-837. https://doi.org/10.2165/00023210-200317110-00004
  8. Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005;331:1169. https://doi.org/10.1136/bmj.38623.768588.47
  9. Bootzin RR, Perlis ML. Nonpharmacologic treatments of insomnia. J Clin Psychiatry 1992;53 Suppl:37-41.
  10. Brasure M, Fuchs E, MacDonald R, et al. Psychological and behavioral interventions for managing insomnia disorder: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med 2016;165:113-124. https://doi.org/10.7326/M15-1782
  11. Stagg CJ, Nitsche MA. Physiological basis of transcranial direct current stimulation. Neuroscientist 2011;17:37-53. https://doi.org/10.1177/1073858410386614
  12. Boggio PS, Rigonatti SP, Ribeiro RB, et al. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Int J Neuropsychopharmacol 2008;11:249-254. https://doi.org/10.1017/S1461145707007833
  13. Hansen N, Obermann M, Poitz F, et al. Modulation of human trigeminal and extracranial nociceptive processing by transcranial direct current stimulation of the motor cortex. Cephalalgia 2011;31:661-670. https://doi.org/10.1177/0333102410390394
  14. Bola M, Prilloff S, Matzke S, Henrich-Noack P. Brain restoration as an emerging field in neurology and neuroscience. Restor Neurol Neurosci 2013;31:669-679.
  15. Minichino A, Bersani FS, Spagnoli F, et al. Prefronto-cerebellar transcranial direct current stimulation improves sleep quality in euthymic bipolar patients: a brief report. Behav Neurol 2014;2014:876521.
  16. Koo YS, Kim SM, Lee C, et al. Transcranial direct current stimulation on primary sensorimotor area has no effect in patients with drug-naive restless legs syndrome: a proof-of-concept clinical trial. Sleep Med 2015;16:280-287. https://doi.org/10.1016/j.sleep.2014.07.032
  17. Altena E, Van Der Werf YD, Sanz-Arigita EJ, et al. Prefrontal hypoactivation and recovery in insomnia. Sleep 2008;31:1271-1276.
  18. Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ. Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 2004;161:2126-2128. https://doi.org/10.1176/appi.ajp.161.11.2126
  19. Spiegelhalder K, Regen W, Prem M, et al. Reduced anterior internal capsule white matter integrity in primary insomnia. Hum Brain Mapp 2014;35:3431-3438. https://doi.org/10.1002/hbm.22412
  20. Riemann D, Nissen C, Palagini L, Otte A, Perlis ML, Spiegelhalder K. The neurobiology, investigation, and treatment of chronic insomnia. Lancet Neurol 2015;14:547-558. https://doi.org/10.1016/S1474-4422(15)00021-6
  21. Jiang CG, Zhang T, Yue FG, Yi ML, Gao D. Efficacy of repetitive transcranial magnetic stimulation in the treatment of patients with chronic primary insomnia. Cell Biochem Biophys 2013;67:169-173. https://doi.org/10.1007/s12013-013-9529-4
  22. Reidler JS, Zaghi S, Fregni F. Chapter 12-neurophysiological effects of transcranial directcurrent stimulation. In: Coben R, Evans JR. Neurofeedback and neuromodulation techniques and applications. 1st ed. San Diego: Academic Press, 2011;319-349.