Pubblicazioni

Guidelines for TMS/tES Clinical Services and Research through the COVID-19 Pandemic

M, Bikson; CA, Hanlon; AJ, Woods; BT, Gillick; L, Charvet; C, Lamm; G, Madeo; A, Holczer; J, Almeida; A, Antal; M, Reza Ay; C, Baeken; DM, Blumberger; S, Campanella; J, Camprodon; L, Christiansen; L, Colleen; J, Crinion; P, Fitzgerald; L, Gallimberti; P, Ghobadi-Azbari; I, Ghodratitoostani; R, Grabner; G, Hartwigsen; A, Hirata; A, Kirton; H, Knotkova; E, Krupitsky; P, Marangolo; EM, NAkamura-Palacios; W, Potok; SK, Praharaj; CC, Ruff; G, Schlaug; HR, Siebner; CJ, Stagg; A, Thielscher; N, Wenderoth; T-F, Yuan; X, Zhang; H, Ekhtiariat

Abstract:

Background The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. Objective To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). Methods The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain relevant expertise spanning NIBS technology, clinical services, and basic and clinical research – with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. Results A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. Conclusion There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.

Patologie/Applicazioni:

• Stimolazione Magnetica Transcranica (TMS)
• Stimolazione elettrica transcranica (TES)
• Linee guida

Anno:

2020

Tipo di pubblicazione:

Articolo

Parola chiave:

Linee guida; NIBS; COVID-19; TMS; stimolazione magnetica transcranica; stimolazione elettrica transcranica; tDCS; tACS; tES

Testata scientifica:

Brain Stimulation

Nota:

Queste linee guida forniscono l'orientamento per eseguire trattamenti di stimolazione cerebrale non invasiva NIBS al tempo della pandemia da COVID-19 in massima sicurezza per i pazienti e gli operatori sanitari. In particolare, si determina un modello basato su tre fasi (impatto iniziale del COVID-19, pratiche attuali e preparazione futura) con una checklist di 11 fasi (che comprende la rimozione o l'ottimizzazione dei protocolli, l'integrazione della telemedicina e la gestione degli eventi avversi associati al COVID-19). Vengono delineate raccomandazioni sull'attuazione del distanziamento sociale e della sterilizzazione delle apparecchiature correlate alla NIBS, considerazioni specifiche sulle popolazioni positive di COVID-19, comprese le comorbidità di salute mentale, nonché considerazioni riguardanti le normative e le risorse umane. Si discutono considerazioni dell'impatto della pandemia specificamente per alcune popolazioni cliniche tra cui soggetti colpiti da ictus, da dipendenze, ma anche bambini e anziani. La strategia solida e strutturata proposta mira ad affrontare le sfide attuali e previste future, mantenendo il rigore scientifico e gestendo i rischi.

DOI:

//doi.org/10.1016/j.brs.2020.05.010