WISER Program

Plasticity modulation by a host of brain stimulation techniques that apply weak intensity energies (weak intensity electrical / magnetic / ultrasonic modalities) offer promise in treating psychiatric disorders through enhancement of deficient brain functions as well as amelioration of recalcitrant symptoms facilitating re-integration – these techniques are being implemented in the InSTAR clinics through a program called “Weak Intensity Stimulation for Enhancement and Re-integration” or “WISER” Program.  These weak intensity brain stimulation techniques under the WISER program will include a) Electrical: Transcranial Direct Current Stimulation (tDCS), Transcranial Alternating Current Stimulation (tACS), Transcranial Pulsed Current Stimulation (tPCS),  and Transcranial Random Noise Stimulation (tRNS), Galvanic Vestibular Stimulation (GVS) and transcranial Vagal Nerve Stimulation (tVNS); b) Magnetic: Low Field Magnetic Stimulation (LFMS) and c) Ultrasonic: Transcranial Pulsed Low-intensity, Low Frequency Focused Ultrasonic Stimulation" 

The following is the status of related clinical research studies related to WISER neuromodulatory techniques in the department of psychiatry.  Studies on tDCS/HD-tDCS, tACS are ongoing.  The pilot evaluation for tPCS, tRNS, GVS & tVNS protocols are in process; with regards to ultrasonic neuromodulation, a research project on ultrasonic neuromodulation will be initiated soon.


In tune with the research studies from basic science, clinical benefits of weak stimulation techniques like transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS) are increasingly being reported to be beneficial in treating patients with schizophrenia.  Based on this, a clinical research service called the "WISER Program" is being implemented in the InSTAR Clinic.  

tDCS

​tDCS  is a safe and non-invasive therapeutic procedure for brain stimulation that involves delivery of constant, low strength current. tDCS is an established technique to enhance several cognitive functions. In the recent past, tDCS has been found to be helpful in treating symptoms of schizophrenia that are non-responsive to treatment with antipsychotic medications.  

Under the InSTAR Program, over the past years, through clinical research studies, we have been administering tDCS for schizophrenia patients that have persistent symptoms despite treatment.  We have found tDCS to help in treating auditory hallucinations, negative symptoms as well   as improve insight in these patients.  

Over the past years, as a part of earlier on-going research studies that have been approved by the NIMHANS ethics committee, tDCS has been given to Schizophrenia patients as well as patients with several other psychiatric diagnosis (about 100+ patients have received tDCS over the past years with total number of patient-sessions more than 1000) using a standard equipment as per established guidelines with stringent safety measures. These sessions were well tolerated and there were no significant adverse events (the manuscript on safety data from NIMHANS is under preparation).

Very recently, we have initiated application of transcranial Alternating Current Stimulation (tACS) treatment as well in our clinic.

The following are some of the research publications from our team under the WISER Program.

WISER Program: Research Publications & Conference Presentations

  1. Venkatasubramanian G, Subramaniam A, Rakesh G, Bose A, Nawani H, Shivakumar V, Agarwal SM, Kalmady SV, Narayanaswamy JC. Neural Effects of tDCS on Auditory Verbal Hallucinations in Schizophrenia: Evaluation using high-speed eye tracking, Neurobionics 2013 Conference Proceedings Page No. 34. (Best Poster Award in NEUROBIONICS 2013, Indo-German Workshop on Neurobionics in Clinical Neurology.)
  2. Rakesh G, Shivakumar V, Subramaniam A, Nawani H, Amaresha AC, Narayanaswamy JC, Venkatasubramanian G. Monotherapy with bifocal tDCS for Schizophrenia: A Case Report. Brain Stimulation 2013 Jul;6(4):708-9.
  3. Shivakumar V, Bose A, Rakesh G, Nawani H, Subramaniam A, Agarwal SM, Kalmady SV, Narayanaswamy JC, Venkatasubramanian G. Rapid improvement of auditory verbal hallucinations in schizophrenia after add-on treatment with transcranial direct-current stimulation. J ECT. 2013 Sep;29(3):e43-4.
  4. Nawani H, Kalmady SV, Bose A, Shivakumar V, Rakesh G, Subramaniam A, Narayanaswamy JC, Venkatasubramanian G. Neural Basis of tDCS Effects on Auditory Verbal Hallucinations in Schizophrenia : A Case Report Evidence for Cortical Neuroplasticity Modulation. J ECT. 2014;30(1) e2-4.
  5. Agarwal SM, Shivakumar V, Bose A, Subramaniam A, Nawani H, Chhabra H, Kalmady SV, Narayanaswamy JC, Venkatasubramanian G. Transcranial Direct Current Stimulation in Schizophrenia – A Review. Clinical Psychopharmacology and Neuroscience 2013;11(3):118-125.
  6. Nawani H, Bose, Agarwal SM, Shivakumar V, Chhabra H, Subramaniam A, Kalmady S, Narayanaswamy JC, Venkatasubramanian G. Modulation of Corollary Discharge Dysfunction in Schizophrenia by tDCS: Preliminary Evidence. Brain Stimulation 2014;7(3):486-488.
  7. Bose A, Shivakumar V, Narayanaswamy JC, Nawani H, Subramaniam A, Agarwal SM, Chhabra H, Kalmady SV, Venkatasubramanian G. Insight facilitation with add-on tDCS in Schizophrenia. Schizophrenia Research 2014;156(1):63-65.
  8. Shivakumar V, Narayanaswamy JC, Agarwal SM, Bose A, Subramaniam A, Venkatasubramanian G. Targeted, Intermittent Booster tDCS: A Novel Add-on Application for Maintenance Treatment in a Schizophrenia Patient with Refractory Auditory Verbal Hallucinations. Asian Journal of Psychiatry 2014 Oct;11:79-80.
  9. Narayanaswamy JC, Shivakumar V, Bose A, Agarwal SM, Venkatasubramanian G, Gangadhar BN. Sustained Improvement of Negative Symptoms in Schizophrenia with Add-on tDCS: A Case Report. Clinical Schizophrenia And Related Psychoses 2014 Oct;8(3):135-6
  10. Narayanaswamy JC, Jose D, Chhabra H, Agarwal SM, Shrinivasa B, Hegde A, Bose A, Kalmady SV, Venkatasubramanian G, Reddy YCJ. Successful Application of Add-on Transcranial Direct Current Stimulation (tDCS) for Treatment of SSRI resistant OCD. Brain Stimulation 2015 May-Jun;8(3):655-7     
  11. Shivakumar V, Agarwal SM, Bose A, Kandasamy A, Rao NP, Narayanaswamy JC, Venkatasubramanian G. Safety of transcranial Direct Current Stimulation (tDCS) in Alcohol Induced Psychotic Disorder with Comorbid Psoriasis: A Case Report. Indian Journal of Psychological Medicine 2016 Jan-Feb;38(1):71-3
  12. Fregni F, Nitsche MA, Loo C, Brunoni AR, Marangolo P, Leite J, Carvalho S, Bolognini N, Caumo W, Paik NJ, Simis M, Ueda K, Hamed E, Luu P, Tucker DM, Tyler WJ, Brunelin J, Datta A, Juan CH, Venkatasubramanian G, Boggio PS, Bikson M. Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): Review and recommendations from an expert panel. Clinical Research and Regulatory Affairs 2014 2015 Mar 1;32(1):22-35.
  13. Agarwal SM, Bose A, Shivakumar V, Narayanaswamy JC, Chhabra H, Kalmady SV, Nitsche MA, Venkatasubramanian G. Impact of antipsychotic medication on tDCS effects in schizophrenia patients. International Conference on Schizophrenia (ICONS), Chennai, 21 - 23, August, 2014. [BEST PAPER AWARD IN International Conference on Schizophrenia, Chennai, 2014]
  14. Subramaniam A, Agarwal SM, Kalmady SV, Shivakumar V, Chhabra H, Bose A, Damodharan D, Narayanaswamy JC, Hutton SB, Venkatasubramanian G. Transcranial Direct Current Stimulation (tDCS) Improves Antisaccade Task Performance in Schizophrenia. Indian Journal of Psychological Medicine 2015 Oct-Dec;37(4):419-22.
  15. Bose A, Sowmya S, Shenoy S, Agarwal SM, Chhabra H, Narayanaswamy JC, Venkatasubramanian G. Clinical Utility of Attentional Salience in Treatment of Auditory Verbal Hallucinations in Schizophrenia using Transcranial Direct Current Stimulation (tDCS). Schizophrenia Research 2015 May;164(1-3):279-80
  16. Shivakumar V, Chhabra H, Subbanna M, Agarwal SM, Bose A, Kalmady SV, Narayanaswamy JC, Debnath M, Venkatasubramanian G. Effect of tDCS on Auditory Hallucinations in Schizophrenia: Influence of Catechol-O-Methyltransferase (COMT) Val158Met Polymorphism. Asian Journal of Psychiatry 2015 Aug;16:75-7.
  17. Chhabra H, Shivakumar V, Agarwal SM, Bose A, Venugopal D, Rajasekaran A, Subbanna M, Kalmady SV, Narayanaswamy JC, Debnath M, Venkatasubramanian G. Transcranial Direct Current Stimulation & Neuroplasticity Genes: Implications for Schizophrenia. Acta Neuropsychiatrica 2016 Feb;28(1):1-10.
  18. Agarwal SM, Bose A, Shivakumar V, Narayanaswamy JC, Chhabra H, Kalmady SV, Varambally S, Nitsche MA, Venkatasubramanian G, Gangadhar BN. Impact of antipsychotic medication on transcranial direct current stimulation (tDCS) effects in schizophrenia patients. Psychiatry Res. 2016 Jan 30;235:97-103.
  19. Hazari N, Narayanaswamy JC, Chhabra H, Bose A, Venkatasubramanian G, Janardhan Reddy YC. Response to transcranial direct current stimulation (tDCS) in a case of episodic obsessive compulsive disorder. The Journal of ECT 2016 Mar 23
  20. Agarwal SM, Rajur S, Bose A, Shenoy S, Miriyala S, Shivakumar V, Chhabra H, Narayanaswamy JC, Sivakuamar PT, Venkatasubramanian G. Use of transcranial direct current stimulation (tDCS) in a woman with behavioral variant fronto-temporal dementia. Asian Journal of Psychiatry (in press)
  21. Sreeraj VS, Bose A, Shanbhag V, Narayanaswamy JC, Venkatasubramanian G, Benegal V. Monotherapy With tDCS for Treatment of Depressive Episode During Pregnancy: A Case Report. Brain Stimul. 2016 May-Jun;9(3):457-8.
  22. Sreeraj VS, Shanbhag V, Nawani H, Shivakumar V, Damodaran D, Bose A, Narayanaswamy JC, Venkatasubramanian G. Feasibilty of online neuromodulation using transcranial alternating current stimulation in Schizophrenia: A case report. Indian Journal of Psychological medicine 2016 (in press)