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Updated: Jan 13, 2026
Electrode Positioning and Montage in Transcranial Direct Current Stimulation
Published on: May 23, 2011
Modulating cortical excitability through transcranial direct current stimulation combined with therapeutic exercise
Ramesh Chandra Patra1, Deepti Agrawal Garg1, A Yashudas1
1Lovely Professional University, Phagwara, Punjab, India.
Background:
Temporomandibular dysfunction (TMD) involves pain, motor impairment and psychological distress, often sustained by maladaptive central neuroplasticity. Transcranial direct current stimulation (tDCS) can modulate cortical excitability, enhance descending inhibitory control, and improve function, making it a promising adjunct to multimodal rehabilitation.
Objective:
To examine the effects of tDCS combined with multimodal rehabilitation on pain, motor performance and psychosocial outcomes in TMD and to explore associated neurophysiological mechanism.
Methods:
In this randomized, assessor-blinded trial, participants received either active tDCS plus rehabilitation or Sham tDCS plus rehabilitation. Assessments occurred at baseline, post-intervention (8 weeks) and at 3 and 6-month follow-up. Primary outcomes were EEG Alpha Modulation Index (AMI), Pressure pain threshold (PPT) and Jaw functional limitation scale (JFLS); secondary outcomes included neck disability index (NDI), patient global impression of change (PGIC) data were analyzed via repeated-measures ANOVA with intention-to-treat principles.
Results:
Active tDCS with rehabilitation produced greater improvements than sham in all outcomes (p < 0.001). EEG Alpha Modulation Index increased (η 2 = 0.24), indicating enhanced cortical excitability. PPT improved (η 2 = 0.22) showed significant and sustained functional gains. PGIC scores indicated large perceived improvement (r = 0.72), maintained at 6 months. No serious adverse events were reported. Minor events (headaches, tingling, skin irritation) occurred in <10 % of sessions and were transient.
Conclusion:
tDCS combined with therapeutic exercise safely enhances cortical excitability, pain modulation, function and patient outcomes in TMD, supporting Multimodal rehabilitation. Further research should refine protocals and confirm long-term benefits across populations.
