Sham stimulation for tACS typically involves a ‘control frequency’, i.e. a frequency not thought to be involved in mediating the neural processing under study, and therefore is an active sham by our definition. It is

our view that the use of OAS exposes the participant to additional and frequently unnecessary stimulation. While small amounts of TMS or tCS are thought to be safe and tolerable, we discuss in the next section the risks presented by brain stimulation. The choice of SCS or OAS for a given experiment should be guided by two main factors. The safety of the participant should be paramount when using techniques that may have adverse effects. BGJ398 chemical structure After this, the quality and reliability

of the data should be the next consideration. In the following sections we deal with the potential safety issues in using TMS and tCS, and with the risks to data quality that result from SCS or OAS. Brain stimulation exposes the participant to acute and longer-term risks. While the acute effects such as seizure might be the most easily detectible, there are also risks click here of build-up of effects from repeated stimulation (Monte-Silva et al., 2010; Alonzo et al., 2012). At present, the brain’s response to repeated external challenges is not well known. These effects may be particularly difficult to detect or to manage when the spread of stimulation is more difficult to predict, as in tDCS (Miranda et al., 2006). It is thought that adverse

effects are already under-reported in the literature (Brunoni et al., 2011). In Table 2 we suggest a set of exclusion criteria for participants in brain stimulation. This list is not exhaustive, and each study should be reviewed for its potential interaction with the various risk factors. A recent list of drugs that may interact with TMS is given by Rossi et al. (2009), and it would be reasonable to conclude that the same drugs should be excludable in tCS studies. Triggering a pulse of TMS over the scalp induces the electrical field near the coil to change rapidly both spatially and temporally. These changes cause Janus kinase (JAK) action potentials in the neurones, followed by a longer refractory period as the cells recover. While the safety parameters of TMS are reasonably well explored, there remains a risk of seizure in people who may already be predisposed to epilepsy or who are taking certain medications (Tharayil et al., 2005; Bae et al., 2007). Initial studies of tDCS in the 1960s reported some significant respiratory or circulatory side-effects (Lippold & Redfearn, 1964; Redfearn et al., 1964). In modern studies current levels are lower; nevertheless a potential side-effect of tDCS is burning of the skin due to heating (Frank et al., 2010).