***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Prefrontal repetitive transcranial magnetic stimulation ( rTMS ) has been used to induce side-specific mood changes in volunteers and patients . To clarify inconsistencies between reports that used different stimulation frequencies , we conducted a controlled study with a low ( 1 Hz ) frequency , comparing left with right-sided stimulation Methods Nineteen healthy volunteers received r and omised left or right prefrontal rTMS at a frequency of 1 Hz and 100 % of motor threshold in two sessions two weeks apart . Results There were significant improvements with TMS for performance in the digit symbol substitution and verbal fluency tests , but no change of mood on a number of measures . There was also a reduction of pulse rate after TMS . The only side-specific TMS-effect was on mean arterial pressure , which decreased pressure after left , but not after right prefrontal TMS . Conclusions Apart from the unexpected and so far unreplicated effect on mean arterial pressure , there were no side-specific effects on mood in volunteers . It is unlikely that a simple laterality model of mood together with the assumed activating effect of higher and ' quenching ' effect of lower stimulation frequency can account for the effects of TMS on mood Background Behavioral and psychological symptoms of dementia ( BPSD ) occur in 70 - 90 % of patients at different stages of Alzheimer ’s Disease ( AD ) , but the available methods for managing these problems are of limited effectiveness . Aim Assess the effects of high-frequency repetitive transcranial magnetic stimulation ( rTMS ) , applied over the left dorsolateral prefrontal cortex ( DLPFC ) , on BPSD and cognitive function in persons with AD . Methods Fifty-four patients with AD and accompanying BPSD were r and omly divided into an intervention group ( n=27 ) and a control group ( n=27 ) . In addition to st and ard antipsychotic treatment , the intervention group was treated with 20Hz rTMS five days a week for four weeks , while the control group was treated with sham rTMS.The  Behavioral Pathology in Alzheimer 's Disease Rating Scale ( BEHAVE-AD ) , the Alzheimer 's Disease Assessment Scale-Cognitive ( ADAS-Cog ) , and the Treatment Emergent Symptom Scale ( TESS ) were administered by raters who were blind to the group assignment of patients before and after four weeks of treatment . Results Twenty-six subjects from each group completed the study . After four weeks of antipsychotic treatment with adjunctive real or sham rTMS treatment , the mean ( sd ) total BEHAVE-AD scores and mean total ADAS-Cog scores of both groups significantly decreased from baseline . After adjusting for baseline values , the intervention group had significantly lower scores ( i.e. , greater improvement ) than the control group on the BEHAVE-AD total score , on five of the seven BEHAVE-AD factor scores ( activity disturbances , diurnal rhythm , aggressiveness , affective disturbances , anxieties and phobias ) , on the ADAS-Cog total score , and on all four ADAS-Cog factor scores ( memory , language , constructional praxis , and attention ) . The proportion of individuals whose behavioral symptoms met a predetermined level of improvement ( i.e. , a drop in BEHAVE-AD total score of > 30 % from baseline ) in the intervention group was greater than that in the control group ( 73.1 % vs.42.3 % , X2=5.04 , p=0.025 ) . Conclusion Compared to treatment of AD with low-dose antipsychotic medications alone , the combination of low-dose antipsychotic medication with adjunctive treatment with high frequency rTMS can significantly improve both cognitive functioning and the behavioral and psychological symptoms that often accompany AD Cranial electrotherapy stimulation ( CES ) is reported to aid in relieving symptoms of depression and anxiety , though the mechanism underlying this effect remains unclear . Therefore , the present study aim ed to evaluate changes in the hypothalamic-pituitary-adrenal ( HPA ) axis response and levels of neurotrophic factors , as well as changes in mood state , in patients undergoing CES therapy . Fifty healthy postmenopausal women were r and omly assigned to either a Sham CES group ( n = 25 ) or an Active CES group ( n = 25 ) . CES treatment was conducted in 20-minute sessions , three times per week for 8 weeks , using a micro current cranial electrotherapy stimulator .  Blood sample s were collected prior to and following the 8-week treatment period for measurement of cortisol , adrenocorticotropic hormone ( ACTH ) , brain-derived neurotrophic factor ( BDNF ) , and nerve growth factor ( NGF ) levels . Changes in mood state were also examined at the time of blood collection using the Profile of Mood States ( POMS ) . No significant differences in cortisol , ACTH , BDNF , or NGF were observed between the two participant groups ( p > 0.05 ) following the treatment period . However , those in the Active CES group exhibited significantly decreased Tension-Anxiety and Depression-Dejection scores on the POMS relative to pre-treatment scores ( p < 0.05 ) . Furthermore , Depression-Dejection scores following treatment were significantly lower in the Active CES group than in the Sham CES group ( p < 0.05 ) . No significant differences were observed in any other POMS scores such as Anger-Hostility , Vigor-Activity , Fatigue-Inertia , and Confusion-Bewilderment ( p > 0.05 ) . These results suggest that 8 weeks of CES treatment does not induce changes in blood levels of neurotrophic factors or HPA-axis-related hormones , though such treatment may be effective in treating symptoms of anxiety and depression Background : Data from the human motor cortex suggest that , depending on polarity , direct current ( DC ) brain polarization can depress or activate cortical neurons . Activating effects on the frontal lobe might be beneficial for patients with frontal lobe disorders . This phase 1 study tested the safety of frontal DC , including its effects on frontal and other brain functions . Methods : The authors applied 20 minutes of anodal , cathodal , or sham DC to the left prefrontal cortex in three groups of right-h and ed subjects and looked for effects on global measures of processing and psychomotor speed , emotion , and verbal fluency , a measure of local cortical function . In one experiment ( n = 30 ) , the authors tested before and after 1 mA DC and monitored EEG in 9 subjects . In two other experiments using 1 mA ( n = 43 ) and 2 mA ( n = 30 ) , the authors tested before and then starting 5 minutes after the onset of DC . Results : All subjects tolerated DC well . There were no significant effects on performance with 1 mA DC . At 2 mA , verbal fluency improved significantly with anodal and decreased mildly with cathodal DC . There were no clinical ly significant effects on the other measures . Conclusions : Limited exposure to direct current polarization of the prefrontal cortex is safe and can enhance verbal fluency selectively in healthy subjects . As such , it deserves consideration as a procedure to improve frontal lobe function in patients Research has demonstrated that left-prefrontal cortical activity is associated with positive affect , or approach motivation , and that right-prefrontal cortical activity is associated with negative affect , or withdrawal motivation . In past research , emotional valence ( positive-negative ) has been confounded with motivational direction ( approach-withdrawal ) , such that , for instance , the only emotions examined were both positive and approach related . Recent research has demonstrated that trait anger , a negative but approach-related emotion , is associated with increased left-prefrontal and decreased right-prefrontal activity , suggesting that prefrontal asymmetrical activity is associated with motivational direction and not emotional valence . The present experiment tested whether  state-induced anger  is associated with relative left-prefrontal activity and whether this prefrontal activity is also associated with  aggression .  Results supported these hypotheses The central nervous system seems to have an important role in fatigue and exercise tolerance . Novel noninvasive techniques of neuromodulation can provide insights on the relationship between brain function and exercise performance . The purpose of this study was to determine the effects of transcranial direct current stimulation ( tDCS ) on physical performance and physiological and perceptual variables with regard to fatigue and exercise tolerance . Eleven physically active subjects participated in an incremental test on a cycle simulator to define peak power output . During 3 visits , the subjects experienced 3 stimulation conditions ( anodal , cathodal , or sham tDCS — with an interval of at least 48 h between conditions ) in a r and omized , counterbalanced order to measure the effects of tDCS on time to exhaustion at 80 % of peak power . Stimulation was administered before each test over 13 min at a current intensity of 2.0 mA. In each session , the Brunel Mood State question naire was given twice : after stimulation and after the time-to-exhaustion test . Further , during the tests , the electromyographic activity of the vastus lateralis and rectus femoris muscles , perceived exertion , and heart rate were recorded . RM-ANOVA showed that the subjects performed better during anodal primary motor cortex stimulation ( 491 ± 100 s ) compared with cathodal stimulation ( 443 ± 11 s ) and sham ( 407 ± 69 s ) . No significant difference was observed between the cathodal and sham conditions . The effect sizes confirmed the greater effect of anodal M1 tDCS ( anodal x cathodal = 0.47 ; anodal x sham = 0.77 ; and cathodal x sham = 0.29 ) . Magnitude-based inference suggested the anodal condition to be positive versus the cathodal and sham conditions . There were no differences among the three stimulation conditions in RPE ( p = 0.07 ) or heart rate ( p = 0.73 ) . However , as hypothesized , RM- ANOVA revealed a main effect of time for the two variables ( RPE and HR : p < 0.001 ) . EMG activity also did not differ during the test accross the different conditions . We conclude that anodal tDCS  increases exercise tolerance in a cycling-based , constant-load exercise test , performed at 80 % of peak power . Performance was enhanced in the absence of changes in physiological and perceptual variables Aggressive behavior is aim ed at causing damage or pain to another individual . Aggression has been associated with structural and functional deficits in numerous brain areas , including the dorsolateral region of the prefrontal cortex ( DLPFC ) , typically related to inhibition and impulse control . In this study , we used inhibitory continuous theta-burst magnetic stimulation ( cTBS ) to explore the role of the right and left DLPFC in aggression . Sixteen healthy right-h and ed volunteers underwent two sessions involving r and om , real and sham , right and left DLPFC stimulations . These sessions were followed by the Social Orientation Paradigm ( SOP ) , a monetary task that was specially design ed to assess participants ' aggressive tendencies by measuring the patterns of their reactive aggression ( a response to a perceived provocation ) and proactive aggression ( an aggressive act with goal -oriented purpose s ) . Results indicate that using cTBS to target the left DLPFC was associated with a greater increase in aggressive responses than right DLPFC stimulation . This pattern of results was found for both reactive and proactive types of aggressive reactions . It is concluded that DLPFC asymmetry is involved in modulating reactive and proactive aggression . Our results are in line with recent studies suggesting that the left DLPFC plays a major role in aggressive behavior Clinical and functional imaging studies suggest that the cerebellar vermis is involved in the regulation of a range of nonsomatic functions including cardiovascular control , thirst , feeding behavior , and primal emotions . Cerebello-hypothalamic circuits have been postulated to be a potential neuroanatomical substrate underlying this modulation . We tested this putative relationship between the cerebellar vermis and nonsomatic functions by stimulating the cerebellum noninvasively via neuronavigated transcranial magnetic stimulation . In this r and omized , counter-balanced , within-subject study , intermittent theta burst stimulation ( TBS ) was applied on three different days to the vermis and the right and left cerebellar hemispheres of 12 right-h and ed normal subjects with the aim of modulating activity in the targeted cerebellar structure . TBS-associated changes were investigated via cardiovascular monitoring , a series of emotionally arousing picture stimuli , subjective analog scales for primal emotions , and the Profile of Mood States test . All 36 sessions of cerebellar stimulation were tolerated well without serious adverse events . Cardiovascular monitoring pointed to a mild but significant decrease in heart rate subsequent to vermal stimulation ; no changes were detected in systolic or diastolic blood pressure measurements . Subjective ratings detected a significant increase in Thirst and a trend toward increased Appetite following vermal stimulation . These observations are consistent with existing neurophysiological and neuroimaging data indicating a role for the cerebellum in the regulation of visceral responses . In conjunction with the modulatory function of the cerebellum , our results suggest a role for the vermis in somatovisceral integration likely through cerebello-hypothalamic pathways . Further research is warranted to eluci date the potential mechanisms underlying the cerebellar modulation of nonsomatic functions Although negative results have been reported , an important aspect of the physiology of repetitive transcranial magnetic stimulation ( rTMS ) could be related to the endocrinological response of the hypothalamic-pituitary-adrenal ( HPA ) axis , such as cortisol secretion . Because endocrinological responses are influenced by anxiety states , this could influence the effect of rTMS in healthy individuals . In this sham-controlled , " single blind " crossover study , we exam 
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Nevertheless , the application of non-invasive brain stimulation techniques , especially transcranial direct current stimulation , over the right PFC seemed to reduce violent reactions in these individuals by interfering with the interpretation of the unfavourable situations ( e.g. , threating signals ) or inner states that evoked anger .
The main conclusion of these studies was that bilateral stimulation of the PFC satisfactorily reduced anger and irritability  only in inmates , patients with autism spectrum disorders ( ASD ) , people who suffered a closed-head injury , and agitated patients with Alzheimer 's disease .
Moreover , combining these techniques with risperidone considerably reduced aggressiveness in these patients .