000285468 001__ 285468 000285468 005__ 20260309093112.0 000285468 0247_ $$2doi$$a10.1016/j.clinph.2025.2111436 000285468 0247_ $$2pmid$$apmid:41622107 000285468 0247_ $$2pmc$$apmc:PMC7618810 000285468 0247_ $$2ISSN$$a1388-2457 000285468 0247_ $$2ISSN$$a0921-884X 000285468 0247_ $$2ISSN$$a1872-8952 000285468 037__ $$aDZNE-2026-00245 000285468 041__ $$aEnglish 000285468 082__ $$a610 000285468 1001_ $$aAntal, Andrea$$b0 000285468 245__ $$aLow intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines (2017-2025: An update) - endorsed by the European Society for Brain Stimulation (ESBS) and by the International Federation for Clinical Neurophysiology (IFCN). 000285468 260__ $$aAmsterdam [u.a.]$$bElsevier Science$$c2026 000285468 3367_ $$2DRIVER$$aarticle 000285468 3367_ $$2DataCite$$aOutput Types/Journal article 000285468 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1773045026_14562$$xReview Article 000285468 3367_ $$2BibTeX$$aARTICLE 000285468 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000285468 3367_ $$00$$2EndNote$$aJournal Article 000285468 520__ $$aThis guideline summarizes updated safety data (2017-2025) and provides expert recommendations on the use of low intensity transcranial electrical stimulation (tES) in humans. tES encompasses several techniques including transcranial direct current stimulation (tDCS), oscillatory transcranial direct current stimulation (otDCS), transcranial alternating current stimulation (tACS), transcranial random noise stimulation (tRNS), transcranial temporal interference stimulation (tTIS), and their combinations or variations. Across over 300,000 sessions involving healthy individuals, patients with neuropsychiatric conditions, and other clinical populations, no tES-related serious adverse events (AEs) have been reported. Moderate AEs are rare and limited to a small range of specific applications. Mild AEs are common and include transient symptoms such as localized sensations (e.g., tingling or burning), headaches, and fatigue. Similar mild AEs are also reported by individuals receiving placebo stimulation. The frequency, magnitude, and type of AEs are comparable across healthy, clinical, and vulnerable groups, including children, elderly, or pregnant women. Combined interventions (e.g., co-application with EEG, TMS, or neuroimaging) have not shown increased safety risks. Safety is well-established for both bipolar and multichannel tES when applied up to 4 mA and up to 60 min per day. Higher intensities and longer stimulation durations may also be safe. Nevertheless, the number of studies using intensities above 4 mA or stimulating longer than 60 min is low. Home-based use of treatments is growing rapidly, leveraging remote supervision to provide patients with greater access and enable repeated, sustained dosing paradigms. We recommend using screening and AE questionnaires in future controlled studies, in particular when planning to extend the stimulation parameters applied. We discuss recent regulatory and ethical issues. 000285468 536__ $$0G:(DE-HGF)POF4-353$$a353 - Clinical and Health Care Research (POF4-353)$$cPOF4-353$$fPOF IV$$x0 000285468 588__ $$aDataset connected to CrossRef, PubMed, , Journals: pub.dzne.de 000285468 650_7 $$2Other$$aAdverse events 000285468 650_7 $$2Other$$aEthics 000285468 650_7 $$2Other$$aRegulation 000285468 650_7 $$2Other$$aSafety 000285468 650_7 $$2Other$$aTraining 000285468 650_7 $$2Other$$atACS 000285468 650_7 $$2Other$$atDCS 000285468 650_7 $$2Other$$atES 000285468 650_2 $$2MeSH$$aHumans 000285468 650_2 $$2MeSH$$aTranscranial Direct Current Stimulation: adverse effects 000285468 650_2 $$2MeSH$$aTranscranial Direct Current Stimulation: standards 000285468 650_2 $$2MeSH$$aTranscranial Direct Current Stimulation: methods 000285468 650_2 $$2MeSH$$aTranscranial Direct Current Stimulation: ethics 000285468 650_2 $$2MeSH$$aSocieties, Medical: standards 000285468 650_2 $$2MeSH$$aNeurophysiology: legislation & jurisprudence 000285468 650_2 $$2MeSH$$aNeurophysiology: standards 000285468 650_2 $$2MeSH$$aEurope 000285468 650_2 $$2MeSH$$aTranscranial Magnetic Stimulation 000285468 650_2 $$2MeSH$$aBrain: physiology 000285468 7001_ $$aBjekić, Jovana$$b1 000285468 7001_ $$aGanho-Ávila, Ana$$b2 000285468 7001_ $$aAlekseichuk, Ivan$$b3 000285468 7001_ $$aAssecondi, Sara$$b4 000285468 7001_ $$aBergmann, Til Ole$$b5 000285468 7001_ $$aBikson, Marom$$b6 000285468 7001_ $$aBrunelin, Jerome$$b7 000285468 7001_ $$aBrunoni, Andre R$$b8 000285468 7001_ $$aCharvet, Leigh$$b9 000285468 7001_ $$aChen, Robert$$b10 000285468 7001_ $$aCohen Kadosh, Roi$$b11 000285468 7001_ $$aDiedrich, Lukas$$b12 000285468 7001_ $$aD'Urso, Giordano$$b13 000285468 7001_ $$aFerrucci, Roberta$$b14 000285468 7001_ $$aFilipović, Saša R$$b15 000285468 7001_ $$aFitzgerald, Paul B$$b16 000285468 7001_ $$0P:(DE-2719)2812683$$aFlöel, Agnes$$b17$$udzne 000285468 7001_ $$aFröhlich, Flavio$$b18 000285468 7001_ $$aGeorge, Mark S$$b19 000285468 7001_ $$aHamilton, Roy H$$b20 000285468 7001_ $$aHaueisen, Jens$$b21 000285468 7001_ $$aHallett, Mark$$b22 000285468 7001_ $$aHerrmann, Christoph S$$b23 000285468 7001_ $$aHummel, Friedhelm C$$b24 000285468 7001_ $$aJaberzadeh, Shapour$$b25 000285468 7001_ $$aLangguth, Berthold$$b26 000285468 7001_ $$aLavidor, Michal$$b27 000285468 7001_ $$aLefaucheur, Jean-Pascal$$b28 000285468 7001_ $$aMiniussi, Carlo$$b29 000285468 7001_ $$aMoliadze, Vera$$b30 000285468 7001_ $$aNikander, Mika$$b31 000285468 7001_ $$aNikolin, Stevan$$b32 000285468 7001_ $$aNitsche, Michael A$$b33 000285468 7001_ $$aOpitz, Alexander$$b34 000285468 7001_ $$aO'Shea, Jacinta$$b35 000285468 7001_ $$aPadberg, Frank$$b36 000285468 7001_ $$aPlewnia, Christian$$b37 000285468 7001_ $$aPriori, Alberto$$b38 000285468 7001_ $$aRamasawmy, Perianen$$b39 000285468 7001_ $$aRazza, Lais B$$b40 000285468 7001_ $$aRossi, Simone$$b41 000285468 7001_ $$aRothwell, John$$b42 000285468 7001_ $$aRueger, Maria A$$b43 000285468 7001_ $$aRuffini, Giulio$$b44 000285468 7001_ $$aSack, Alexander T$$b45 000285468 7001_ $$aSalvador, Ricardo$$b46 000285468 7001_ $$aSchellhorn, Klaus$$b47 000285468 7001_ $$aSchuhmann, Teresa$$b48 000285468 7001_ $$aShirota, Yuichiro$$b49 000285468 7001_ $$aSiebner, Hartwig Roman$$b50 000285468 7001_ $$aThielscher, Axel$$b51 000285468 7001_ $$aUgawa, Yoshikazu$$b52 000285468 7001_ $$aUusitalo, Susanne$$b53 000285468 7001_ $$aWexler, Anna$$b54 000285468 7001_ $$aPaulus, Walter$$b55 000285468 7001_ $$aVanderhasselt, Marie-Anne$$b56 000285468 7001_ $$aVan Waes, Vincent$$b57 000285468 7001_ $$aWessel, Maximilian J$$b58 000285468 7001_ $$aWischnewski, Miles$$b59 000285468 7001_ $$aBaeken, Chris$$b60 000285468 7001_ $$aZiemann, Ulf$$b61 000285468 773__ $$0PERI:(DE-600)1499934-1$$a10.1016/j.clinph.2025.2111436$$gVol. 184, p. 2111436 -$$p2111436$$tClinical neurophysiology$$v184$$x1388-2457$$y2026 000285468 8564_ $$uhttps://pub.dzne.de/record/285468/files/DZNE-2026-00245.pdf$$yRestricted 000285468 8564_ $$uhttps://pub.dzne.de/record/285468/files/DZNE-2026-00245.pdf?subformat=pdfa$$xpdfa$$yRestricted 000285468 9101_ $$0I:(DE-588)1065079516$$6P:(DE-2719)2812683$$aDeutsches Zentrum für Neurodegenerative Erkrankungen$$b17$$kDZNE 000285468 9131_ $$0G:(DE-HGF)POF4-353$$1G:(DE-HGF)POF4-350$$2G:(DE-HGF)POF4-300$$3G:(DE-HGF)POF4$$4G:(DE-HGF)POF$$aDE-HGF$$bGesundheit$$lNeurodegenerative Diseases$$vClinical and Health Care Research$$x0 000285468 9141_ $$y2026 000285468 915__ $$0StatID:(DE-HGF)0420$$2StatID$$aNationallizenz$$d2025-11-06$$wger 000285468 915__ $$0StatID:(DE-HGF)0200$$2StatID$$aDBCoverage$$bSCOPUS$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)0300$$2StatID$$aDBCoverage$$bMedline$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)0199$$2StatID$$aDBCoverage$$bClarivate Analytics Master Journal List$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)1190$$2StatID$$aDBCoverage$$bBiological Abstracts$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)0160$$2StatID$$aDBCoverage$$bEssential Science Indicators$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)0113$$2StatID$$aWoS$$bScience Citation Index Expanded$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)0150$$2StatID$$aDBCoverage$$bWeb of Science Core Collection$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)1030$$2StatID$$aDBCoverage$$bCurrent Contents - Life Sciences$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)1050$$2StatID$$aDBCoverage$$bBIOSIS Previews$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)0100$$2StatID$$aJCR$$bCLIN NEUROPHYSIOL : 2022$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)0600$$2StatID$$aDBCoverage$$bEbsco Academic Search$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)0030$$2StatID$$aPeer Review$$bASC$$d2025-11-06 000285468 915__ $$0StatID:(DE-HGF)9900$$2StatID$$aIF < 5$$d2025-11-06 000285468 9201_ $$0I:(DE-2719)5000081$$kAG Flöel$$lDementia Prevention – Mechanisms and Clinical Implementation$$x0 000285468 980__ $$ajournal 000285468 980__ $$aEDITORS 000285468 980__ $$aVDBINPRINT 000285468 980__ $$aI:(DE-2719)5000081 000285468 980__ $$aUNRESTRICTED