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Marom Bikson - One of the best experts on this subject based on the ideXlab platform.
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Impact of brain atrophy on tDCS and HD-tDCS current flow: a modeling study in three variants of primary progressive aphasia
Neurological Sciences, 2020Co-Authors: Gozde Unal, Marom Bikson, Bronte Ficek, Kimberly Webster, Syed Shahabuddin, Dennis Truong, Benjamin Hampstead, Kyrana TsapkiniAbstract:Background During transcranial direct current stimulation (tDCS), the amount and distribution of current that reaches the brain depends on individual anatomy. Many progressive neurodegenerative diseases are associated with cortical atrophy, but the importance of individual brain atrophy during tDCS in patients with progressive atrophy, including primary progressive aphasia (PPA), remains unclear. Objective In the present study, we addressed the question whether brain anatomy in patients with distinct cortical atrophy patterns would impact brain current intensity and distribution during tDCS over the left IFG. Method We developed state-of-the-art, gyri-precise models of three subjects, each representing a variant of primary progressive aphasia: non-fluent variant PPA (nfvPPA), semantic variant PPA (svPPA), and logopenic variant PPA (lvPPA). We considered two exemplary montages over the left inferior frontal gyrus (IFG): a conventional pad montage (anode over F7, cathode over the right cheek) and a 4 × 1 high-definition tDCS montage. We further considered whether local anatomical features, specifically distance of the cortex to skull, can directly predict local electric field intensity. Results We found that the differences in brain current flow across the three PPA variants fall within the distribution of anatomically typical adults. While clustering of electric fields was often around individual gyri or sulci, the minimal distance from the gyri/sulci to skull was not correlated with electric field intensity. Conclusion Limited to the conditions and assumptions considered here, this argues against a specific need to adjust the tDCS montage for these patients any more than might be considered useful in anatomically typical adults. Therefore, local atrophy does not, in isolation, reliably predict local electric field. Rather, our results are consistent with holistic head anatomy influencing brain current flow, with tDCS producing diffuse and individualized brain current flow patterns and HD-tDCS producing targeted brain current flow across individuals.
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state of art neuroanatomical target analysis of high definition and conventional tdcs montages used for migraine and pain control
Frontiers in Neuroanatomy, 2015Co-Authors: Alexandre F Dasilva, Abhishek Datta, Dennis Q Truong, Marcos F Dossantos, Rebecca L Toback, Marom BiksonAbstract:Although transcranial direct current stimulation (tDCS) studies promise to modulate cortical regions associated with pain, the electric current produced usually spreads beyond the area of the electrodes’ placement. Using a forward-model analysis, this study compared the neuroanatomic location and strength of the predicted electric current peaks, at cortical and subcortical levels, induced by conventional and High-Definition-tDCS (HD-tDCS) montages developed for migraine and other chronic pain disorders. The electrodes were positioned in accordance with the 10-20 or 10-10 electroencephalogram (EEG) landmarks: motor cortex-supraorbital (M1-SO, anode and cathode over C3 and Fp2, respectively), dorsolateral prefrontal cortex bilateral (DLPFC, anode over F3, cathode over F4), vertex-occipital cortex (anode over Cz and cathode over Oz), HD-tDCS 4x1 (one anode on C3, and four cathodes over Cz, F3, T7, and P3) and HD-tDCS 2x2 (two anodes over C3/C5 and two cathodes over FC3/FC5). M1-SO produced a large current flow in the prefrontal cortex (PFC). Peaks of current flow also occurred in deeper brain structures, such as the cingulate cortex, insula, thalamus and brainstem. The same structures received significant amount of current with Cz-Oz and DLPFC tDCS. However, there were differences in the current flow to outer cortical regions. The visual cortex, cingulate and thalamus received the majority of the current flow with the Cz-Oz, while the anterior parts of the superior and middle frontal gyri displayed an intense amount of current with DLPFC montage. HD-tDCS montages enhanced the focality, producing peaks of current in subcortical areas at negligible levels. This study provides novel information regarding the neuroanatomical distribution and strength of the electric current using several tDCS montages applied for migraine and pain control. Such information may help clinicians and researchers in deciding the most appropriate tDCS montage to treat each pain disorder.
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pediatric stroke and transcranial direct current stimulation methods for rational individualized dose optimization
Frontiers in Human Neuroscience, 2014Co-Authors: Bernadette T Gillick, Preet Minhas, Adam Kirton, Jason B Carmel, Marom BiksonAbstract:Background- Transcranial direct current stimulation (tDCS) has been investigated mainly in adults and doses may not be appropriate in pediatric applications. In perinatal stroke where potential applications are promising, rational adaptation of dosage for children remains under investigation. Objective - Construct child-specific tDCS dosing parameters through case study within a perinatal stroke tDCS safety and feasibility trial. Methods- 10-year-old subject with a diagnosis of presumed perinatal ischemic stroke and hemiparesis was identified. T1 MRI scans used to derive computerized model for current flow and electrode positions. Workflow using modeling results and consideration of dosage in previous clinical trials was incorporated. Prior Ad hoc adult montages versus de novo optimized montages provided distinct risk benefit analysis. Approximating adult dose required consideration of changes in both peak brain current flow and distribution which further tradeoff between maximizing efficacy and adding safety factors. Electrode size, position, current intensity, compliance voltage, and duration were controlled independently in this process. Results- Brain electric fields modeled and compared to values previously predicted models. Approximating conservative brain current flow patterns and intensities used in previous adult trials for comparable indications, the optimal current intensity established was 0.7 mA for 10 minutes with a tDCS C3/C4 montage. Specifically 0.7 mA produced comparable peak brain current intensity of an average adult receiving 1.0 mA. Electrode size of 5x7 cm2 with 1.0 mA and low-voltage tDCS was employed to maximize tolerability. Safety and feasibility confirmed with subject tolerating the session well and no serious adverse events. Conclusion- Rational approaches to dose customization, with steps informed by computational modeling, may improve guidance for pediatric stroke tDCS trials.
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the value and cost of complexity in predictive modelling role of tissue anisotropic conductivity and fibre tracts in neuromodulation
Journal of Neural Engineering, 2014Co-Authors: Syed Salman Shahid, Marom Bikson, Humaira Salman, Tony AhfockAbstract:Objectives. Computational methods are increasingly used to optimize transcranial direct current stimulation (tDCS) dose strategies and yet complexities of existing approaches limit their clinical access. Since predictive modelling indicates the relevance of subject/pathology based data and hence the need for subject specific modelling, the incremental clinical value of increasingly complex modelling methods must be balanced against the computational and clinical time and costs. For example, the incorporation of multiple tissue layers and measured diffusion tensor (DTI) based conductivity estimates increase model precision but at the cost of clinical and computational resources. Costs related to such complexities aggregate when considering individual optimization and the myriad of potential montages. Here, rather than considering if additional details change current-flow prediction, we consider when added complexities influence clinical decisions. Approach. Towards developing quantitative and qualitative metrics of value/cost associated with computational model complexity, we considered field distributions generated by two 4 × 1 high-definition montages (m1 = 4 × 1 HD montage with anode at C3 and m2 = 4 × 1 HD montage with anode at C1) and a single conventional (m3 = C3-Fp2) tDCS electrode montage. We evaluated statistical methods, including residual error (RE) and relative difference measure (RDM), to consider the clinical impact and utility of increased complexities, namely the influence of skull, muscle and brain anisotropic conductivities in a volume conductor model. Main results. Anisotropy modulated current-flow in a montage and region dependent manner. However, significant statistical changes, produced within montage by anisotropy, did not change qualitative peak and topographic comparisons across montages. Thus for the examples analysed, clinical decision on which dose to select would not be altered by the omission of anisotropic brain conductivity. Significance. Results illustrate the need to rationally balance the role of model complexity, such as anisotropy in detailed current flow analysis versus value in clinical dose design. However, when extending our analysis to include axonal polarization, the results provide presumably clinically meaningful information. Hence the importance of model complexity may be more relevant with cellular level predictions of neuromodulation.
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inter individual variation during transcranial direct current stimulation and normalization of dose using mri derived computational models
Frontiers in Psychiatry, 2012Co-Authors: Abhishek Datta, Dennis Q Truong, Preet Minhas, Lucas C Parra, Marom BiksonAbstract:BACKGROUND: Transcranial Direct Current Stimulation (tDCS) is a non-invasive, versatile, and safe neuromodulation technology under investigation for the treatment of neuropsychiatric disorders, adjunct to rehabilitation, and cognitive enhancement in healthy adults. Despite promising results, there is variability in responsiveness. One potential source of variability is the intensity of current delivered to the brain which is a function of both the operator controlled tDCS dose (electrode montage and total applied current) and subject specific anatomy. We are interested in both the scale of this variability across anatomical typical adults and methods to normalize inter-individual variation by customizing tDCS dose. Computational FEM simulations are a standard technique to predict brain current flow during tDCS and can be based on subject-specific anatomical MRI. OBJECTIVE: To investigate this variability, we modeled multiple tDCS montages across 3 adults (ages 34-41, 1 female). RESULTS: Conventional pad stimulation led to diffuse modulation with maximum current flow between the pads across all subjects. There was high current flow directly under the pad for some subjects while the location of peak induced cortical current flow was variable. The High-Definition tDCS montage led to current flow restricted to within the ring perimeter across all subjects. The current flow profile across all subjects and montages was influenced by details in cortical gyri/sulci. CONCLUSIONS: This data suggests that subject-specific modeling can facilitate consistent and more efficacious tDCS.
Paul L Nunez - One of the best experts on this subject based on the ideXlab platform.
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international federation of clinical neurophysiology ifcn eeg research workgroup recommendations on frequency and topographic analysis of resting state eeg rhythms part 1 applications in clinical research studies
Clinical Neurophysiology, 2020Co-Authors: Claudio Babiloni, Robert J Barry, Erol Basar, K J Blinowska, Andrzej Cichocki, Wilhelmus Drinkenburg, Wolfgang Klimesch, Robert T Knight, Fernando Lopes H Da Silva, Paul L NunezAbstract:Abstract In 1999, the International Federation of Clinical Neurophysiology (IFCN) published “IFCN Guidelines for topographic and frequency analysis of EEGs and EPs” (Nuwer et al., 1999). Here a Workgroup of IFCN experts presents unanimous recommendations on the following procedures relevant for the topographic and frequency analysis of resting state EEGs (rsEEGs) in clinical research defined as neurophysiological experimental studies carried out in neurological and psychiatric patients: (1) recording of rsEEGs (environmental conditions and instructions to participants; montage of the EEG electrodes; recording settings); (2) digital storage of rsEEG and control data; (3) computerized visualization of rsEEGs and control data (identification of artifacts and neuropathological rsEEG waveforms); (4) extraction of “synchronization” features based on frequency analysis (band-pass filtering and computation of rsEEG amplitude/power density spectrum); (5) extraction of “connectivity” features based on frequency analysis (linear and nonlinear measures); (6) extraction of “topographic” features (topographic mapping; cortical source mapping; estimation of scalp current density and dura surface potential; cortical connectivity mapping), and (7) statistical analysis and neurophysiological interpretation of those rsEEG features. As core outcomes, the IFCN Workgroup endorsed the use of the most promising “synchronization” and “connectivity” features for clinical research, carefully considering the limitations discussed in this paper. The Workgroup also encourages more experimental (i.e. simulation studies) and clinical research within international initiatives (i.e., shared software platforms and databases) facing the open controversies about electrode montages and linear vs. nonlinear and electrode vs. source levels of those analyses.
Abhishek Datta - One of the best experts on this subject based on the ideXlab platform.
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state of art neuroanatomical target analysis of high definition and conventional tdcs montages used for migraine and pain control
Frontiers in Neuroanatomy, 2015Co-Authors: Alexandre F Dasilva, Abhishek Datta, Dennis Q Truong, Marcos F Dossantos, Rebecca L Toback, Marom BiksonAbstract:Although transcranial direct current stimulation (tDCS) studies promise to modulate cortical regions associated with pain, the electric current produced usually spreads beyond the area of the electrodes’ placement. Using a forward-model analysis, this study compared the neuroanatomic location and strength of the predicted electric current peaks, at cortical and subcortical levels, induced by conventional and High-Definition-tDCS (HD-tDCS) montages developed for migraine and other chronic pain disorders. The electrodes were positioned in accordance with the 10-20 or 10-10 electroencephalogram (EEG) landmarks: motor cortex-supraorbital (M1-SO, anode and cathode over C3 and Fp2, respectively), dorsolateral prefrontal cortex bilateral (DLPFC, anode over F3, cathode over F4), vertex-occipital cortex (anode over Cz and cathode over Oz), HD-tDCS 4x1 (one anode on C3, and four cathodes over Cz, F3, T7, and P3) and HD-tDCS 2x2 (two anodes over C3/C5 and two cathodes over FC3/FC5). M1-SO produced a large current flow in the prefrontal cortex (PFC). Peaks of current flow also occurred in deeper brain structures, such as the cingulate cortex, insula, thalamus and brainstem. The same structures received significant amount of current with Cz-Oz and DLPFC tDCS. However, there were differences in the current flow to outer cortical regions. The visual cortex, cingulate and thalamus received the majority of the current flow with the Cz-Oz, while the anterior parts of the superior and middle frontal gyri displayed an intense amount of current with DLPFC montage. HD-tDCS montages enhanced the focality, producing peaks of current in subcortical areas at negligible levels. This study provides novel information regarding the neuroanatomical distribution and strength of the electric current using several tDCS montages applied for migraine and pain control. Such information may help clinicians and researchers in deciding the most appropriate tDCS montage to treat each pain disorder.
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inter individual variation during transcranial direct current stimulation and normalization of dose using mri derived computational models
Frontiers in Psychiatry, 2012Co-Authors: Abhishek Datta, Dennis Q Truong, Preet Minhas, Lucas C Parra, Marom BiksonAbstract:BACKGROUND: Transcranial Direct Current Stimulation (tDCS) is a non-invasive, versatile, and safe neuromodulation technology under investigation for the treatment of neuropsychiatric disorders, adjunct to rehabilitation, and cognitive enhancement in healthy adults. Despite promising results, there is variability in responsiveness. One potential source of variability is the intensity of current delivered to the brain which is a function of both the operator controlled tDCS dose (electrode montage and total applied current) and subject specific anatomy. We are interested in both the scale of this variability across anatomical typical adults and methods to normalize inter-individual variation by customizing tDCS dose. Computational FEM simulations are a standard technique to predict brain current flow during tDCS and can be based on subject-specific anatomical MRI. OBJECTIVE: To investigate this variability, we modeled multiple tDCS montages across 3 adults (ages 34-41, 1 female). RESULTS: Conventional pad stimulation led to diffuse modulation with maximum current flow between the pads across all subjects. There was high current flow directly under the pad for some subjects while the location of peak induced cortical current flow was variable. The High-Definition tDCS montage led to current flow restricted to within the ring perimeter across all subjects. The current flow profile across all subjects and montages was influenced by details in cortical gyri/sulci. CONCLUSIONS: This data suggests that subject-specific modeling can facilitate consistent and more efficacious tDCS.
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transcranial dc stimulation in fibromyalgia optimized cortical target supported by high resolution computational models
The Journal of Pain, 2011Co-Authors: Mariana E Mendonca, Marom Bikson, Marcus B Santana, Abrahao Fontes Baptista, Abhishek Datta, Felipe Fregni, Cintia P AraujoAbstract:In this study we aimed to determine current distribution and short-term analgesic effects of transcranial direct current stimulation (tDCS) in fibromyalgia using different electrode montages. For each electrode montage, clinical effects were correlated with predictions of induced cortical current flow using magnetic resonance imaging-derived finite element method head model. Thirty patients were randomized into 5 groups (Cathodal-M1 (primary motor cortex), Cathodal-SO (supra- orbital area), Anodal-M1, Anodal-SO, and Sham) to receive tDCS application (2 mA, 20 minutes) using an extracephalic montage. Pain was measured using a visual numerical scale (VNS), pressure pain threshold (PPT), and a body diagram (BD) evaluating pain area. There was significant pain reduction in cathodal-SO and anodal-SO groups indexed by VNS. For PPT there was a trend for a similar effect in anodal-SO group. Computer simulation indicated that the M1-extracephalic montage produced dominantly temporo-parietal current flow, consistent with lack of clinical effects with this montage. Conversely, the SO-extracephalic montage produced current flow across anterior prefrontal struc- tures, thus supporting the observed analgesic effects. Our clinical and modeling findings suggest that electrode montage, considering both electrodes, is critical for the clinical effects of M1-tDCS as electric current needs to be induced in areas associated with the pain matrix. These results should be taken into consideration for the design of pain tDCS studies. Perspective: Results in this article support that electrode montage is a critical factor to consider for the clinical application of tDCS for pain control, as there is an important correlation between the location of induced electrical current and tDCS-induced analgesic effects.
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electrode montages for tdcs and weak transcranial electrical stimulation role of return electrode s position and size
Clinical Neurophysiology, 2010Co-Authors: Marom Bikson, Abhishek Datta, Asif Rahman, Jen ScaturroAbstract:In this issue, Moliadze and colleagues investigate the role of electrode montage in the induction of acute lasting excitability changes by transcranial Direction Current Stimulation (tDCS) and transcranial Random Noise Stimulation (tRNS); specifically they demonstrate that during weak transcranial electrical stimulation, the position of the “return” electrode affects neuromodulation under the “active” electrode. Moliadze and colleagues introduce the development of modern tDCS protocols at the turn of the decade (Priori et al., 1998; Nitsche and Paulus, 2000, 2001; Terney et al., 2008). Despite wide-spread subsequent dissemination of tDCS, there remain significant unknowns about the mechanisms of tDCS and the design of electrode montages, including electrode size and placement. Moliadze and colleagues address the role of “return” electrode’s position (and distance) in the induction of Transcranial Magnetic Stimulation (TMS) evoked excitability changes under an “active” electrode over motor cortex (Moliadze et al., 2010). Understanding and controlling electrotherapy dose is evidently critical in determining behavioral and clinical outcome. The position of stimulating electrodes governs current flow through the body, and hence the distribution of induced electric fields in the brain. These induced cortical currents/electric fields modulate neuronal excitability for DC stimulation and, in turn, determine behavioral and clinical outcomes (Bikson et al., 2008). The most simplistic dose design schemes for tDCS assume a region of “increased excitability” in the cortex directly under the anode electrode, and a region of “decreased excitability’ under the cathode, with intermediary regions largely spared (unaffected). Several studies have suggested limitations in this simplified approach including the need to consider: 1) Current density at the electrode (Nitsche et al., 2007; Miranda et al., 2006; Miranda et al., 2009); 2) Individual differences (Madhavan et al., 2010); 3) Significant current flow in intermediary regions, including the potential for current clustering (Datta et al, 2009); 4) Montages for unidirectional modulation (Rossini et al., 1985; Saypol et al.,1991; Datta et al., 2008); and 5) Relative electrode position, including inter-electrode distance (Stecker et al.,2005; Datta et al., 2008) and the use of extra-cephalic electrodes (Accornero et al., 2007; Ferrucci et al., 2008, Baker et al., 2010). Generally, increasing electrode separation on the head is expected to increase cortical modulation by increased relative amount of current entering the brain rather than “shunted” across the scalp. The report by Moliadze and colleagues provides some of the strongest clinical evidence to-date that the relative position of stimulation electrode can affect neuromodulation under each electrode – namely that in determining electrotherapy dose the two stimulating electrodes cannot be considered separately and independently, even for relatively distant electrode positions. Moreover, increasing electrode distance may decrease the magnitude of neuro-modulation, depending on the specific montage and physiological measure. The current flow through the body is strongly influenced by anatomical details, because of the different electrical conductivities of tissues such as scalp, skull/vertebrae, muscle, CSF, and brain – as a result the induced current profile in the brain may be detailed and complex. Given this, it is thus not surprising that the position of both electrodes determines the resulting current flow distribution through the cortex. Simultaneously, the complexity of current flow indicates that determining electrode montages dose by simplified assumptions may not be prudent, as highlighted by the results of Moliadze et al., 2010. One solution to addressing this complexity in the design of rational stimulation protocols is the prediction of current flow patterns through the brain using computer models. The sophistication of computer models using finite-element-methods (FEM) for this purpose (Butson et al., 2007; De Lucia et al., 2007) has increased to allow high-resolution (e.g. 1 mm; Datta et al., 2009) and individualized modeling (Wagner et al.,2007; Datta et al., in press). Figure 1 illustrates the resulting brain current flow for three electrode montages – in all cases, the size and position of the “active” electrode over motor cortex is fixed, while the position or size of the “return” electrode is varied. The position and size of the “return” electrode affects the electric field distribution across the entire cortex. In addition, changing the position of the “return” electrode affects the electric field distribution in cortex directly under the “active” electrode. Figure 1 Effect of “return” electrode’s position and size on cortical electric fields induced by a 4 cm × 4 cm “active” electrode over the left primary motor cortex. An individualized FEM head model was created from ... Our modeling results support the clinical finding by Moliadze and colleagues that even if the direct actions of the “return” electrode are mitigated by its position (e.g. extracephalic) or size (Nitsche et al., 2007); the “return” electrode will still influence the current path through the brain from the “active” electrode. For example, the repositioning of the return pad from the contralateral forehead to the contralateral upper arm may have shifted the preferential flow of current from across the frontal regions to across the posterior regions of the brain (see Montage A and C versus Montage B in Figure 1). More generally, the regions of brain modulation may not be simply under the “active” electrode (Datta et al., 2009; Sadleir et al., 2010), such that some “surprising” clinical findings, including by Moliadze and colleagues may be understood by considering the concurrent neuro-modulation of multiple cortical and sub-cortical regions. Additional experimental studies investigating the specific role of electrode placements and intensity, and careful consideration of electrode montage in designing therapeutic protocols, is warranted.
Claudio Babiloni - One of the best experts on this subject based on the ideXlab platform.
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international federation of clinical neurophysiology ifcn eeg research workgroup recommendations on frequency and topographic analysis of resting state eeg rhythms part 1 applications in clinical research studies
Clinical Neurophysiology, 2020Co-Authors: Claudio Babiloni, Robert J Barry, Erol Basar, K J Blinowska, Andrzej Cichocki, Wilhelmus Drinkenburg, Wolfgang Klimesch, Robert T Knight, Fernando Lopes H Da Silva, Paul L NunezAbstract:Abstract In 1999, the International Federation of Clinical Neurophysiology (IFCN) published “IFCN Guidelines for topographic and frequency analysis of EEGs and EPs” (Nuwer et al., 1999). Here a Workgroup of IFCN experts presents unanimous recommendations on the following procedures relevant for the topographic and frequency analysis of resting state EEGs (rsEEGs) in clinical research defined as neurophysiological experimental studies carried out in neurological and psychiatric patients: (1) recording of rsEEGs (environmental conditions and instructions to participants; montage of the EEG electrodes; recording settings); (2) digital storage of rsEEG and control data; (3) computerized visualization of rsEEGs and control data (identification of artifacts and neuropathological rsEEG waveforms); (4) extraction of “synchronization” features based on frequency analysis (band-pass filtering and computation of rsEEG amplitude/power density spectrum); (5) extraction of “connectivity” features based on frequency analysis (linear and nonlinear measures); (6) extraction of “topographic” features (topographic mapping; cortical source mapping; estimation of scalp current density and dura surface potential; cortical connectivity mapping), and (7) statistical analysis and neurophysiological interpretation of those rsEEG features. As core outcomes, the IFCN Workgroup endorsed the use of the most promising “synchronization” and “connectivity” features for clinical research, carefully considering the limitations discussed in this paper. The Workgroup also encourages more experimental (i.e. simulation studies) and clinical research within international initiatives (i.e., shared software platforms and databases) facing the open controversies about electrode montages and linear vs. nonlinear and electrode vs. source levels of those analyses.
Franca Deriu - One of the best experts on this subject based on the ideXlab platform.
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The vestibulo-masseteric reflex and the acoustic-masseteric reflex: a reliability and responsiveness study in healthy subjects
Experimental Brain Research, 2020Co-Authors: Andrea Manca, Francesca Ginatempo, Franca DeriuAbstract:The vestibulo-masseteric reflex (VMR or p11 wave), the acoustic-masseteric reflex (AMR or p1/n21 wave) and the mixed vestibulo-cochlear p11/n21 potential are responses of masseter muscles to sound that can be employed to evaluate brainstem function. This study was aimed at establishing the test–retest reliability and responsiveness of these reflex parameters according to the type of electrode configuration. Twenty-two healthy volunteers (M:F = 11:11; mean age 25.3 ± 5.2 years) participated in two testing sessions separated by one week. Zygomatic and mandibular montages were compared following unilateral and bilateral stimulations. For reliability purposes, intraclass correlation coefficient (ICC), coefficient of variation of the method error (CVME) and standard error of measurement (SEM) were calculated. The minimal detectable difference (MDD) was also determined as a measure of responsiveness. Both VMR (p11 wave) and AMR could be consistently evoked from test to retest, although the frequency rate was significantly higher (all p values ≤ 0.009) with zygomatic (VMR: 97.7–100%; AMR: 86.9–97.6%) than mandibular montage (VMR: 84.7–89.8%; AMR: 65.0–67.8%), with no significant differences between unilateral and bilateral stimulations. Good-to-excellent reliability and responsiveness (high ICC, low CV_ME, SEM and MDD scores) were detected for corrected amplitudes and peak latencies for all reflex responses, whereas raw amplitudes were associated to poor reliability. The reliability of the zygomatic montage proved superior to the mandibular montage for all reflex responses. Given their high test–retest consistency and capability to study different features of the reflex arch, both peak latencies and corrected amplitudes should be reported and considered in the interpretation of reflex testing results.