A checklist for assessing the methodological quality of concurrent tES-fMRI studies (ContES checklist): a consensus study and statement

Hamed Ekhtiari*, Peyman Ghobadi-Azbari, Axel Thielscher, Andrea Antal, Lucia M. Li, A. Duke Shereen, Yuranny Cabral-Calderin, Daniel Keeser, Til Ole Bergmann, Asif Jamil, Ines R. Violante, Jorge Almeida, Marcus Meinzer, Hartwig R. Siebner, Adam J. Woods, Charlotte J. Stagg, Rany Abend, Daria Antonenko, Tibor Auer, Marc BächingerChris Baeken, Helen C. Barron, Henry W. Chase, Jenny Crinion, Abhishek Datta, Matthew H. Davis, Mohsen Ebrahimi, Zeinab Esmaeilpour, Brian Falcone, Valentina Fiori, Iman Ghodratitoostani, Gadi Gilam, Roland H. Grabner, Joel D. Greenspan, Georg Groen, Gesa Hartwigsen, Tobias U. Hauser, Christoph S. Herrmann, Chi Hung Juan, Bart Krekelberg, Stephanie Lefebvre, Sook Lei Liew, Kristoffer H. Madsen, Rasoul Mahdavifar-Khayati, Nastaran Malmir, Paola Marangolo, Andrew K. Martin, Timothy J. Meeker, Hossein Mohaddes Ardabili, Marius Moisa, Davide Momi, Beni Mulyana, Alexander Opitz, Natasza Orlov, Patrick Ragert, Christian C. Ruff, Giulio Ruffini, Michaela Ruttorf, Arshiya Sangchooli, Klaus Schellhorn, Gottfried Schlaug, Bernhard Sehm, Ghazaleh Soleimani, Hosna Tavakoli, Benjamin Thompson, Dagmar Timmann, Aki Tsuchiyagaito, Martin Ulrich, Johannes Vosskuhl, Christiane A. Weinrich, Mehran Zare-Bidoky, Xiaochu Zhang, Benedikt Zoefel, Michael A. Nitsche, Marom Bikson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


Low-intensity transcranial electrical stimulation (tES), including alternating or direct current stimulation, applies weak electrical stimulation to modulate the activity of brain circuits. Integration of tES with concurrent functional MRI (fMRI) allows for the mapping of neural activity during neuromodulation, supporting causal studies of both brain function and tES effects. Methodological aspects of tES-fMRI studies underpin the results, and reporting them in appropriate detail is required for reproducibility and interpretability. Despite the growing number of published reports, there are no consensus-based checklists for disclosing methodological details of concurrent tES-fMRI studies. The objective of this work was to develop a consensus-based checklist of reporting standards for concurrent tES-fMRI studies to support methodological rigor, transparency and reproducibility (ContES checklist). A two-phase Delphi consensus process was conducted by a steering committee (SC) of 13 members and 49 expert panelists through the International Network of the tES-fMRI Consortium. The process began with a circulation of a preliminary checklist of essential items and additional recommendations, developed by the SC on the basis of a systematic review of 57 concurrent tES-fMRI studies. Contributors were then invited to suggest revisions or additions to the initial checklist. After the revision phase, contributors rated the importance of the 17 essential items and 42 additional recommendations in the final checklist. The state of methodological transparency within the 57 reviewed concurrent tES-fMRI studies was then assessed by using the checklist. Experts refined the checklist through the revision and rating phases, leading to a checklist with three categories of essential items and additional recommendations: (i) technological factors, (ii) safety and noise tests and (iii) methodological factors. The level of reporting of checklist items varied among the 57 concurrent tES-fMRI papers, ranging from 24% to 76%. On average, 53% of checklist items were reported in a given article. In conclusion, use of the ContES checklist is expected to enhance the methodological reporting quality of future concurrent tES-fMRI studies and increase methodological transparency and reproducibility.

Original languageAmerican English
Pages (from-to)596-617
Number of pages22
JournalNature Protocols
Issue number3
StatePublished - Mar 2022

Bibliographical note

Funding Information:
R.A. is partially supported by the National Institute of Mental Health Intramural Research Program. J.A. is supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 802553 – ‘ContentMAP’) and by grant PTDC/PSI-GER/30745/2017 from Fundação para a Ciência e a Tecnologia Portugal and Programa COMPETE. A.A. is supported by the Ministry for Science and Culture of Lower Saxony Germany (76251-12-7/19 ZN 3456) and by the BMBF (STIMCODE 01GP2124B). D.A. is supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation (AN 1103/3-1)). C.B. is supported by the Research Foundation–Flanders (FWO) and the Queen Elisabeth Medical Foundation for Neurosciences. H.C.B. is supported by the Medical Research Council (MRC) UK (MC_UU_00003/4 and MC_UU_12024/3). T.O.B. is supported by the Boehringer Ingelheim Foundation and the DFG (Grant 362546008). M.B. is supported by grants from Harold Shames and the National Institutes of Health: NIH-NIDA UG3DA048502, NIH-NIGMS T34GM137858, NIH-NINDS 1R01NS112996, NIH-NINDS 1R01NS101362, NIH-NIMH 1R01MH111896 and NIH-NINDS 1R01NS095123. J.C. is supported by a Wellcome Trust Senior Clinical Fellowship (106161/Z/14/Z). M.H.D. is supported by the UK MRC (SUAG044/G101400). H.E. is supported by the Laureate Institute for Brain Research (LIBR), Warren K. Family Foundation, Oklahoma Center for Advancement of Science and Technologies (OCAST, #HR18-139) and Brain and Behavior Foundation (NARSAD Young Investigator Award #27305). V.F. is supported by the Italian Ministry of Health (grant GR-2018-12365991). P.G.-A. is supported by the Cognitive Science and Technologies Council (grant CSTC-7761). I.G. is supported (grant number: 2013/07375-0) by Innovation and Diffusion of Mathematical Sciences Center Applied to Industry (CEPID-CeMEAI) of Sao Paulo Research Foundation (FAPESP), the University of Sao Paulo. G. Gilam is supported by the Redlich Pain Research Endowment and the Feldman Family Foundation Pain Research Fund. G.H. is supported by the Max Planck Society and by the DFG (HA 6314/3-1, HA 6314/4-1 and HA 6314/9-1). T.U.H. is supported by a Sir Henry Dale Fellowship (211155/Z/18/Z) from Wellcome Trust and the Royal Society, an ERC Starting Grant, a grant from the Jacobs Foundation (2017-1261-04), the Medical Research Foundation and a 2018 NARSAD Young Investigator grant (27023) from the Brain & Behavior Research Foundation. C.S.H. is supported by the German Federal Ministry of Education and Research (BMBF, grant nos. 16SV7787 and 13GW0273D) as well as the DFG under Germany’s Excellence Strategy (grant no. EXC 2177/1 – Project ID 390895286). C.-H.J. is supported by the Ministry of Science and Technology, Taiwan (grant nos.108-2639-H-008-001-ASP and 108-2321-B-075 -004 -MY2) and sponsored by a Taiwan Ministry of Education’s ‘Academic Strategic Alliance: Taiwan and Oxford University’ project grant. D.K. is supported by the German Center for Brain Stimulation (GCBS) research consortium (Work Package 5, grant no. 01EE1403E), funded by the BMBF. B.K. is supported by the National Institute of Neurological Disorders and Stroke and the National Institute of Mental Health under awards R01MH111766 and R21MH113917. L.M.L. is supported by an NIHR Clinical Lectureship, Academy of Medical Sciences Starter Grant and the NIHR Brain Injury MedTech Cooperative. S.-L.L. is supported by the National Institutes of Health (K01 HD091283 and R01 NS115845). T.J.M. is supported by a Postdoctoral Scholarship from the Neurosurgery Pain Research Institute at the Johns Hopkins Medical Institute and National Institutes of Health (R01 NS107602). M. Meinzer is supported by the DFG (ME 3161/3-1). M.A.N. is supported by DFG Projektnummer 316803389 – SFB 1280, the German Federal Ministry of Education and Research (BMBF, GCBS grant 01EE1501) and the EU (NEUROTWIN, grant 101017716). A.O. is supported by RF1MH117428 and RF1MH124909. C.C.R. is supported by an ERC Consolidator grant (BRAINCODES, grant #725355) and by the Swiss National Science Foundation (grant #100019L_173248). M.R. was supported by Deutscher Akademischer Austauschdienst (DAAD - Project-ID 57212180). G. Schlaug acknowledges support by U01NS102353 and R01MH111874. A.D.S. is supported by National Institute of Neurological Disorders and Stroke under award R21NS115018. H.R.S. holds a 5-year professorship in precision medicine at the Faculty of Health Sciences and Medicine, University of Copenhagen, which is sponsored by the Lundbeck Foundation (grant no. R186-2015-2138). H.R.S. has received a Lundbeckfonden ‘Collaborative Alliance’ grant (grant no. R336-2020-1035). H.R.S. and A.T. are supported by Innovationfund Denmark grant agreement number 9068-00025B. C.J.S. holds a Sir Henry Dale Fellowship, funded by the Wellcome Trust and the Royal Society (102584/Z/13/Z). B.T. is supported by CIHR grant 390283, CFI grant 34095 and NSERC grants RPIN-05394 and RGPAS-477166. A. Thielscher was supported by the Lundbeck foundation (R244-2017-196 and R313-2019-622). D.T. is supported by the DFG - Projektnummer 316803389 - SFB 1280. I.R.V. and T.A. are supported by the BBSRC (BB/S008314/1). B.Z. is supported by the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement number 743482. The views presented in this manuscript represent those of the authors and not necessarily those of the funding agencies.

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