1. Foc.us Alex Simon Biotech Journal Club June 12 th, 2014

2. Foc.us Promo Video To Youtube

3. Electrotherapy Began 2000 Years Ago Torpedo Electric Fish (Romans) – Headache and Epilepsy Relief Aldini (1804) – First in modern era to treat mental disorders with weak direct current Electroconvulsive Therapy discovered (1930s) – tDCS (transcranial Direct Current Stimulation) falls out of favor A resurgence of interest in tDCS (2000s) – Noninvasive, well-tolerated, inexpensive Stagg and Nitsche, 2011

4. Foc.us is Based on Transcranial Direct Current Stimulation (tDCS) Paulus et al., 2013

5. tDCS Yields Long Lasting Effects Stagg and Nitsche, 2011 Anodal Stimulation Strength of current is also important Iterative tDCS sessions can increase duration of excitability

6. tDCS Modulates Neuronal Excitability Anode vs. Cathode Varies from Transcranial Magnetic Stimulation (TMS) www.gizmag.com Anodal Stimulation

7. Mechanisms of LTP for Long Term Changes with Anodal Stimulation Increases cAMP levels – 2 nd messenger, leads to transcription of synaptic machinery via CREB NMDA receptor dependent Increases Intracellular Ca ++ Graupner and Brunel, 2010

8. What disease models has tDCS been tried in? Depression Rigonatti et al., 2008

9. tDCS Has Many Potential Applications Parkinson's disease Tinnitus Amblyopia Fibromyalgia Post-stroke motor deficits Anxiety Disorders Schizophrenia Addiction Full Summary of tDCS Studies http://bit.ly/1kjXZW2 Full Summary of tDCS Studies http://bit.ly/1kjXZW2 What about cognition?

10. Anodal tDCS Improves Cognitive Function (Working Memory) (p=.004) Fregni et al., 2005

11. Cognitive Enhancement May Come at a Cost Learning of the Task (Acquisition) Reaction time of Learned Task (Automaticity) Iuculano and Kadosh, 2013

12. Who started Foc.us? Michael Oxley – Not a scientist Grown out of a DIY community

13. The First Commercially Available tDCS Device $249 iOS Integration via Bluetooth Uses established current/electr ode parameters

14. Warnings by scientists “Meddling with the tDCS dose is potentially as dangerous as tampering with a drug’s chemical composition” – Nature, 2013 Side Effects: – Burning Skin, Phosphenes, Itching, Headache, Nausea, Fatigue Long term effects? Stimulation protocols are very nuanced – Duration, Anodal/Cathodal, Current Intensity, Location, Handedness, Sweat/Hair, Interactions with Extant Treatment Is Foc.us up to combating these health challenges, and potential FDA regulations?

15. tDCS Competitors Halo Headband PhDs, Ex-CEOs, Google, Facebook Andreessen Horowitz SoftTech VC: 1.5M Seed Round, May 2014 No physical product yet

16. Discussion Points Where’s the regulation? Do business owners have a responsibility for safety or efficacy? What are similar cognitive enhancing markets that could avoid FDA regulations? What other ‘homebrew’ technologies could be commercialized? How?