At-Home Transcranial Direct Current Stimulation (tDCS) With Telehealth Support for Symptom Control in Chronically-Ill Patients With Multiple Symptoms

Abstract

Transcranial direct current stimulation (tDCS) delivered in multiple sessions can reduce symptom burden, but access of chronically ill patients to tDCS studies is constrained by the burden of office-based tDCS administration. Expanded access to this therapy can be accomplished through the development of interventions that allow at-home tDCS applications.Objective: We describe the development and initial feasibility assessment of a novel intervention for the chronically ill that combines at-home tDCS with telehealth support.Methods: In the developmental phase, the tDCS procedure was adjusted for easy application by patients or their informal caregivers at home, and a tDCS protocol with specific elements for enhanced safety and remote adherence monitoring was created. Lay language instructional materials were written and revised based on expert feedback. The materials were loaded onto a tablet allowing for secure video-conferencing. The telehealth tablet was paired with an at-home tDCS device that allowed for remote dose control via electronic codes dispensed to patients prior to each session. tDCS was delivered in two phases: once daily on 10 consecutive days, followed by an as needed regimen for 20 days. Initial feasibility of this tDCS-telehealth system was evaluated in four patients with advanced chronic illness and multiple symptoms. Change in symptom burden and patient satisfaction were assessed with the Condensed Memorial Symptom Assessment Scale (CMSAS) and a tDCS user survey.Results: The telehealth-tDCS protocol includes one home visit and has seven patient-tailored elements and six elements enhancing safety monitoring. Replicable electrode placement at home without 10–20 EEG measurement is achieved via a headband that holds electrodes in a pre-determined position. There were no difficulties with patients’ training, protocol adherence, or tolerability. A total of 60 tDCS sessions were applied. No session required discontinuation, and there were no adverse events. Data collection was feasible and there were no missing data. Satisfaction with the tDCS-telehealth procedure was high and the patients were comfortable using the system.Conclusion: At-home tDCS with telehealth support appears to be a feasible approach for the management of symptom burden in patients with chronic illness. Further studies to evaluate and optimize the protocol effectiveness for symptom-control outcomes are warranted.

Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review

“…Study design. Of the 16 tDCS studies reviewed, five were double blind randomized controlled trials [26,33,[37][38][39], two were single blind randomized sham controlled trials [31,40], two were pilot studies [25,34], two featured a randomized double-blind cross-over design [22,41], two were open label studies [33,36], one was a multiple case study with four participants [42] and two were single case studies [30,35]. See Table 1 for details.…”

“…Participants either self-administered tDCS (n = 4/16 studies) [22,[38][39][40], administered tDCS with the help of an aide or study partner (n = 6/16 studies) [25,30,31,35,37,41], or could choose what they preferred [42]. Five studies encouraged self-administration, but used a proxy or caregiver if further assistance was required [26,[32][33][34]36] (see Table 1 for details).…”

“…Although the majority of studies employed tDCS training at the baseline testing visit or during the first session at the research center (n = 12/16 studies) [22, 25, 26, 32-34, 36-39, 41, 42], the length, intensity and nature of training varied across research. In most cases training sessions consisted of an instructional video, hands-on tDCS coaching and monitoring by a study technician [26,32,34,36,39,41,42], troubleshooting techniques [26,34,39,41,42], as well as an assessment of the participant's ability to replicate the procedures competently at home [26,[38][39][40][41][42]. Training also incorporated safety assessments, including tolerability testing at the initial clinic visit [25, 26, 32-34, 36, 39, 42] (see Table 2 for details on training).…”

Updated Technique for Reliable, Easy, and Tolerated Transcranial Electrical Stimulation Including Transcranial Direct Current Stimulation

“…For the M1-SO montage, replicable electrode placement was achieved. There were no difficulties with patients' training, protocol adherence, or tolerability 26 . For the bifrontal montage replicable and tolerable stimulation was achieved in both patients with multiple sclerosis and Parkinson's disease 32 , confirming reliable placement was achieved even for self-application in subject with motor deficits.…”

“…The purpose of this article is to demonstrate modern setup procedures for the administration of tDCS and related transcranial electrical stimulation techniques, such as transcranial alternating current stimulation (tACS), transcranial ransom noise stimulation (tRNS) 24 , and transcranial pulsed current stimulation (tPCS) and its variants 25 . This guide demonstrates tDCS using commonly applied montages intended for motor cortex 26 and dorsolateral prefrontal cortex (DLPFC) stimulation…”