Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis

Background Fatigue is a common and debilitating feature of multiple sclerosis (MS) that remains without reliably effective treatment. Transcranial direct current stimulation (tDCS) is a promising option for fatigue reduction. We developed a telerehabilitation protocol that delivers tDCS to participants at home using specially designed equipment and real-time supervision (remotely supervised transcranial direct current stimulation (RS-tDCS)). Objective To evaluate whether tDCS can reduce fatigue in individuals with MS. Methods Dorsolateral prefrontal cortex left anodal tDCS was administered using a RS-tDCS protocol, paired with 20 minutes of cognitive training. Here, two studies are considered. Study 1 delivered 10 open-label tDCS treatments (1.5 mA; n = 15) compared to a cognitive training only condition (n = 20). Study 2 was a randomized trial of active (2.0 mA, n = 15) or sham (n = 12) delivered for 20 sessions. Fatigue was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS)—Fatigue Short Form. Results and conclusion In Study 1, there was modest fatigue reduction in the active group (−2.5 ± 7.4 vs −0.2 ± 5.3, p = 0.30, Cohen’s d = −0.35). However, in Study 2 there was statistically significant reduction for the active group (−5.6 ± 8.9 vs 0.9 ± 1.9, p = 0.02, Cohen’s d = −0.71). tDCS is a potential treatment for MS-related fatigue.

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“…During the 20-minute stimulation period, participants completed cognitive training games targeting processing speed and working memory. 34 …”

Section: Methodsmentioning

confidence: 99%

Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial

et al. 2017

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“…To this end, Charvet and colleagues proposed 8 recommendations, which we followed in this study [29]. The same team applied these principles in a remotely-supervised tDCS randomized clinical trial (RCT) associated with cognitive training in patients with multiple sclerosis [30]. This study showed not only the feasibility of such a design in a large population but also the efficiency of combining tDCS with other rehabilitation procedures as abovementioned.…”

Section: G Martens Et Al / Brain Stimulation XXX (2018) 1e9mentioning

confidence: 97%

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Martens¹,

et al. 2018

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a b s t r a c tBackground: Patients with chronic disorders of consciousness face a significant lack of treatment options. Objective: We aimed at investigating the feasibility and the behavioral effects of home-based transcranial direct current stimulation (tDCS), applied by relatives or caregivers, in chronic patients in minimally conscious state (MCS). Methods: Each participant received, in a randomized order, 20 sessions of active and 20 sessions of sham tDCS applied over the prefrontal cortex for 4 weeks; separated by 8 weeks of washout. Level of consciousness was assessed using the Coma Recovery Scale-Revised before the first stimulation (baseline), at the end of the 20 tDCS sessions (direct effects) and 8 weeks after the end of each stimulation period (long-term effects). Reported adverse events and data relative to the adherence (i.e., amount of sessions effectively received) were collected as well. Results: Twenty-seven patients completed the study and 22 patients received at least 80% of the stimulation sessions. All patients tolerated tDCS well, no severe adverse events were noticed after real stimulation and the overall adherence (i.e., total duration of stimulation) was good. A moderate effect size (0.47 and 0.53, for modified intention to treat and per protocol analysis, respectively) was observed at the end of the 4 weeks of tDCS in favor of the active treatment. Conclusions: We demonstrated that home-based tDCS can be used adequately outside a research facility or hospital by patients' relatives or caregivers. In addition, 4 weeks of tDCS moderately improved the recovery of signs of consciousness in chronic MCS patients.© 2018 Elsevier Inc. All rights reserved. IntroductionPatients who suffered from a severe brain injury and stay with a disorder of consciousness (DOC) represent a challenging population to treat since, by definition, these patients are unable to communicate, and therefore to participate in active rehabilitation programs. Currently, their treatment options are limited, especially in the chronic setting. Several drugs to improve the level of consciousness have been studied (e.g., zolpidem, levodopa or baclofen) [1]. However, so far, only amantadine showed significant clinical effects [2]. Recently, transcranial direct current stimulation (tDCS) showed promising results in patients in a minimally conscious state (MCS e i.e., showing fluctuating but reproducible signs of consciousness, such as response to command or visual pursuit for instance, while being unable to functionally communicate) while patients in unresponsive wakefulness syndrome (UWS e i.e., only showing cyclic eye-opening and reflexive behaviors) seem to be less responsive to that treatment. We demonstrated that a single session of tDCS, applied with the anode over the left dorsolateral prefrontal cortex (DLPFC) and the cathode over the contralateral supraorbital area, induced transient clinical improvement [4], as

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“…Charvet et al report on a randomized, open‐label clinical trial in multiple sclerosis patients undergoing either computer‐based cognitive training or cognitive training + tDCS. The combined treatment was superior to cognitive training alone in terms of cognitive processing.…”

Section: Resultsmentioning

confidence: 99%

Home Use, Remotely Supervised, and Remotely Controlled Transcranial Direct Current Stimulation: A Systematic Review of the Available Evidence

Palm

Kumpf

Behler

et al. 2018

Neuromodulation: Technology at the Neural Interface

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Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis

Cited by 74 publications

References 89 publications

Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial

Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Home Use, Remotely Supervised, and Remotely Controlled Transcranial Direct Current Stimulation: A Systematic Review of the Available Evidence

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