Transcranial Direct Current Stimulation for Post Treatment Lyme Disease

Transcranial Direct Current Stimulation (tDCS) of Brain Fog in Patients With Post Treatment Lyme Disease

The primary purpose of this pilot study is to investigate a novel approach to the treatment of cognitive symptoms that persist despite prior antibiotic treatment for Lyme disease (Post treatment Lyme Disease or PTLD).

Aim 1: The primary aim of this study is to assess whether the processing speed of individuals with PTLD can be enhanced by combining transcranial direct current stimulation (tDCS) with computer based cognitive training games. To achieve this aim, over a 4-week period, all individuals with PTLD will participate in at home adaptive cognitive training combined with either active stimulation or sham stimulation.

Aim 2: To determine if treatment benefit in processing speed is sustained, the study will compare the sham and active groups 8 weeks after completion of study treatment.

Study Overview

• Status: Recruiting
• Conditions: Post-Treatment Lyme Disease
• Intervention / Treatment: Device: Transcranial Direct Current Stimulation (tDCS); Behavioral: Cognitive training

Detailed Description

The primary purpose of this pilot study is to investigate a novel approach to the treatment of cognitive symptoms that persist despite prior antibiotic treatment for Lyme disease (Post treatment Lyme Disease or PTLD).

Processing speed has been shown to be one of the primary areas of cognition affected by PTLD and may be a critical component of "brain fog," an everyday term for the fuzzy/scattered thinking, lack of mental sharpness and forgetfulness commonly reported by PTLD patients. Deficits in processing speed may also relate to fatigue and have broader effects on other aspects of cognitive performance including problems with memory and language.

This study will enroll participants with PTLD (definitive, probable, possible) who will be randomly assigned to one of two treatment groups at a 1:1 ratio. The at-home treatment duration is 30 minutes daily for 20 sessions spanning approximately 4 weeks. Group 1 will receive active transcranial direct current stimulation (tDCS) combined with computer-based cognitive training. Group 2 will receive sham tDCS combined with computer-based cognitive training. The cognitive training exercises are personalized to each user's performance level and are aimed at improving cognitive performance by improving information processing speed.

The study will assess changes in cognitive functioning in the context of tDCS treatment using both formal neuropsychological tests as well as questionnaires regarding cognitive lapses in everyday situations. In addition, the study will be examining whether tDCS will lead to improvements in other aspects of functioning such as mood, fatigue and pain symptoms as measured by clinical rating scales.

• Study Type: Interventional
• Enrollment (Estimated): 110
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ellen Brown, BA; Phone Number: 646-774-7503; Email: eb3048@cumc.columbia.edu
• Study Contact Backup: Name: Mara Kuvaldina, PhD; Phone Number: 646-774-8108; Email: mk4480@cumc.columbia.edu

Study Locations

• United States
  • California
    • San Francisco, California, United States, 94110
      • Recruiting
      • University of California, San Francisco
      • Principal Investigator: Felicia Chow, MD
      • Contact: Piper Chase, BA; Phone Number: 203-822-2116; Email: piper.chase@ucsf.edu
  • New York
    • New York, New York, United States, 10032
      • Recruiting
      • Columbia University Department of Psychiatry
      • Contact: Mara Kuvaldina, PhD; Phone Number: 646-774-8108; Email: mk4480@cumc.columbia.edu
      • Contact: Alex Wetmore, BA; Phone Number: 646-774-7503; Email: aw3661@cumc.columbia.edu
      • Principal Investigator: Brian A Fallon, MD, MPH

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• History of diagnosis of Lyme disease by a health care provider, meeting criteria for either definite or probable or possible LD
• Willingness to provide documentation of prior LD testing and/or related medical records
• Total prior antibiotic treatment for LD was at least 2 courses of antibiotic therapy
• Have cognitive symptoms attributed to Lyme disease that have persisted or returned despite antibiotic therapy
• Current cognitive symptoms interfere with function and/or cause distress
• Have evidence of slowed processing speed on a screening measure
• Participant is willing to be off of antibiotic treatment for tick-borne disease for at least 4 weeks prior to final determination of study eligibility and for the duration of the 12-week study.
• Participant expresses willingness to not start new medications that might affect treatment outcome during the trial (unless medically necessary), and willingness to inform study staff regarding any changes in medication
• Live in the US or Canada and comfortable speaking English
• Age 18-70
• Stable and continuous access to internet service
• Adequate home facilities (enough space, access to quiet and distraction free area)
• Able to commit to the 12-week study period (4 weeks of training sessions and an 8-week post treatment visit)
• Estimated intellectual ability >= 85

Exclusion Criteria:

- Medical Illness: Any of the following: a. Unstable non-Lyme-related chronic medical illness over the last 12 months (e.g., cancer, acute myocardial infarction, labile hypertension) b. Any severe skin disorder or skin sensitive area near stimulation locations (e.g. forehead)

Neurologic: Any of the following:

• History of traumatic brain injury with persistent post-concussive symptoms
• History of seizure disorder or recent (<5 years) seizure history
• History of neurosurgery to the head
• Chronic headaches or migraines of moderate to severe intensity within the last month
• Post stroke deficits that may interfere with assessment
• Any progressive neurodegenerative disorder or other neurological disorders that may interfere with assessment at discretion of the investigator.

Psychiatric: Any of the following:

• History of intellectual disability, or other developmental neurological condition associated with cognitive impairment
• Current primary psychiatric disorder that would interfere with ability to participate
• Current alcohol or other substance use disorder
• Current suicide risk as assessed by the C-SSRS (any level)
• History of suicidal behavior over the last year
• History of a diagnosis of a psychotic disorder, mania or bipolar disorder

• Depression rating of moderate or severe at screening

  • Currently taking opiate-based medications, dissociative drugs (prescribed or illicit), or other medication considered likely to interfere with treatment outcome at the discretion of the investigator. The use of a stable dose of benzodiazepines, anticholinergic agents and non-narcotic pain medications is permitted. The use of an occasional dose of these medications is also permitted, but not within 48 hours of neurocognitive study assessments.
  • Participants whose current daily medication regimen has not been stable for a minimum of 4 weeks prior to final determination of study eligibility
  • Medical device implanted in the head (such as a Deep Brain Stimulator) or in the neck (such as a Vagus Nerve Stimulator), or metal implants in the head or neck
  • Inadequate visual or motor skills needed for regular computer use or to operate study equipment, or inability to provide informed consent
  • Individuals who are pregnant or breastfeeding or planning to become pregnant
  • Lifestyle Considerations: Participants not willing to refrain from beginning, resuming or increasing non study cognitive training or cognitive enhancing supplements/medications or other therapies that might affect treatment outcome

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cognitive training and active tDCS; The cognitive training and brain stimulation sessions are conducted at home at the same time over 30 minutes, 5 days/week, for 4 weeks for a total of 20 sessions. Transcranial direct current stimulation (tDCS) is delivered by a user-friendly device; the participant wears a head-band that allows delivery of a weak electrical current (2mA) through two electrode patches over the forehead. The active stimulation session lasts 30 minutes. The cognitive training tasks are administered via a computer-based program BrainHQ (Posit Science). The BrainHQ adaptive cognitive training tasks have been previously associated with improved processing speed in other populations.	Device: Transcranial Direct Current Stimulation (tDCS); Transcranial direct current stimulation (tDCS) is delivered by a device that has a user-friendly interface and a large-button keypad, making it is easy to use at home. The device delivers a weak electrical current of 2.0 mA that is transmitted through two electrodes placed on the scalp to target the dorsolateral prefrontal cortex region of the brain. The electrodes are easily placed through a headset. The active stimulation session lasts 30 minutes. The inactive (sham) stimulation session will also last 30 minutes.; Behavioral: Cognitive training; The cognitive training tasks are administered via a computer-based program BrainHQ (Posit Science). There are 20 sessions, each 30 minutes a day, conducted over approximately 4 weeks. The BrainHQ adaptive cognitive training tasks have been previously associated with improved processing speed in other populations.
Sham Comparator: Cognitive training and sham tDCS; The cognitive training and brain stimulation sessions are conducted at home at the same time over 30 minutes, 5 days/week, for 4 weeks for a total of 20 sessions. Transcranial direct current stimulation (tDCS) is delivered by a user-friendly device; the participant wears a head-band that allows delivery of a weak electrical current (2mA) through two electrode patches over the forehead. The inactive (sham) stimulation session lasts 30 minutes. The cognitive training tasks are administered via a computer-based program BrainHQ (Posit Science). The BrainHQ adaptive cognitive training tasks have been previously associated with improved processing speed in other populations.	Device: Transcranial Direct Current Stimulation (tDCS); Transcranial direct current stimulation (tDCS) is delivered by a device that has a user-friendly interface and a large-button keypad, making it is easy to use at home. The device delivers a weak electrical current of 2.0 mA that is transmitted through two electrodes placed on the scalp to target the dorsolateral prefrontal cortex region of the brain. The electrodes are easily placed through a headset. The active stimulation session lasts 30 minutes. The inactive (sham) stimulation session will also last 30 minutes.; Behavioral: Cognitive training; The cognitive training tasks are administered via a computer-based program BrainHQ (Posit Science). There are 20 sessions, each 30 minutes a day, conducted over approximately 4 weeks. The BrainHQ adaptive cognitive training tasks have been previously associated with improved processing speed in other populations.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Coding test scale score for acute treatment	The WAIS-IV Coding test is part of the Processing Speed Subtest and consists of three measured abilities, including visual-motor coordination, motor and mental speed, and visual working memory. In this coding task, participants using the key provided at the top of the exercise form draw the symbol under the corresponding number. Subtests yielding scaled scores that sum to derive the full-scale score. The score is the number of correct symbols from 0-133 drawn within a period of 120 seconds. The standardized T-score ranges from 1 to 19 with higher numbers indicating a better outcome/performance.	4 weeks
Coding test scale score for post-treatment follow-up	The WAIS-IV Coding test is part of the Processing Speed Subtest and consists of three measured abilities, including visual-motor coordination, motor and mental speed, and visual working memory. In this coding task, participants using the key provided at the top of the exercise form draw the symbol under the corresponding number. Subtests yielding scaled scores that sum to derive the full-scale score. The score is the number of correct symbols from 0-133 drawn within a period of 120 seconds. The standardized T-score ranges from 1 to 19 with higher numbers indicating a better outcome/performance.	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Composite score of the reaction time measures	Composite score of the reaction time measures (Coding, Choice Reaction Time, Grooved Pegboard, and the Test of Silent Word Reading Fluency-2), measured in Z-scores from -4 to +4 with a higher score representing a better outcome.	4 weeks
Fatigue Severity Scale (FSS) Score	This is a self-reported measure of fatigue. This measure consists of 9 items inquiring about the severity of fatigue in different situations over the past week. Scores for each item range from 1 to 7 where 1 indicates strong disagreement and 7 strong agreements. Higher scores indicate higher levels of fatigue.	4 weeks
General Symptom Questionnaire (GSQ-30) Score	This is a 30 item self-reported measure of symptom burden. The measure asks participants to rate how bothered they have been with a particular symptom over a 2-week time frame. The total score ranges from 0 to 120 with higher score indicating higher symptom severity.	4 weeks
Generalized Anxiety Disorder-7 (GAD-7) Score	This is a measure of severity of anxiety. It has 7 seven items, and the scores range from 0 to 21 with higher scores indicating more pronounced anxiety.	4 weeks
PROMIS Emotional Distress-Depression-Short Form Score	This is a self-reported measure that assesses symptoms of depression during the past 7 days. It has 8 items. Each item ranges from 1 (never) to 5 (always) with higher scores representing more pronounced depression.	4 weeks
Patient-Reported Outcomes Measurement Information System (PROMIS-29) symptom summary score	The PROMIS-29 is a 29 item self-report measure covering 7 symptom domains. The questions are ranked on a 5-point Likert Scale. The PROMIS-29 SPADE score represents the average T-score across the 5 SPADE (sleep disturbance, pain, anxiety, depression, and low energy/fatigue) domains with higher scores indicating greater symptom severity. The SPADE T-score ranges from 20-80 with higher scores indicating more symptom severity.	4 weeks
Cognitive functioning z-score	Measures that include domains of cognitive function that are affected by processing speed (attention, memory, working memory and language fluency). Each measure has a raw score that is converted to z-score that ranges from -4 to +4 with higher score representing a better outcome.	4 weeks
Neuro-QoL Short Form v1.0 - Applied Cognition Score	This is a self-reported measure that assesses cognitive function across neurological conditions. Items are scored on a 5-point scale that uses different language depending on assessment. The questions range from least (1) to most (5) based on frequency of behavior, amount of difficulty, or degree of agreement. Raw scores are converted based on consistent metric (T-distribution) with data from the US general population with a T-score mean of 50 and standard deviation of 10. Higher score indicates a greater degree of reported cognitive difficulties.	4 weeks
Brain Fog Visual Analogue Scale (Brain Fog VAS) Score	This is self-reported measure of cognitive complaints severity (brain fog). It measures the period over the last 7 days, score ranges from 0 to 10 with higher score indicating a higher severity of reported brain fog.	4 weeks

Collaborators and Investigators

• Sponsor: Columbia University
• Collaborators: Steven & Alexandra Cohen Foundation
• Investigators: Principal Investigator: Brian A Fallon, MD, Columbia University

Publications and helpful links

Helpful Links

• Lyme Clinical Trials Network website
• Columbia Univ Medical Center Lyme tDCS Study
• UCSF Lyme tDCS Study

Study record dates

Study Major Dates

• Study Start (Actual): July 14, 2025
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): August 1, 2027

Study Registration Dates

• First Submitted: April 2, 2025
• First Submitted That Met QC Criteria: April 2, 2025
• First Posted (Actual): April 8, 2025

Study Record Updates

• Last Update Posted (Actual): May 6, 2026
• Last Update Submitted That Met QC Criteria: May 1, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: tDCS; Neuromodulation; Lyme Disease; Brain Stimulation; Cognitive training; Brain Fog; Chronic Lyme
• Additional Relevant MeSH Terms: Vector Borne Diseases; Post-Infectious Disorders; Pathologic Processes; Chronic Disease; Disease Attributes; Behavioral Symptoms; Infections; Bacterial Infections; Bacterial Infections and Mycoses; Gram-Negative Bacterial Infections; Borrelia Infections; Spirochaetales Infections; Tick-Borne Diseases; Fatigue; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Post-Lyme Disease Syndrome; Lyme Disease; Mental Fatigue; Therapeutics; Patient Care; Health Services; Health Care Facilities Workforce and Services; Behavioral Disciplines and Activities; Rehabilitation; Aftercare; Continuity of Patient Care; Electric Stimulation Therapy; Convulsive Therapy; Psychiatric Somatic Therapies; Electroshock; Psychological Techniques; Neurological Rehabilitation; Transcranial Direct Current Stimulation; Cognitive Training
• Other Study ID Numbers: AAAV1512

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No