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

Abstract

Objective: To explore the efficacy of remotely-supervised transcranial direct current stimulation (RS-tDCS) paired with cognitive training (CT) exercise in participants with multiple sclerosis (MS).

Methods: In a feasibility study of RS-tDCS in MS, participants completed ten sessions of tDCS paired with CT (1.5 mA × 20 min, dorsolateral prefrontal cortex montage). RS-tDCS participants were compared to a control group of adults with MS who underwent ten 20-min CT sessions through the same remotely supervised procedures. Cognitive outcomes were tested by composite scores measuring change in performance on standard tests (Brief International Cognitive Assessment in MS or BICAMS), basic attention (ANT-I Orienting and Attention Networks, Cogstate Detection), complex attention (ANT-I Executive Network, Cogstate Identification and One-Back), and intra-individual response variability (ANT-I and Cogstate identification; sensitive markers of disease status).

Results: After ten sessions, the tDCS group (n = 25) compared to the CT only group (n = 20) had significantly greater improvement in complex attention (p = 0.01) and response variability (p = 0.01) composites. The groups did not differ in measures of basic attention (p = 0.95) or standard cognitive measures (p = 0.99).

Conclusions: These initial findings indicate benefit for RS-tDCS paired with CT in MS. Exploratory analyses indicate that the earliest tDCS cognitive benefit is seen in complex attention and response variability. Telerehabilitation using RS-tDCS combined with CT may lead to improved outcomes in MS.

Keywords: Cognitive; multiple sclerosis; remotely supervised; tDCS; telerehabilitation.

Conflict of interest statement

Conflict of Interest: CUNY has patents with Marom Bikson as inventor. Marom Bikson is an advisor for and has equity in Soterix Medical. CUNY has patents with Abhishek Datta as inventor. Abhishek Datta is an employee and has equity in Soterix Medical. The remaining authors have no potential conflicts of interest to declare.

For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/WileyCDA/Section/id-301854.html

© 2017 International Neuromodulation Society.

Figures

Figure 1

Working memory CT is associated with increased perfusion of left precentral gyrus/frontal middle gyrus/superior frontal gyrus. The “OLE” DLPFC tDCS montage is optimized to target similar regions (62). [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Change z-scores from baseline to follow-up are graphed. The directionality of scores have been adjusted so that positive change values indicate improvement and negative values indicate worsening (indicated by a †). Sample sizes and characteristics are listed in Table 3. (*) represent significant difference (p ≤ 0.05) as determined by two-tailed independent samples t-test.