Researchers at New York University’s Langone Medical Center and other institutions have test-driven a new approach to mitigate multiple sclerosis (MS) symptoms, combining transcranial direct current stimulation (tDCS) with cognitive training. Even better for patients, these interventions were performed at home, removing the need for constant clinic visits.
“We’re interested in reducing the symptom burden for people with MS,” said Leigh Charvet, director of research at NYU’s MS Brain Center, in a phone interview. “We’d like patients to be able to follow along in a conversation more quickly, understand context better and keep a few things in working memory for longer.”
The starting point was cognitive training: adaptive games that accommodate a patient’s abilities.
“The games respond in real time,” said Charvet. “If you slow down or are missing some, they will also slow down and meet you there. Or they will speed up with you as you get better. It keeps patients from disengaging.”
The group tested these games in an earlier study, but the benefits were modest and took a long time to accrue. Charvet and colleagues thought non-invasive brain stimulation might synergize with the training.
“We were interested in tDCS as a way of enhancing outcomes – either a faster benefit or a greater benefit – when combined with cognitive remediation,” said Charvet.
Non-invasive brain stimulation is an old idea that’s been experiencing a resurgence over the past decade. With tDCS, the electrical stimulation doesn’t actually make neurons fire, but rather primes them to fire.
“The neurons are more likely to make connections or have the strength of connection based on having the electrical current there to help them fire more readily,” said Charvet.
The telemedicine aspect grew out of the team’s experience with cognitive training. They had sent computers home with patients and reasoned they could layer the tDCS protocol on top, though perhaps with a steep learning curve.
“It’s a headset. Electrodes are inserted in a sponge, which has to be moistened, and placed in the headset,” noted Charvet. “There are a lot of little procedures in there. For MS patients who have trouble with fine motor skills, it can be pretty cumbersome.”
The patients received training in the clinic with follow-up support at home. Their NYU-provided computers were controlled from the lab. Pre-moistened sponges, and other refinements, have gradually made the protocol more patient-friendly.
The results from this pilot study, published in Neuromodulation: Technology at the Neural Interface, were encouraging, if not earth-shattering. Standard neurological and basic attention metrics were mostly unchanged between the study group, which received the tDCS, and the control, which only played the game. However, tDCS definitely benefited complex attention and reaction time.
“Those are both sensitive measures consistent with dorsolateral prefrontal cortex function, which was where we were stimulating,” said Charvet.
In addition, by reducing the travel burden for MS patients, the telemedicine aspect could lead to expanded therapeutic options and ease recruitment for future studies.
With this proof-of-concept out of the way, the researchers hope to optimize dosing, try more sessions and possibly expand the protocol to investigate Parkinson’s disease.
“It looks like tDCS definitely does something in synergy with cognitive training games,” said Charvet. “We would hope that, after additional sessions, the benefits would continue to expand.”
Photo: NYU Langone Medical Center