title: A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation (tDCS) in Multiple Sclerosis (MS).
abstract: Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses low amplitude direct currents to alter cortical excitability. With well-established safety and tolerability, tDCS has been found to have the potential to ameliorate symptoms such as depression and pain in a range of conditions as well as to enhance outcomes of cognitive and physical training. However, effects are cumulative, requiring treatments that can span weeks or months and frequent, repeated visits to the clinic. The cost in terms of time and travel is often prohibitive for many participants, and ultimately limits real-world access. Following guidelines for remote tDCS application, we propose a protocol that would allow remote (in-home) participation that uses specially-designed devices for supervised use with materials modified for patient use, and real-time monitoring through a telemedicine video conferencing platform. We have developed structured training procedures and clear, detailed instructional materials to allow for self- or proxy-administration while supervised remotely in real-time. The protocol is designed to have a series of checkpoints, addressing attendance and tolerability of the session, to be met in order to continue to the next step. The feasibility of this protocol was then piloted for clinical use in an open label study of remotely-supervised tDCS in multiple sclerosis (MS). This protocol can be widely used for clinical study of tDCS.
authors.affiliation: Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kasschau
authors.affiliation: Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Sherman
authors.affiliation: Department of Neurology, Stony Brook Medicine.
authors.forename: Lamia
authors.initials: L
authors.lastname: Haider
authors.affiliation: Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine.
authors.forename: Ariana
authors.initials: A
authors.lastname: Frontario
authors.affiliation: Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine.
authors.forename: Michael
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Soterix Medical, Inc.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Datta
authors.affiliation: Department of Biomedical Engineering, The City College of New York.
authors.forename: Marom
authors.initials: M
authors.lastname: Bikson
authors.affiliation: Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine; Leigh.Charvet@nyumc.org.
authors.forename: Leigh
authors.initials: L
authors.lastname: Charvet
mesh_terms: D002986:Clinical Trials as Topic; D005240:Feasibility Studies; D019983:Guideline Adherence; D006801:Humans; D009103:Multiple Sclerosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D065908:Transcranial Direct Current Stimulation / Q000295:instrumentation / Q000379:methods* / Q000592:standards