title: 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.
authors.affiliation: Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Leigh
authors.initials: L
authors.lastname: Charvet
authors.affiliation: Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Dobbs
authors.affiliation: Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
authors.forename: Ariana
authors.initials: A
authors.lastname: Frontario
authors.affiliation: Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Sherman
authors.affiliation: Engineering Department, City College of New York, New York, NY, USA.
authors.forename: Marom
authors.initials: M
authors.lastname: Bikson
authors.affiliation: Soterix Medical, New York, NY, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Datta
authors.affiliation: Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Krupp
authors.affiliation: Engineering Department, City College of New York, New York, NY, USA.
authors.forename: Esmail
authors.initials: E
authors.lastname: Zeinapour
authors.affiliation: School of Health Technology and Management, Stony Brook Medicine, Stony Brook, NY, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kasschau
mesh_terms: D000328:Adult; D000368:Aged; D001288:Attention; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D065908:Transcranial Direct Current Stimulation / Q000379:methods*
keywords: Cognitive; multiple sclerosis; remotely supervised; tDCS; telerehabilitation