CMSC INforMS: Multiple sclerosis - New technology improves cognition
Sunday, February 26, 2017
Posted by: Elizabeth Porco
Multiple sclerosis is a debilitating neurological disease that affects tens of thousands of Americans. While there is yet no cure for the illness, researchers are working hard to understand its causes and mitigate its symptoms. New research investigates the effects of cutting-edge cognitive training technology on people with multiple sclerosis.
Multiple sclerosis (MS) is an often disabling neurological disease that affects one's muscles, vision, mood, and concentration.
MS is estimated to affect anywhere between 250,000-350,000 people in the United States, and 200 new cases of MS are diagnosed each week.
While there is currently no cure for the condition, treatment options are available for reducing the symptoms. The most common therapy consists of steroid drugs, which have been shown to speed up recovery.
A new technology called transcranial direct current stimulation (tDCS) has been recently shown to improve some of the symptoms of MS. The tDCS device was created by Marom Bikson, Ph.D., a professor of biomedical engineering at The City College of New York, in collaboration and Abhishek Datta, Ph.D., the chief technology officer of Soterix Medical.
Researchers from New York University's (NYU) Langone's Multiple Sclerosis Comprehensive Care Center conducted a feasibility study for tDCS, and the results were published in the journal Neuromodulation: Technology at the Neural Interface.
The team was led by Leigh E. Charvet, Ph.D., associate professor of neurology and director of research at Langone's Multiple Sclerosis Comprehensive Care Center.
Studying the impact of tDCS on cognition
During the tDCS procedure, a low-amplitude current that travels through a set of electrodes is placed on the scalp of the participants.
The electric current stimulates the brain's cortex, thus enabling neurons to signal to each other more easily. This, in turn, improves neural connectivity and hastens the learning process that occurs during MS rehabilitation.
For the study, 25 participants used tDCS while playing computer games as part of their brain-training program. The aim of the games was to improve cognitive skills, such as problem-solving abilities, attention, information processing, response time, and other working memory skills.
The tDCS training targeted the brain's dorsolateral prefrontal cortex. This brain region has been associated with fatigue, depression, and cognition - areas that are affected by MS.
The participants underwent the training at home, where they completed 10 sessions of cognitive training while being supervised remotely. A study technician would check in with each participant via online video conferencing, and they were able to control the tDCS dosage remotely. Each session lasted for 20 minutes.
The study also included a control group of 20 participants who also underwent cognitive training, but without tDCS.
The cognitive outcomes were assessed using composite scores that measured performance on standard cognition tests, basic and complex attention tests, as well as response variability.
TDCS improved problem-solving and response time in patients with MS
Overall, the tDCS group scored higher on the cognitive scores than those who just played the brain-training computer games.
Sensitive, computerized measurements of complex attention showed the tDCS group had much greater improvements compared with the control group. The tDCS-trained participants also showed significantly greater response time, and these improvements all increased with the number of sessions. The earliest signs of improvement were observed in complex attention and response time.
The study found no differences in basic attention or standard cognitive measures. According to Charvet, this suggests more treatment sessions may be needed for improvements to show in the patients' day-to-day activities.
"Our research adds evidence that tDCS, while done remotely under a supervised treatment protocol, may provide an exciting new treatment option for patients with multiple sclerosis who cannot get relief for some of their cognitive symptoms.
Many MS medications are aimed at preventing disease flares, but those drugs do not help with daily symptom management, especially cognitive problems. We hope tDCS will fill this crucial gap and help improve quality of life for people with MS."
Leigh E. Charvet
The authors also note this technology could replace hospital visits, which often proves challenging for those living with MS and especially for those whose disease is advancing. However, they also caution against several tDCS products on the market which are available directly to the consumer.
These products, Charvet says, are not backed by clinical research, so he strongly recommends that anyone wishing to try out this technology consult with their physician.
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