The woman sits alone at her desk, a laptop before her and a large plastic tackle box at her side. She pops open the box and removes a headset wired to a handheld device by a set of red and black electrical cables. After snapping a pair of moistened sponges to the front of the headpiece, she slips the rig over her head. On the laptop, a technician supervising the setup via a video link conducts a safety check, then provides the woman with a four-digit code that will unlock the device. Once activated, it sends a mild pulse of electricity into her brain.
It may sound like a scene from a high-tech spy thriller, but this setup is actually part of a first-of-its-kind experimental treatment offered by NYU Langone’s Multiple Sclerosis Comprehensive Care Center. The goal is to relieve the debilitating fatigue and cognitive impairment commonly caused by multiple sclerosis (MS), a neurodegenerative disease that affects an estimated 400,000 Americans and 2 million people worldwide. “We’re always looking for new ways—especially nonpharmaceutical ways—to treat these symptoms and enhance quality of life in patients with MS,” says clinical neuropsychologist Leigh Charvet, PhD, the center’s research program director, who—along with the center’s director, Lauren Krupp, MD, the Nancy Glickenhaus Pier Professor of Pediatric Neuropsychiatry—joined NYU Langone last year from Stony Brook Medicine.
In MS, the body’s immune system mounts an attack on the protective myelin sheath that covers the nerves in the central nervous system. The symptoms—wide ranging and often debilitating—include muscle weakness, muddled thinking, severe exhaustion, and depression. With the cause of MS unknown, therapies are aimed at managing the symptoms, with varied success. “There is no FDA-approved therapy for fatigue or cognitive impairment associated with the disease,” notes Dr. Krupp. Antidepressants are notoriously hit or miss.
This is where the electrodes come in. Some studies suggest that a mild form of electrical stimulation called transcranial direct-current stimulation, or tDCS, can boost brain activity and improve cognition and mood. But the supporting science is limited. Most of the trials to date have included very few subjects or used only one or two sessions. Moreover, few studies have tested the technique on people with MS—owing, perhaps, to the nature of the disease. “It’s a real drain for patients to travel in for therapy day in and day out,” explains Dr. Charvet. “Many of them juggle work and family obligations or are so disabled that they are dependent on a caregiver or don’t have access to transportation.”
As a solution, Dr. Charvet has sought to adapt the procedure so that it can be performed in the home with online supervision from a technician. Remote monitoring is not only easier for patients, but it has enabled her team to conduct a large number of treatment sessions—enough to see meaningful results—while maintaining the standards of an in-clinic visit.
Initial tests indicate that remote monitoring works. In a recently completed trial, participants were sent home with computers and asked to play customized brain-training games as members of Dr. Charvet’s team tracked their progress from the clinic. The results showed that participants displayed a significant improvement in mental function, and just as important, demonstrated that remote monitoring can be used successfully to provide cognitive rehabilitation outside a clinical setting.
To test this approach with tDCS, Dr. Charvet has since collaborated with a biomedical engineer and medical device manufacturer to custom-design a device and a headset tailored to people with MS. The apparatus delivers a mild current to the dorsolateral prefrontal cortex, a part of the brain, just behind the forehead, involved in mood, alertness, and some aspects of cognition. The stimulation program runs for 20 minutes, during which subjects are observed as they engage in a variety of cognitive exercises on the computer.
“We’re always looking for new ways—especially nonpharmaceutical ways—to treat these symptoms and enhance quality of life in patients with MS.”
—Leigh Charvet, PhD, Clinical Neuropsychologist
The debut trial, conducted on 25 patients, demonstrated that the method was safe and feasible. “We had over 96 percent compliance, and we never had to discontinue a session because of pain or tolerability issues,” says Dr. Charvet, who published her findings last year in the journal Neuromodulation. The study also showed positive effects on information-processing speed, mood, and fatigue. “These are the kinds of things that people with MS really struggle with,” explains Dr. Krupp. Some participants even showed improved gait and overall physical activity. “That was totally unexpected,” she adds. “So I think there’s a tremendous amount of promise with this approach, which is offered only at NYU Langone.”
How much of the benefit stems from electrical stimulation instead of, say, the daily online interaction with a supportive technician or the simple feeling of being helped? To find out, the team recently extended their study to include a placebo condition.
Whatever the mechanism, Dr. Charvet believes the at-home protocol could potentially help mitigate symptoms from a broad range of conditions. She’s now collaborating with researchers at NYU Langone’s Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders to test whether it can be adapted for use in Parkinson’s disease. “This tool is perfectly aligned with our clinical mission to enhance patients’ potential and minimize their symptoms,” says Dr. Krupp.