Abstract Details

Title Can Tele-Monitored transcranial Direct Current Stimulation (tDCS) Help Manage Fatigue and Cognitive Symptoms in Parkinson’s disease?

Topic Movement Disorders

Presentation(s) S55 - Movement Disorders: Neuromodulation, Circuits, and Management (4:18 PM-4:30 PM)

Poster/Presentation
Number 005

Objective To assess feasibility and explore the therapeutic potential of tele-monitored transcranial direct current stimulation (tele-tDCS) paired with cognitive training (CT) for PD patients. Clinical outcomes included fatigue, mood, motor and other non-motor symptoms.

Background Fatigue is one of the most prevalent and under-assessed non-motor symptoms in Parkinson’s disease (PD). Current therapies have limited effectiveness. Presently, tDCS has shown potential to improve certain symptoms of PD. We designed a tDCS protocol to allow study participation from the patient’s home.

Design/Methods Double-blind, randomized, sham controlled study of tele-tDCS paired with CT. Participants completed 20 daily tele-tDCS sessions (20-minute, 2.0-mA, F3-F4 bifrontal montage, left anodal).

Results

31 participants were screened, 29 enrolled (one screen failure); one participant withdrew consent, one participant is active.

Tolerability and Safety: stimulation with ≤6 on visual analog scale for pain was 100%. Adverse events were comparable with previously published studies using conventional tDCS in lab settings. There were no serious adverse events.

Compliance: 530 tele-tDCS sessions were performed with 100% compliance. One participant withdrew consent.

Clinical Outcomes: Fatigue Severity Scale (FSS): both groups showed a decrease on FSS, however these improvement did not reach significance (p>0.05). Further analysis of 20 RS-tDCS sessions (in the subset of participants receiving real RS-tDCS and completing the extra 10 open label sessions) showed a significant decrease in mean FSS of 10.5 (SD 10.7) points (p=0.27) representing 23% of improvement.

Exploratory Outcomes: there were significant improvements in fatigue (PROMIS fatigue), depression (BDI), sleep (PROMIS sleep impairment) and non-motor symptoms of PD (NMSS). The Holm-Bonferroni method was used for multiple comparisons.

Conclusions At-home RS-tDCS therapy paired with CT is safe and well tolerated by PD patients, with the advantages of ease of recruitment and optimal subject compliance. At-home tele-tDCS therapy shows potential to remediate PD symptoms. Our paradigm may be influential in designing future studies.

Authors/Disclosures
Kush Sharma, MBBS PRESENTER	Dr. Sharma has nothing to disclose.
Shashank Agarwal, MD, MBBS (RWJBH Cooperman Barnabas Medical Center)	Dr. Agarwal has nothing to disclose.
	No disclosure on file
Alberto Cucca, MD (The Marlene and Paolo Fresco Institute for Parkinsons and Movement Disorders)	No disclosure on file
Steven Frucht, MD (New York University Medical Center)	Dr. Frucht has nothing to disclose.
Andrew S. Feigin, MD (NYU Langone Health)	Dr. Feigin has received personal compensation for serving as an employee of Rho, Inc.. Dr. Feigin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Kenai. Dr. Feigin has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ADCS/ATRI. Dr. Feigin has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PTC. Dr. Feigin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Feigin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. The institution of Dr. Feigin has received research support from Huntngton Study Group. The institution of Dr. Feigin has received research support from Prilenia.
Milton Biagioni, MD (UCB Biopharma SRL)	No disclosure on file

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