A telehealth tDCS approach to decrease cannabis use: Towards reducing multiple sclerosis disability in multiple sclerosis

项目总结/摘要 大麻被多达一半的美国人使用，超过100万人患有多种神经系统疾病。 硬化症（MS）是影响工作年龄的成年人的最常见的慢性和进行性CNS疾病。 越来越多的证据表明，大麻的使用实际上使许多人患上了MS残疾， 认知障碍的常见（>75%）致残特征。然而，对于许多寻求 减少或停止使用，几乎没有任何可用的干预措施， 调查人员只建议停止调查。 为了满足这一关键需求，我们的专家团队将我们在使用非侵入性脑 刺激MS，以其在物质使用障碍治疗中的既定应用。虽然神经 导致这种成瘾循环的神经回路是众所周知的，但目前还没有基于神经回路的治疗方法 用于大麻使用障碍（CUD）治疗。我们提出了一种新颖且易于扩展的方法， 由于其远程医疗服务，所有研究程序都可以在家中完成，因此非常容易获得。 我们的创新方法将使用重复的经颅直流电刺激（tDCS） 应用于背外侧前额叶皮层（DLPFC），作为负面情绪的目标， 这是造成物质使用混乱的原因之一。Koob & Koobow的三阶段模型的核心特征是， 成瘾，负面影响都是无序使用的结果，也是持续使用的驱动力。因此我们假设 在这种情况下减少痛苦将导致大麻使用的减少。我们克服了一个主要的限制， tDCS的临床评价迄今为止与我们的远程协议，使访问治疗，并提供扩展 充分评估其累积效益的治疗。 我们将招募MS和CUD患者的现成样本，每天评估20例（M-F） 为期一个月的会议，使用RS-tDCS作为减少痛苦（目标1）和减少大麻使用（目标 2）。由于tDCS理想地与并发活动配对，以增加益处并保持一致的“大脑状态” 为了评估其效果，刺激将与引导正念冥想配对。结合这一 评估，我们将收集认知和症状的措施，以达到我们的最终目标，评估其 对疾病负担的影响。我们将收集干预后1个月、2个月和3个月的随访结果。 公共卫生意义：我们将开创RS-tDCS远程医疗干预的先河， 停止大麻，在MS患者中进行评估，适用于许多慢性 大麻可能导致他们残疾的大脑疾病。随着2019冠状病毒病大流行 前所未有的物质使用障碍率，对可扩展的远程治疗的需求， 远程医疗行为技术的应用更为重要。

Project Summary/Abstract Cannabis is used by up to half of the U.S. >1 million people living with the neurologic condition of multiple sclerosis (MS), which is the most common chronic and progressive CNS disease to affect adults of working age. Growing evidence shows that cannabis use actually worsens MS disability for many, and specifically contributes to the commonly (>75%) disabling feature of cognitive impairment. However, for the many patients seeking to reduce or discontinue their use, there are few if any accessible interventions available, leaving both clinicians and investigators to only counsel for its discontinuation. To meet this critical need, our expert team connects our extensive work in the use of noninvasive brain stimulation in MS to its established applications in the treatment of substance use disorders. Although the neural circuitry contributing to this cycle of addiction is well known, there are no neural circuit based therapeutics available for cannabis use disorder (CUD) treatment. We propose a novel and readily scalable approach that is highly accessible due to its telehealth delivery that allows all study procedures to be completed form home. Our innovative approach will use repeated sessions of transcranial direct current stimulation (tDCS) applied to the dorsolateral prefrontal cortex (DLPFC) as a target of negative affect that is identified as a key component in perpetuating disordered substance use. A core feature of Koob & Volkow’s 3-stage model of addiction, negative affect both results from disordered use and drives continued use. We therefore hypothesize that reducing distress in this context will lead to reduced cannabis use. We overcome a major limitation in the clinical evaluation of tDCS to date with our remote protocol, enabling access to treatment and providing extended treatments for adequate evaluation of its cumulative benefits. We will recruit a readily available sample of patients with MS and CUD, to evaluate 20 daily (M-F) sessions over one month, using RS-tDCS as a tool to decrease distress (Aim 1) and reduce cannabis use (Aim 2). As tDCS is ideally paired with a concurrent activity to increase benefit and to maintain consistent “brain state” to evaluate its effects, stimulation will be paired with guided mindfulness meditation. In the context of this evaluation, we will collect cognitive and symptomatic measures towards our ultimate objective of evaluating its effects on disease burden. We will collect follow-up outcomes at one-, two- and three-months post-intervention. Public Health Significance: We will pioneer our RS-tDCS telehealth intervention for individuals seeking to discontinue cannabis, evaluated in people living with MS and applicable across the many patients with chronic brain disorders for whom cannabis may contribute to their disability. With the COVID-19 pandemic driving unprecedented rates of substance use disorders, the need for scalable, remote therapeutics that can be coupled with telehealth behavioral techniques is even more critical.