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

项目摘要/摘要 在美国100万患有多发性神经症的人中，多达一半的人使用大麻。 硬化症(MS)，这是最常见的慢性和进行性中枢神经系统疾病，影响到工作年龄的成年人。 越来越多的证据表明，大麻的使用实际上会加重许多人的多发性硬化症的残疾，而且特别是对 对于认知障碍的常见(&gt；75%)致残特征。然而，对于许多寻求 减少或停止使用它们，几乎没有可用的干预措施，留下两名临床医生 而调查人员只为它的终止提供法律顾问。 为了满足这一关键需求，我们的专家团队将我们在非侵入性大脑使用方面的广泛工作联系起来 多发性硬化症的刺激对其在物质使用障碍治疗中的既定应用。尽管神经细胞 促成这种成瘾循环的神经回路是众所周知的，目前还没有基于神经回路的疗法。 可用于大麻使用障碍(CUD)治疗。我们提出了一种新颖且易于扩展的方法，即 由于其远程医疗服务，所有研究程序都可以在家中完成，因此非常方便。 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质(DLPFC)，作为负性情绪的目标，被认为是关键 使无序物质使用永久化的组成部分。Koob&Volkow的三阶段模型的一个核心特征 上瘾，对无序使用的结果和继续使用的动力都有负面影响。因此，我们假设 在这方面减少痛苦将导致大麻使用的减少。我们克服了以下方面的主要限制 到目前为止，使用我们的远程方案对TDC进行了临床评估，使患者能够获得治疗并提供更广泛的 充分评估其累积效益的治疗方法。 我们将招募一个现成的MS和CUD患者样本，每天评估20名(M-F) 一个多月的会议，使用RS-tDCS作为减少痛苦(目标1)和减少大麻使用(目标1)的工具 2)。由于tdcs理想地与并行活动配对，以增加收益并保持一致的“大脑状态”。 为了评估其效果，刺激将与引导的正念冥想配对。在此背景下 评估，我们将收集认知和症状措施，以实现我们评估其最终目标的目标 对疾病负担的影响。我们将在干预后1个月、2个月和3个月收集随访结果。 公共卫生意义：我们将开创RS-TDCS远程医疗干预的先河，为寻求 停用大麻，在多发性硬化症患者中进行评估，并适用于许多慢性疾病患者 大麻可能导致其残疾的脑部疾病。随着新冠肺炎大流行的推动 史无前例的物质使用障碍比率，对可扩展的远程治疗的需求 使用远程健康行为技术更是至关重要。

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.