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

减少大麻使用的远程医疗 tDCS 方法：减少多发性硬化症中的多发性硬化症残疾

• 批准号: 10389675
• 负责人: Leigh Charvet
• 金额: $ 25.78万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10389675
• 关键词: Adult; Adverse effects; Affect; Age; Anodes; Anxiety; Assessment tool; Automobile Driving; Behavioral; Brain; Brain Diseases; COVID-19; COVID-19 pandemic; Cannabis; Cathodes; Central Nervous System Diseases; Chronic; Cognitive; Consumption; Counseling; Coupled; Data; Data Analyses; Dependence; Disease; Distress; Double-Blind Method; Drug usage; Electrodes; Emotional; Evaluation; Functional Magnetic Resonance Imaging; Future; Goals; Health Services Accessibility; Health Status; Home; Impaired cognition; Individual; Interdisciplinary Study; Intervention; Joints; Knowledge; Left; Linear Regressions; Link; Literature; Marijuana; Measures; Mental Depression; Modeling; Multiple Sclerosis; Neurobehavioral Manifestations; Neurobiology; Neurologic; Outcome; Participant; Patients; Pattern; Perception; Persons; Phase; Prefrontal Cortex; Procedures; Process; Protocols documentation; Public Health; Publications; Questionnaires; Randomized; Regulation; Research Personnel; Rural Community; Sampling; Schedule; Substance Use Disorder; Supervision; Symptoms; Techniques; Testing; Therapeutic; Time; TimeLine; Urban Community; Urine; Work; addiction; base; burden of illness; cannabis withdrawal; craving; data integration; disability; efficacy evaluation; executive function; experience; follow-up; high reward; high risk; innovation; marijuana use; marijuana use disorder; member; mindfulness meditation; multiple sclerosis patient; negative affect; negative emotional state; neural circuit; neuroregulation; noninvasive brain stimulation; novel; post intervention; psychological distress; recruit; reduce symptoms; research clinical testing; substance use treatment; telehealth; tool; video visit

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.

项目摘要/摘要 大麻被多达一半的美国使用，> 100万人患有多个神经系统状况 硬化症（MS），这是影响工作年龄成年人的最常见的慢性和进行性中枢神经系统疾病。 越来越多的证据表明，大麻的使用实际上会使许多人对许多人的残疾恶化，并特别贡献 通常（> 75％）的认知障碍特征。但是，对于许多寻求的患者 减少或停止使用它们，几乎没有任何可访问的干预措施，两位临床医生 调查人员只向咨询咨询。 为了满足这一关键需求，我们的专家团队将我们在使用无创大脑的使用方面联系起来 MS刺激其在治疗物质使用障碍中的已建立应用。虽然中立 导致这种成瘾周期的电路是众所周知的，没有基于神经回路的治疗 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 由于其远程医疗交付，因此可以访问所有学习程序。 我们的创新方法将使用thrancranial直流刺激（TDC）的重复会议 应用于背侧前额叶皮层（DLPFC）作为负面影响的目标，被识别为钥匙 永久使用物质使用的组成部分。 Koob＆Volkow的三阶段模型的核心功能 成瘾，负面影响因素不当和驱动器继续使用。因此，我们假设 在这种情况下，减少困扰将导致大麻使用减少。我们克服了 到目前 对其累积收益进行充分评估的治疗方法。 我们将招募一个随时可用的MS和CUD患者样本，以评估20（M-F） 一个月以上的会议，使用RS-TDC作为减少困扰（AIM 1）和减少大麻使用的工具（AIM 2）。由于TDC与并发活动配对，以增加收益并保持一致的“大脑状态” 为了评估其效果，刺激将与有指导的正念冥想配对。在此上面 评估，我们将收集认知和症状测量，以评估其最终目标 对伯恩疾病的影响。我们将在干预后的一个，两个月和三个月内收集后续成果。 公共卫生的意义：我们将为寻求的个人开创RS-TDCS远程医疗干预措施 终止大麻，对患有MS的人进行评估，并适用于许多慢性患者 大麻可能导致其残疾的脑部疾病。与19号大流行驾驶 史无前例的物质使用障碍率，需要可扩展的远程治疗 使用远程医疗的行为技术更为关键。