Episode 24

full
Published on:

7th Jun 2025

Dr. Charvet & Dr. Pilloni - #24 - June 7, 2025

Exploring Remote Neurostimulation in Multiple Sclerosis: A Conversation with Drs. Charvet and Pilloni

In this episode of the Neurostimulation Podcast, Dr. Michael Passmore from the University of British Columbia engages with Dr. Leigh Charvet and Dr. Giuseppina Pilloni, who break down their research on remotely supervised transcranial direct current stimulation (RS-tDCS). Their discussion focuses on the feasibility, safety, and real-world applications of home-based neurostimulation treatments for multiple sclerosis (MS), targeting symptoms like fatigue and hand dexterity. They also explore broader implications for the future of personalized and accessible neurorehabilitation and explain the mechanisms and potential of tDCS as a complementary treatment option, extending to areas like depression and addiction. The episode underscores the promise of integrating therapy into the home, providing valuable insights for clinicians, researchers, and individuals living with neurological disorders.

NYU Langone Clinical tDCS Service Program

https://nyulangone.org/care-services/tdcs-program?cid=sem_google&sem_campaign_id=22139905662&sem_ad_group_id=&sem_creative_id=&gad_source=1&gad_campaignid=22139906628&gbraid=0AAAAAC9qk2v7bAhjNaz7bDanP8kgj4JsH&gclid=CjwKCAjwo4rCBhAbEiwAxhJlCTSji-MZmNiT9pziGg86R4hb7Mst8JAEHawsJKYB3-vob28tdL4D0RoC2B0QAvD_BwE

Clinical Research Study: HRV-Guided tDCS: Integrating a Biomarker for Clinical Utility https://clinicaltrials.med.nyu.edu/clinicaltrial/2591/hrv-guided-tdcs-integrating-biomarker/


Clinical Research Study: Home-Based Transcranial Direct Current Stimulation (tDCS) for Depression in Multiple Sclerosis

https://clinicaltrials.gov/study/NCT06901687?cond=multiple%20sclerosis%20&intr=tDCS&rank=1


NYU Langone’s Neuromodulation Lab

https://med.nyu.edu/research/charvet-lab/


Publications

https://med.nyu.edu/research/charvet-lab/publications


00:00 Introduction to the Neurostimulation Podcast


02:06 Today's Episode: Remote Supervised tDCS for MS


03:38 Meet the Experts: Dr. Charvet and Dr. Pilloni


04:24 Dr. Charvet's Journey in Neurostimulation


06:18 Dr. Pilloni's Background and Research


08:30 The Importance of Remote Neurostimulation


11:05 Study Design and Methodology


13:11 Results and Implications of the Study


21:18 Challenges and Future Directions


26:50 Exploring Integrated Markers for Treatment Guidance


28:12 The Role of Biomarkers in Depression Studies


30:16 Mechanistic Studies and Brain Perfusion Insights


33:01 Broad Activation and Neuroplasticity


34:09 tDCS as a Complementary Treatment


37:09 Challenges and Safety in Home-Based tDCS


41:12 Accessibility and Future Directions


44:57 Cannabis Use and Neurostimulation


47:52 Closing Thoughts and Future Prospects


51:12 Final Remarks and Podcast Wrap-Up

Transcript
Mike:

Welcome to the Neurostimulation Podcast.

2

:

I'm Dr.

3

:

Michael Passmore, clinical associate

professor in the Department of

4

:

Psychiatry at the University of

British Columbia in Vancouver, Canada.

5

:

The Neurostimulation Podcast is about

exploring the fascinating world of

6

:

neuroscience in general and clinical

neurostimulation in particular.

7

:

Every week we are going to explore

how neurostimulation works, what are

8

:

the latest research breakthroughs and

how that research is being translated

9

:

into real world treatments that

can improve health and wellbeing?

10

:

So whether you are a healthcare

professional, a researcher, a student, or

11

:

just somebody who's curious about how our

brains work and what we can do to help

12

:

them work better, this podcast is for you.

13

:

My mission is to make the

science accessible, inspiring,

14

:

and relevant to your life.

15

:

This podcast is separate from my clinical

and academic roles, and as part of my

16

:

personal effort to bring neuroscience

education to the general public.

17

:

Accordingly, I would like to emphasize

that the information shared here is

18

:

for educational purposes only and not

intended as medical advice or a substitute

19

:

for professional medical guidance.

20

:

Always consult with your healthcare

provider to discuss your specific

21

:

health needs and treatment options.

22

:

Today's episode is presented

by ZipStim Neurostimulation.

23

:

ZipStim is the neurostimulation

clinic that I operate.

24

:

You can find out more about our clinical

neurostimulation programs at zipstim.com.

25

:

That's Z-I-P-S-T-I-M.com.

26

:

Today's episode dives into one of the most

exciting frontiers in neurostimulation,

27

:

remote supervised transcranial direct

current stimulation, or RS-tDCS, and

28

:

in particular, we're going to have

a discussion today about  RS-tDCS'

29

:

potential to transform care for

people living with multiple sclerosis.

30

:

I'm joined by two leading

voices in this space, Dr.

31

:

Charvet and Dr.

32

:

Pelloni, specializing in

neurostimulation research.

33

:

Together, they've led a series of class

1 sham-controlled trials evaluating

34

:

home-based tDCS paired with cognitive

and motor training for multiple sclerosis

35

:

symptoms like fatigue and hand dexterity.

36

:

Their work not only demonstrates

feasibility and safety, but it also lays

37

:

the foundation for scalable, accessible

and personalized neurostimulation

38

:

in the neurorehabilitation

field, delivered right from home.

39

:

In this conversation, we're going to

unpack the design of their study, the

40

:

results, challenges that they experienced,

and the real world implications of

41

:

their research and what it means for

the future of remote neurostimulation.

42

:

So stay tuned.

43

:

I think you're really going

to enjoy this conversation.

44

:

Welcome back to the

Neurostimulation podcast.

45

:

I'm really excited today

to be joined by Dr.

46

:

Leigh Charvet and Dr.

47

:

Guiseppina Pelloni.

48

:

Drs.

49

:

Charvet and Pelloni are lead authors on a

really interesting study entitled Remotely

50

:

Supervised Transcranial Direct Current

Stimulation: Results from two Class 1

51

:

sham-controlled home-based, randomized

controlled trials in multiple sclerosis.

52

:

Dr.

53

:

Charvet and Dr.

54

:

Pelloni, thanks so much

for joining me today.

55

:

Dr. Charvet:

56

:

Thanks so much for having us.

57

:

Yeah, thank you so much.

58

:

It's a pleasure.

59

:

Mike: Oh, great.

60

:

Maybe we could start by you introducing

yourselves, helping us to understand

61

:

more about your work and your background,

and then we can launch into a discussion

62

:

about this really interesting study.

63

:

Dr. Charvet:

64

:

I'll go ahead and start.

65

:

I'm older, so I'm a clinical

neuropsychologist by background and

66

:

have a long history working with people,

living with MS, and many other conditions.

67

:

And as a neuropsychologist my entire

clinical research program and career

68

:

has been driven by recommendations.

69

:

What can we do and say to help people

improve their quality of life now

70

:

living with burden of neurologic

disease or psychiatric disease.

71

:

And there's so many lifestyle

interventions and non-drug interventions

72

:

in particular that are really

interesting to me to see if we can

73

:

again, help people augment what their

therapies are to try to improve things.

74

:

And so I was an early adopter of

tele rehabilitation for cognitive

75

:

remediation doing cognitive

remediation to study it, but at home.

76

:

And I did a home-based tele

rehabilitation trial with brain training.

77

:

And that was a aha moment in that

we were overwhelmed really by

78

:

people who wanted to participate.

79

:

We rapidly enrolled and this trial

happened to be 60 hours of training over

80

:

12 weeks, and we had really high fidelity

to treatment, our completion rates.

81

:

And so I was convinced then that was

the way to go, was that people wanted,

82

:

these things that you have to do

repeatedly to get the benefit, need to

83

:

be at home right away to study even.

84

:

That's what brought me to tDCS.

85

:

After that trial, I was fortunate

to connect with biomedical

86

:

engineers, in particular Dr.

87

:

Marone Dixon at City College.

88

:

And he was very interested in home-based

tDCS, and so we partnered in that

89

:

way and developed our whole research

program that's 12 years old now which

90

:

we can't believe, and also has an

offshoot of a clinical telehealth

91

:

tDCS service we can tell you about.

92

:

But along in that journey, I was really

so fortunate to connect with biomedical

93

:

engineers as partners, and I call

it clinical biomedical engineering

94

:

because of the insights both with, from

engineering and from clinical care.

95

:

It's just a wonderful partnership.

96

:

And that's how I happened upon Dr.

97

:

Pelloni.

98

:

So I'll let her introduce herself.

99

:

Yeah.

100

:

Dr. Pilloni:

101

:

As Leigh mentioned, I'm a

biomedical engineer by background

102

:

and I study and train in Italy.

103

:

And during my master thesis, I like met

with a physical therapist from Brazil

104

:

that she showed me amazing result about

the application of tDCS in in like to

105

:

recover motor function in kids with

cerebral palsy and it was so fascinating.

106

:

And I come from a small island in

the middle of the Mediterranean

107

:

that is called Sardinia.

108

:

And unfortunately we have a very

high rate of multiple sclerosis.

109

:

And it was the time when I was

deciding, oh, should I pursue my faculty

110

:

career or like change in industry?

111

:

And I got the opportunity to apply

for PhD, scholarship in Sardinia and

112

:

propose my own project where I say let

me try, if I'm able to replicate such

113

:

an amazing result in SBR palsy, even

in patient with multiple sclerosis that

114

:

also report like moderate dysfunction,

especially in walking and hyper.

115

:

Upper extremity and during this journey

I was very fortunate and I think

116

:

the faith put me together with Dr.

117

:

Charvet.

118

:

And I was able to spend sometimes here

during my PhD where I did a parallel

119

:

study in patient with MS using tDCS.

120

:

This small study was actually

done here in clinic, but I

121

:

was very fascinating because.

122

:

I, I was the only one in the lab

seeing patient in person and I said

123

:

probably I should now translate this

one, this project, it was in clinic

124

:

where I was seeing everyday patient.

125

:

And I also understand what is

the challenge, especially in

126

:

big city like New York to come

every day for an intervention.

127

:

And I say probably we should re-propose

what I'm doing in home base setting.

128

:

And this is like how.

129

:

I was matched with Dr.

130

:

She and I think we have

very complimentary skills.

131

:

Mike: Yeah, definitely.

132

:

Thanks so much both of

you for that introduction.

133

:

It really, it basically covers one of the

first questions that I had, which was what

134

:

in particular inspired your both of you

and your team to pursue this therapeutic?

135

:

Option for folks with MS in particular.

136

:

But I guess the second question that

I had that follows on from what you

137

:

were just describing is that, with

neurological disorders in general,

138

:

but I think in particular, given the

burden of chronic symptoms in ms, like

139

:

fatigue and cognitive dysfunction,

and obviously the motor deficits.

140

:

Maybe could you explain for viewers

and listeners why it was particularly

141

:

important to explore a neuromodulation

solution that can be delivered remotely

142

:

Dr. Charvet:

143

:

Well, the remote part is for access,

deployability availability and

144

:

sufficient dosing, which is key.

145

:

So It's a fascinating, and

as rapidly evolving world and

146

:

non-invasive brain stimulation.

147

:

We're all the way on

the clinical end, right?

148

:

We're very eager for clinical application.

149

:

But if you look at the clinical

trials, we have thousands of

150

:

clinical trials in PubMed and really

still no, like definitive clinical

151

:

trials outside of depression.

152

:

And that's because.

153

:

low sample sizes, but also underdosing.

154

:

We really believe that you need

at least 20 consecutive sessions

155

:

to evaluate potential for benefit.

156

:

And the vast majority of trials are

10 sessions or less with a lot of five

157

:

session or less, or even single st

application clinical studies reporting.

158

:

And also with variable dosing

parameters, we believe very much

159

:

it should be a paired treatment.

160

:

So that tDCS is functionally targeted

to the region that's engaged in

161

:

a training exercise, even if it's

for something like depression.

162

:

And so that paired treatment

is really a critical part of

163

:

the dosing parameters as well.

164

:

And that's underdressed or under reported.

165

:

And so while we have this huge volume

of work, we, it's very hard to compare

166

:

across trials and it's very hard to have

these definitive trials to guide us.

167

:

To getting to something that we

can deploy to patients right away.

168

:

Mike: So the pairing, yeah it's very

interesting because I think it's

169

:

emerging, obviously as you're describing

that it's because the tDCS is more

170

:

of a priming, I suppose you'd say

in general terms mechanism that the

171

:

pairing then with whatever the, yeah.

172

:

Dr. Charvet:

173

:

Targeted.

174

:

Mike: Yeah.

175

:

Go ahead.

176

:

Dr. Charvet:

177

:

Yeah, like a boost, upregulating

and neuroplasticity and

178

:

reinforcing things That's why we

started with cognitive training.

179

:

So while the brain training

games do work it's a lot of work.

180

:

And so I was thinking could

we potentiate this, right?

181

:

It's get more out of less training

and have it more, be more durable.

182

:

And that's really the

whole start of everything.

183

:

And so tDCS added in our, over and over,

we see this boost added to cognitive

184

:

motor, upper or lower extremity motor

or speech and language training.

185

:

Any kind of training it

will reinforce and boost.

186

:

And then certainly we have other,

targets too as terms of depression

187

:

primarily, and, our work and

fatigue and that kind of thing.

188

:

Mike: So do you mind Yeah, maybe

talking more specifically about this

189

:

study in terms of broad thumbnail

sketch, and then we can talk a

190

:

bit more about the the details.

191

:

Dr. Charvet:

192

:

Yeah.

193

:

I'll start with the

broad sketch and then Dr.

194

:

Poney can start at the details,

but I so our whole goal, and truly

195

:

patient led right to, to try to

develop this in practical way.

196

:

Like how can we use

this in home right away?

197

:

And it was really.

198

:

A lot of work to develop this

very optimized home-based system.

199

:

And and in collaboration with our early

participants who really told us, I can do

200

:

this, I can't do this, that kind of thing.

201

:

So our goal was to facilitate

research to get these trials

202

:

to, that we need these class one

randomized, sham controlled trials.

203

:

And so we did that with the two

trials that we reported in this paper.

204

:

So we've had, so as a single

center nationally recruiting

205

:

for one of them, we've had two.

206

:

Large scale randomized sham controlled

trials one in fatigue and then the other

207

:

in upper extremity motor functioning.

208

:

Looking at that paired activity, we

have gone on unrelated to ms, but

209

:

we've also just last year had a proof

of principle that we can also be the

210

:

single site for delivery of treatment

in multicenter clinical trials

211

:

as well, which is very important.

212

:

So last year we were a single

treating site for the recovered

213

:

nihs, recovered neuros.

214

:

Study, which was evaluating treatments

for long COVID, the cognitive

215

:

involvement or aspects of long COVID,

of which tDCS was one treatment.

216

:

And so we were able to enroll 328 people

across 22 sites in the United States with

217

:

50 sessions of treatment all in one year.

218

:

So all of these, we just

really wanna advertise that we

219

:

believe going home right away.

220

:

First it's gonna be how ultimately

this equipment is used, but that

221

:

right away is a way to accelerate.

222

:

The clinical research that

we need to moving it to

223

:

clinical guidance and approval.

224

:

So

225

:

Mike: yeah

226

:

Dr. Charvet:

227

:

that's the broad overview.

228

:

So those are our two proof of

principle trials and MS with motor.

229

:

And then that we, the period

cognitive fatigue treatment and

230

:

then just also learning that we can

reach a lot of people in this way.

231

:

So it's a very feasible approach.

232

:

Yeah.

233

:

Mike: Yeah.

234

:

Thanks for that.

235

:

Before Dr.

236

:

Polone, before you maybe talk a bit

more about the specifics, I was just

237

:

curious for clarifying, so the class

one designation of the trials, what

238

:

does that refer to specifically?

239

:

Dr. Charvet:

240

:

Yeah, so that's based on the Prisma

guidance level of evidence, and so

241

:

you need two class one trials to meet

that level A requirement for being.

242

:

Considered to be definitively effective.

243

:

So that's parallel, for instance, to

phase three in the pharma industry.

244

:

So you, it needs to be, it needs to

meet certain re design requirements

245

:

and certain size requirements.

246

:

And that's why we refer to that pyramid

and level of evidence in that way.

247

:

Mike: Perfect.

248

:

Yeah.

249

:

Thank you.

250

:

That's I thought so, but I

just thank for clarifying that.

251

:

Dr. Charvet:

252

:

Yeah.

253

:

It's defined differently across

different disciplines but in

254

:

general, these are large definitive.

255

:

Sufficiently designed,

randomized controlled trials

256

:

that are sufficiently rigorous.

257

:

And those are few and far between.

258

:

Unfortunately, in the world of tDCS.

259

:

Mike: Yeah.

260

:

Congratulations for bringing that

together and certainly, so let's

261

:

find out more specifics about it.

262

:

Dr.

263

:

Polone, do you mind telling us a

bit more about the nuts and bolts of

264

:

the study in terms of the inception

and the design and the methodology?

265

:

Dr. Pilloni:

266

:

I.

267

:

Sure.

268

:

So the first study was for, it

was targeting patient with primary

269

:

progressive ms, but with primary

and secondary progressive ms.

270

:

So our patient that they have like

advanced disability, and generally they

271

:

report like limited upper upper limb.

272

:

Limitation in term of not only movement,

but also like manual disparity.

273

:

And so what I wanna also to

highlight that is that TVCS is not.

274

:

Mean to treat a disease per se, but

like we are more focused on treating

275

:

like symptoms related to the disease

and we, it depend on the symptoms

276

:

and on the proactivity that we decide

what kind of brain target we are

277

:

gonna the brain, we are gonna decide.

278

:

The brain target and then

also the electrode placement.

279

:

So for the for this first study

where we enroll primary where we

280

:

enroll progressive patients because

they were completing during the

281

:

tDCS intervention some dexterity

exercise they we decide to target.

282

:

The primary motor cortex placing the

anode that is the active electrode over

283

:

the primary motor, over the primary motor

cortex, and the return electrode over the

284

:

over the controlled supraorbital area.

285

:

So in this way basically our hypothesis

was like the tDCS should like.

286

:

Give a boost of the activation that was

generated by performing simultaneously.

287

:

This patient completed for this

study, 20 daily sessions each last

288

:

the tDCS component last 20 minutes,

but the exercise when we're about

289

:

30 minutes, so they have a little

bit of exercise without tDCS study.

290

:

Toward the end of the session.

291

:

And it was a randomized

sham control study.

292

:

So we have both participant assigned to

active and participant assigned to Sham.

293

:

And they were performing the TER exercise

with both the left and the right hand.

294

:

And was very interesting because

what we found was that patient with.

295

:

That was assigned to the active group,

reported an improvement in hand disparity.

296

:

But even if it was not clinical.

297

:

It was not meaningful from

a clinical point of view.

298

:

This improvement was like

a signal of improvement.

299

:

And this is very important for progressive

patient because they tend to progress.

300

:

So what the rehabilitation should

aim is like really try to preserve

301

:

function in this kind of patient.

302

:

And mainly this one for Leigh.

303

:

Do you wanna talk about the fatigue?

304

:

Mike: Sure, yeah, that'd be great.

305

:

Yeah, I appreciate that.

306

:

Yeah.

307

:

Dr. Charvet:

308

:

Yeah.

309

:

I also have to say, 'cause I'm

a very practical clinician, so

310

:

this was, typically older people

with higher burden of disability

311

:

and they were incredibly good.

312

:

Sports.

313

:

So I can't tell you the amount of

equipment that we sent home with

314

:

them, and that's these huge hand

kits and it was all very feasible.

315

:

So a lot of times early reviewers

would say, oh, people can't do this.

316

:

Or, a little bit ageist of older people

can't adopt technology and and we've

317

:

just, learned all of that is not,

we've had people who just are, have

318

:

never even really used a computer or

a laptop and we can get them through.

319

:

So it was really accessible.

320

:

So that was another thing that

we learned and that study is

321

:

just a very doable approach.

322

:

And so I, this.

323

:

Pair treatment.

324

:

So we're targeting here, the

dorsal lateral prefrontal cortex

325

:

left nodal is the go-to treatment

for cognitive functioning.

326

:

And the idea is that the frontal regions

are, the hub or of selective attention,

327

:

executive networks and that kind of thing.

328

:

In particularly.

329

:

Particularly relevant for people

with MS is that we like to

330

:

enhance speeded processing, right?

331

:

Because that's the first thing

that become slow and then it can

332

:

transfer to new learning and problem

solving and just to speed up things

333

:

to experience a cognitive benefit.

334

:

And that we see that over and over.

335

:

So we did pre speed of processing

training with Brain hq, which are

336

:

these online adaptive cognitive

training games with the frontal tDCS.

337

:

And that's become the standard treatment

really for all things cognition

338

:

across all disorders is what we used

with the long COVID study as well.

339

:

We did a pilot first when we were

developing the methods and while we were

340

:

looking, to add on, we saw just a, a, a.

341

:

Proof of principle signal and

computer-based measures already

342

:

at 10 sessions in our pilot study.

343

:

But our patients also were telling

us they were less fatigued.

344

:

So we in we then did a pilot, showed a

really nice drop with active versus sham

345

:

tDCS and fatigue with that same treatment.

346

:

So this trial was, the

primary outcome was fatigue.

347

:

So patients weren't recruited on the

basis of having cognitive impairment or

348

:

to targeted and the secondary outcome

was cognitive functioning of, so

349

:

really interested just to see as well.

350

:

And so there, this was.

351

:

A 30 session treatment, so for six

weeks, and they did that paired

352

:

cognitive with D-L-P-F-C-T-D-C-S.

353

:

In this trial we didn't see any

fatigue separate between the two

354

:

arms and, but both groups got better.

355

:

So the active dropped just as much in our

pilot as before, but also the sham did.

356

:

That's really an open question of why.

357

:

So it's interesting I'll mention this in

the podcast, is we had an unusual sham.

358

:

It was a very robust, we were

very excited to be, sure that

359

:

we were very much shammed.

360

:

And so over those 20 minutes and each

session there was three injections

361

:

of current ramp up, ramp down.

362

:

So that may have actually mimicked.

363

:

Some active or at least a low dose,

so that could have been one of the

364

:

reasons why we saw a sham response.

365

:

Another reason would be that

the active component could have

366

:

been the cognitive training.

367

:

Also unusual for fatigue trials.

368

:

We excluded on the basis

of depression, so it.

369

:

Could be that depression is mediating.

370

:

What the, we see a lot in

these fatigue benefits.

371

:

So really interesting.

372

:

Everybody got better with fatigue.

373

:

Cognitive though the groups did separate

out, so there was a clear significant

374

:

cognitive benefit for active versus

sham tDCS on things like MS specific

375

:

cognitive batteries at the study end.

376

:

Even though we didn't recruit.

377

:

On the basis of, or role on the

basis of cognitive impairment.

378

:

And interestingly, the cognitive

benefit was greater for people

379

:

with more severe disabilities.

380

:

So higher EDSS scores.

381

:

And the benefit was actually

preventing a little bit of decline.

382

:

So not significant decline, but I just

wanted to mention that as well, because

383

:

we're starting to see in some of the

really newer depressions, dementia

384

:

studies, looking at depression and for

instance, in MCI, early Alzheimer's.

385

:

Looking at that preservation of function

and prevention of decline, yeah.

386

:

Are still really stabilization and

anecdotally in our clinical service,

387

:

our clinical program, a lot of people

use us that way to stabilize themselves

388

:

and prevent decline versus looking

at full recovery back to baseline.

389

:

Mike: Yeah, that's, yeah,

there's a lot there.

390

:

It's complicated.

391

:

I appreciate that.

392

:

That final kind of summary too, 'cause

that's a, I'll start with a question about

393

:

what you were mentioning just before that,

and then maybe we'll just quickly touch

394

:

on that last piece 'cause Yeah, that's

it's subtle, but it's really important.

395

:

The thing that I was wondering about

initially has to do with that difficulty

396

:

in, in distinguishing between these

overlap symptoms like the fatigue, the

397

:

cognition, and the depression, because

it must be challenging to, in a way, to

398

:

control for those in an RCT like this

because conceivably, and I think in

399

:

clinical practice, it's pretty clear that

there's significant overlap with how those

400

:

Dr. Pilloni:

401

:

correct.

402

:

Mike: Are, in incorporated into any kind

of particular underlying neuropsychiatric.

403

:

Pathology and so then would potentially

be prone to becoming treatable

404

:

under the same sort of rubric.

405

:

So that's how is, that's a

406

:

Dr. Charvet:

407

:

great point and especially for

people, they say if you've met

408

:

somebody living with a mass, you've

met one person living with, because

409

:

it's such a variable disease.

410

:

And so everybody has a different

symptom burden and it's multiple,

411

:

and so we call them amplifiers so

that you can turn up or down the

412

:

experience of what what's resulting

directly damage from the disease.

413

:

But that can be, two

people can ha experience.

414

:

Things very differently.

415

:

And the amplifying factors include

things like depression and fatigue

416

:

and all kinds of things like that.

417

:

And so we may be modifying that and look.

418

:

And so we do include now we just

are starting a large, we're really

419

:

excited because this is very end to

clinic use, but a very large, rigorous

420

:

nationally recruiting trial, looking

specifically at depression and Ms.

421

:

With the secondary

outcome of symptom burden.

422

:

So looking at functional

measures, but also just that

423

:

experience of symptom burden.

424

:

So we think that's really important.

425

:

So that's a great point.

426

:

We also though do have people come

to us in our clinical service and was

427

:

like, which symptoms should I target

because I just, things bother me on

428

:

different days or I have multiple

symptoms and that we haven't really

429

:

been able to figure out a path forward

other than doing one thing at a time.

430

:

But but it's really important, what

are we doing here in terms of like

431

:

overall improvement of quality of life?

432

:

Mike: Yeah.

433

:

I guess at the end of the day,

I think it's obviously important

434

:

in terms of the designing and

conducting a study that's rigorous.

435

:

But I guess at the end of

the day, if there's a global

436

:

improvement in some of the,

437

:

Dr. Pilloni:

438

:

Shall we

439

:

Mike: maybe call them soft?

440

:

I hate to use the term softer, but

441

:

Dr. Pilloni:

442

:

Right.

443

:

Softer

444

:

Mike: symptoms in terms of more

symptoms that I suppose would

445

:

be more potentially amenable to

some sort of expectation effect.

446

:

That we'll just take that as a

benefit, as far as what the end

447

:

up clinical impact would be.

448

:

And I guess it would be potentially,

maybe we can touch on this.

449

:

I'll try and come back to

this other issue of the.

450

:

Lemme just jump on that.

451

:

Go ahead.

452

:

Yeah.

453

:

Please do.

454

:

Yeah.

455

:

Yeah.

456

:

Because you

457

:

Dr. Charvet:

458

:

raised such good points.

459

:

Yeah.

460

:

Yeah.

461

:

So one of the words that you used was

soft and I wanna mention that there's soft

462

:

aspects to what we're doing here that we

do think are beneficial, that we really

463

:

don't capture with research measures.

464

:

One of them is, and I saw it just with

the cognitive training study too, it's

465

:

a framework for people to schedule.

466

:

Days, right?

467

:

And so that alone, having a scheduled

activity, that's an action versus a

468

:

passive, receipt of some something.

469

:

It's an activity and action that

you've successfully completed for that

470

:

day, which I, for all of us that has

amazingly sec using secondary benefits.

471

:

And then it's also micro intervention

to have contact even just briefly

472

:

with somebody, we're live with video,

visit with people at every session.

473

:

And so that's definitely at least

a micro intervention in terms of,

474

:

people checking in with you, being

able to report and look at things.

475

:

And I, and we do find that

overall structure helps people.

476

:

Overall, and also we're trying to

measure this now, looking at getting

477

:

from A to B to habit adoption.

478

:

Can you continue pick it up and can

it make, so that, can this be like an

479

:

onboarding period where you have this,

scaffold, scaffolding network that

480

:

can help you adopt these healthier.

481

:

Behaviors and or whatever it may

be to improve things going forward.

482

:

So anyway, I just soft.

483

:

Yeah,

484

:

Mike: it's really interesting.

485

:

Then as you spoke, it made me think that

there's probably something else about,

486

:

someone bringing the equipment home and

just having that sense of agency and

487

:

control over their own as opposed to.

488

:

Presenting themselves to a clinic

that's intimidating and feeling as

489

:

though there's that power differential

in the hierarchy where there's more

490

:

ownership and agency over being that

active participant in the treatment.

491

:

That probably goes a long way also.

492

:

Dr. Charvet:

493

:

I believe in that very much.

494

:

Yes.

495

:

Mike: Yeah.

496

:

I guess it's interesting in terms

of I'm not even sure how exactly

497

:

to frame the question about, but

maybe either of you could expand on

498

:

that a bit in terms of what was the

importance of the consideration around.

499

:

Designing the study in a sense to either

identify benefits in terms of symptom

500

:

improvement versus the notion that you

alluded to there in terms of more of a

501

:

stabilizing to prevent a decline, right?

502

:

Because there's important but subtle

differences there in terms of how

503

:

trials would be conducted that, that

are interesting and I think probably

504

:

often overlooked or not adequately

considered when thinking of the results.

505

:

Dr. Charvet:

506

:

I'll take that and then

I'll pass it to Dr.

507

:

Peloni for some.

508

:

But it we're, we, are just,

we just went for direct.

509

:

Can we move the dial?

510

:

Yeah.

511

:

And prove this specific aspect

of symptoms in a pragmatic way.

512

:

Sure.

513

:

So we're taking people with a lot

going on because we wanted it to

514

:

be pragmatic, to be used, that's

my mission is just persistent.

515

:

But can we move the dial?

516

:

And so we didn't really

think about what happened.

517

:

After the dial had been moved,

how long do you preserve it?

518

:

We don't really have any data.

519

:

And then and then so we just, again,

the, I probably didn't mention this,

520

:

but a in this journey in 2019 out

of patient demand people coming out

521

:

of our trials wanting treatment,

people from all over the country.

522

:

We have A-T-D-C-S telehealth service.

523

:

That's through innovative

care here at NYU.

524

:

And that's people across the country

with all different conditions coming to

525

:

us for individualized tDCS, which has

been really a partnership learning lab

526

:

where we hear all these things, right?

527

:

And so we did notice that people

use us to prevent decline.

528

:

That's a very hard study to

design, but also to sell.

529

:

But I think now we're moving towards that.

530

:

And so that signal that we saw in the

cognitive trial may endorse that as

531

:

also a direction that we should go.

532

:

But we really don't, just because

again, you need the volume of sessions

533

:

and we need markers as well, I think

very importantly, to guide you.

534

:

And that's where I

wanna pass it off to Dr.

535

:

About we think that we might be able

to get some kind of integrated markers

536

:

that could really guide treatment that

would really be a game changer for

537

:

answering some of these questions.

538

:

Yeah.

539

:

Dr. Pilloni:

540

:

And I think here we go back

to what is like all these

541

:

mixed result in all the study.

542

:

Sometimes they are also power enough

and also very well structured.

543

:

But what probably we are missing is the,

we are not assessing the right outcome.

544

:

Because this is a very

like this is I think.

545

:

One of the major issue when you

design a study like it is not only

546

:

like the right dosing, but then also

picking up what is the right outcome.

547

:

And sometimes we just rely on mainly

like self-report scale where like.

548

:

Patient just report, like even for

fatigue, like the study we didn't

549

:

really find any like difference

between sham and active, but we

550

:

also question ourselves sometimes,

probably it's because fatigue is.

551

:

Just mainly self-reported by

patient and probably, and is

552

:

influenced by several other factors.

553

:

So in this context now we are just

starting a study where we are trying

554

:

to see if there is any kind of

biomarker physiological biomarker

555

:

that we can use to see who respond.

556

:

To the intervention.

557

:

If it really like marks then benefit

in this like self-report scale.

558

:

And so we decided to, to run this study

in the patient with mild depression.

559

:

That and the biomarker we decide

to pick is like higher variability.

560

:

We decide for RA variability

because we want to, because first

561

:

of all, in one of our previous

study, some of the patient were.

562

:

Because everyone now is able to track

their heart variability, most reporting.

563

:

Oh, I actually found that my

heart variability improve and

564

:

increased during the intervention

and up, and they were like active.

565

:

So we don't know, but this

is what they reported.

566

:

And then we were very interested because

there is some now literature supporting

567

:

that, like people with depression,

rapport, has lower heart rate variability.

568

:

And so we decide to explore in a

better round, like in a randomized

569

:

and better structure clinical trial

if heart rate variability can be used

570

:

as a biomarker of response to tDCS.

571

:

And in order then to move.

572

:

To the next step.

573

:

That is really trying to do

some closed loop stimulation.

574

:

So trying to really move everything

toward what is like personalized

575

:

non-invasive brain stimulation

that I think is a very hot topic.

576

:

And but these results will come.

577

:

Mike: Yeah.

578

:

Yeah.

579

:

No, that's exciting.

580

:

Definitely looking forward to that.

581

:

And I think what we'll do as well for

viewers and listeners is we'll put

582

:

links in the show notes to not only

the research, but also the clinical

583

:

programs that you're talking about.

584

:

And people are interested.

585

:

They can check that out for sure.

586

:

I guess in terms of the hypothesized

mechanisms, maybe you could, you could

587

:

touch on a little bit about what your

thoughts are around what the study.

588

:

Potentially is telling us about the

underlying mechanisms of tDCS in MS in

589

:

terms of the symptoms that were examined,

fatigue, motor performance, and cognition.

590

:

Dr. Pilloni:

591

:

Do you wanna start?

592

:

I can start and I think it, it's what

you mentioned that we don't do, like

593

:

we do, we just, we do clinical trial,

but we do also some mechanistic study.

594

:

We have, we completed study where we

trying to investigate the real me,

595

:

like trying to understand better what

is the mechanism underlying this.

596

:

Technology using protocol where

we deliver PBCS inside the MRI.

597

:

So to see both functional MRI change

and also change in brain per perfusion.

598

:

So this study was done in collaboration

with our colleague here at NYU

599

:

in the radiology department.

600

:

And basically it was like it was run

both in energy control and MS patient.

601

:

And so we, this, they completed

like a single scan where we

602

:

collect first baseline functional

imaging and then brain perfusion.

603

:

And then we turn on tDCS.

604

:

So there, the patient, the participant.

605

:

Receive the tDCS inside the bo.

606

:

This is with technology that we develop

with Soterix that are like MRI compatible.

607

:

And then we also collect data

about variant fusion and brain

608

:

activation after the end of the tDCS.

609

:

So what we found was very interesting.

610

:

We are still working on the functional

MRI side, but like for the brain

611

:

perfusion, we found that there

was an increase in cerebral blood

612

:

flow when we turned on the tDCS.

613

:

So meaning that like really something is.

614

:

And this change was significant both in

healthy control and in patient with ms.

615

:

The patient with MS has a

much higher like it was much

616

:

higher, the change that we saw.

617

:

And like this means that really, like

we are going to we are activating the.

618

:

We are a, we are like generating

stronger activation of the neuron

619

:

at this and because then this result

also in a higher oxygen consumption.

620

:

But this one, it was interesting

because like you can measure

621

:

perfusion both like in a.

622

:

Target way, like dividing

all the different brain area

623

:

in a glo in a global way.

624

:

So we didn't found, we didn't find

any specific like brain area that

625

:

was more like where this change was

much, there was significantly higher.

626

:

But globally we saw this like increase

in cerebral flow and oxygen consumption.

627

:

So these also make us.

628

:

Thinking how tDCS work.

629

:

That is not really we don't have to think

high like transcranial stimulation, where

630

:

you are very like specific in your target.

631

:

It's more a broad activation that we are

gonna go, we are gonna generate using

632

:

tDCS and probably we are gonna activate

it also other like area of the brain.

633

:

And indirectly.

634

:

Mike: That's, yeah.

635

:

That's interesting.

636

:

I guess that maybe speaks to then

how there would be some overlap

637

:

in terms of symptom improvement

if there's more of a broad Yeah.

638

:

Broad kind of effect.

639

:

Dr. Charvet:

640

:

Yeah.

641

:

And then across disorders, so a lot

of it that's specific findings with

642

:

and some of our participants with ms.

643

:

But there's a lot of just broader.

644

:

Known mechanisms in turn

increasing long-term potentiation

645

:

and that kind of thing.

646

:

And markers of neuroplasticity.

647

:

So that boost is, across disorders.

648

:

There's a lot of both disease specific

but also broad mechanisms at play.

649

:

And so I think we'll know in the few

years how to target tDCS and brain

650

:

stimulation in general to some of

the mechanistic factors specific

651

:

to the disease as we move forward.

652

:

Mike: Yeah.

653

:

Yeah, it's interesting.

654

:

I think in many applications it's

becoming clear that it's likely to

655

:

become it is, and it's increasingly

likely to become more of a

656

:

complimentary kind of treatment and Yes.

657

:

In a, per, in a personalized

sense as you're talking about.

658

:

Absolutely.

659

:

Like to, to not replace, but to

compliment the medication side

660

:

or the physical therapy side.

661

:

Yeah.

662

:

Dr. Charvet:

663

:

That's exactly it, and it's so

deployable so that somebody who's

664

:

in suffering now it should be the

first and not the last choice, right?

665

:

It should be the first choice.

666

:

And it can be provided to people

waiting for an appointment.

667

:

For instance, even if you have depression,

you could do tDCS while you're waiting

668

:

for your psychia psychiatrist appointment.

669

:

So it's.

670

:

So deployable in that way.

671

:

Or if have impairment, sudden

impairment and you're going to

672

:

cognitive or PT or rehabilitation,

you can have tDCS added right away

673

:

to that to enhance the recovery.

674

:

So I really do see that exactly

in the future as alongside and

675

:

enhancing other therapies as well.

676

:

So it doesn't have to replace anything,

but it definitely deserves, a place along

677

:

everything alongside the other treatments.

678

:

Mike: Yeah.

679

:

I'm curious is do you think that there

would be potential for treatment like

680

:

other, more perhaps debilitating symptoms

like the spasticity and different and

681

:

more, perhaps more advanced disease?

682

:

I.

683

:

Dr. Charvet:

684

:

So we think, so Dr.

685

:

Pelloni can talk about spasticity.

686

:

Some, those are harder symptoms,

and it's motor control and also

687

:

there's some evidence with spinal

cord lesions in particular.

688

:

Maybe a specific consideration for

people living within mass scope.

689

:

Dr. Pilloni:

690

:

Yeah.

691

:

Yeah.

692

:

Sp yeah.

693

:

At the very beginning, actually, tDCS

was very especially in MS was like

694

:

tested a lot for spasticity because

they were like, I think like TMS for

695

:

spasticity is a better choice than umt

DCS for how is like for, because there

696

:

are different mechanism of action.

697

:

While there is some

study, for example, in ms.

698

:

And spasticity using

TMS that are promising.

699

:

While they were not really promising

the use of tDCS for spasticity,

700

:

but, spasticity then comes with

all functional of, with all the

701

:

functional limit motor limitation.

702

:

And then probably tDCS can help but

not really like treating spasticity

703

:

per se, but more as an a addon

intervention during rehabilitation

704

:

with patient with spasticity.

705

:

Dr. Charvet:

706

:

Yeah.

707

:

But in our progressive study, the

upper, the hand dexterity trial

708

:

people had pretty severe disease.

709

:

And that was the purpose of that.

710

:

That was a special research program

through the DOD to reach those people

711

:

because they've been really overlooked

and understudied or even thought,

712

:

earlier in my career it was thought

that there was no recovery potential

713

:

once you reached a certain stage.

714

:

And I think that's absolutely

disproven at this point.

715

:

So I don't think anything's

too severe to try to help.

716

:

tDCS may have to be optimized

or we may need something

717

:

stronger, as Justine saying.

718

:

But I definitely think that brain

stimulation can be helpful all the way

719

:

through to, to help improve things for

people so there's not like a early window

720

:

that, that you should only use it in.

721

:

Mike: Yeah.

722

:

No, that's great.

723

:

Were there any kinds of common side

effects or other sorts of drawbacks

724

:

that you found from participants

or in the clinical applications

725

:

for these kinds of problems?

726

:

Dr. Charvet:

727

:

I'll refer to Dr.

728

:

Pelloni who did a very ambitious

analysis of all the side effects

729

:

that we completed across trials.

730

:

Yeah,

731

:

Dr. Pilloni:

732

:

I think so we already said that tDCS is

a feasible intervention to be deployed

733

:

at home, but like sometimes when I like

talk with other colleagues, they always

734

:

wonder but it's safe when you do this

intervention in a home setting and you

735

:

don't have direct control and answer is.

736

:

Very simple is yes, but there is

some component you have to take

737

:

account when, like you do your study.

738

:

Because okay, first of all you have

to use medical grade tDCS device

739

:

with all medical grade component.

740

:

Unfortunately, like there is unfortunately

the reality is that sometimes

741

:

when no proper equipment is used.

742

:

tDCS can cause burning lesion, but this

is not, this not should be the case

743

:

because tDCS won't perform correctly.

744

:

With pad, with like sponge

electrode using selling solution.

745

:

In the right amount.

746

:

You should not have any of these

burning lesion that has been reported.

747

:

It's more so and in our review of all

the side effects that happened in our

748

:

previous trial, we found like that patient

memory report, the same side effects.

749

:

Of tDCS when tDCS has done like hiam

setting, like a clinical or a lab,

750

:

it's just like a skin sensation,

like tingling, itching and like

751

:

warm sensation under the electrode.

752

:

But this is mainly because it's affect

dual effect that is a current passing

753

:

through through the scheme and this.

754

:

Cause little bit of over reading, but like

it's not, nothing that is not tolerable.

755

:

And actually then we found the sham

participant reported the same amount of

756

:

side effects that active participant.

757

:

So it is really there is no really

concern of in terms of what.

758

:

The fine side effect, but like right

now we are also not anymore reporting

759

:

them as a side effect because like it

seems a normal consequence when you are

760

:

applying like something like you are

applying a low intensity electricity.

761

:

And also there is no concern when you do

repeat the session for multiple like days.

762

:

Mike: Yeah, so that makes sense.

763

:

I guess in a similar way that there

could potentially be a placebo, then

764

:

there's this concept of the nocebo and

right, the side effect whenever there's

765

:

an idea about electricity being applied.

766

:

But it is a really, I really

appreciate that commentary because

767

:

I think even before we started

recording, we had a brief chat little

768

:

bit about the concern in terms of

tDCS in general around, because it.

769

:

Is very exciting in terms of the

applicability and the broad nature

770

:

of targeted disorders and symptoms

that they're, that opens the door

771

:

perhaps for actors to produce

units that are not medical grade.

772

:

And it's important for people to

understand that in order for this to be

773

:

safe and effective, that it has to be

done in a way that's based on rigorous

774

:

studies and with equipment that is medical

grade and has been properly engineered.

775

:

Dr. Charvet:

776

:

And always in the

context of clinical care.

777

:

And I just think it's, safety of course,

but also for efficacy because I just

778

:

don't we have people who, you know, just

for cost unfortunately and that kind of

779

:

thing, do go out and do their own, find

their own devices and just use them.

780

:

But using, without guidance

and without partnership, it's

781

:

just, it's hard to evaluate.

782

:

It's hard to do routinely.

783

:

And so I do think that this.

784

:

Belongs in the context of clinical

care, even at, in the home setting.

785

:

Either in a prescription

service or in partnership.

786

:

I just really do think that that's

a really important part of the

787

:

treatment to get something out of it.

788

:

Mike: Yeah, no, for sure.

789

:

And that speaks to this real

benefit and attractive nature of the

790

:

accessibility, the scalability, the

equitable nature of the of people.

791

:

Not necessarily, like you say, even

when they're on a wait lift, wait

792

:

list to see the physician or the

practitioner and to start some other

793

:

kind of multimodal treatment, they can.

794

:

Just start the tDCS at home already.

795

:

So can you speak a bit more about

what would be some next steps in terms

796

:

of making it even more accessible to

folks, especially those maybe in more

797

:

rural settings that don't have access

to the research level institutions?

798

:

Dr. Charvet:

799

:

Yeah, so our clinical service, we can

reach anybody in the United States that

800

:

has wifi connection, which is pretty

remarkable now that everybody has one.

801

:

So it's very accessible.

802

:

But unfortunately the clinical part

is the cost is a rate limiting factor.

803

:

And we need a company to get approval.

804

:

And ideally it should be

covered with insurance, right?

805

:

So that people should not have to.

806

:

Pay in our model for any of their care.

807

:

It shouldn't be special that

they have to pay for tDCS.

808

:

And so that's gotta move in some direction

with, FDA approved indication for use.

809

:

Which is unfortunately just we're an

outlier here in the United States.

810

:

But, most comp countries

do have some approved use.

811

:

And so anyway that's really the

biggest I think once we have

812

:

that, then we can move forward.

813

:

And a lot of other uses can join.

814

:

Dosing optimization is critical, right?

815

:

So we need to know how much is minimal

for benefit, how much per plateau, how

816

:

do you know, how do you maintain it?

817

:

What's boosting all of that kind of outer

dosing especially is really important.

818

:

I think there's a really

exciting trend in the field.

819

:

Started with TMS called accelerated

or T-D-C-T-M-S and tDCS where you do

820

:

multiple sessions a day and we don't know.

821

:

Whether, reaching a goal, you

need a marker or a goal, right?

822

:

So they're using depression in

these trials so that, for instance,

823

:

doing 10 space sessions versus

accelerated and all in one day, can

824

:

you reach the same goal quicker?

825

:

I, clinically in our service, I believe

I've really seen, I think the brain

826

:

can only change so fast at a certain

rate, and so you can't really expect

827

:

something like that to, to although

some people do achieve benefit, so

828

:

who how to use that kind of thing, and

all these innovative dosing things.

829

:

Dosing.

830

:

And dosing is really the two

things that I would like to see.

831

:

And just pain idea.

832

:

Dr. Pilloni:

833

:

No, I agree.

834

:

I think like more to

dosing personalization.

835

:

So really trying to understand,

we go back to what we said before,

836

:

really like fine biomarkers response.

837

:

And then working on that about like

personalization of dosing for patient

838

:

because like we, we saw patient that.

839

:

We have seen patient that respond

and patient that don't respond.

840

:

And like we always wondering why.

841

:

Dr. Charvet:

842

:

Yeah.

843

:

Predictors, right?

844

:

Is there anything that we can do?

845

:

So everything's about the

bio, the markers in the end.

846

:

But so obviously no treatment helps

everybody and so trials will be more

847

:

powerful if we can select and certainly

treatment would be more powerful if we

848

:

know before you did 20, 40 sessions, if we

knew something early on that could predict

849

:

it's worth it or not to do all of that.

850

:

That's what's really needed.

851

:

Mike: Yeah.

852

:

No, for sure.

853

:

And I guess it leads to, a

lot of unanswered questions

854

:

that require further study.

855

:

Yes.

856

:

So yeah.

857

:

Do you have other projects on the horizon

that have led, that have been what's the.

858

:

Proper word that have been

inspired, by the studies that

859

:

you've already talked about?

860

:

Dr. Charvet:

861

:

Yeah.

862

:

Nearest term is a depression study in

ms, so close to our heart, and this is

863

:

a really pragmatic clinical trial that I

think will move us very close to clinical

864

:

use and give us that clinical guidance.

865

:

And to be able to look at just what you

brought up, the point about how symptom

866

:

experience and even functional aspects.

867

:

Of symptom burden will move

with the treatment in general.

868

:

And then depression symptoms too.

869

:

So we're really excited and that's

a nationally recruiting trial, so

870

:

we're very excited to start that.

871

:

And then Dr.

872

:

Pelloni, Giuseppina's work with the HRV

as a biomarker because that I think will

873

:

be a powerful, generic really, which

is what we want indicator of benefit.

874

:

And so that once we have something defined

like that, and especially in the closed

875

:

loop application, that's really gonna be

the floodgates to being able to design

876

:

a lot of dosing optimization studies.

877

:

Dr. Pilloni:

878

:

Yeah, and I think we should also mention

that we recently complete the use, like

879

:

trying to like use tDCS for reducing

cannabis use in patient with ms.

880

:

It was another it was a pilot study.

881

:

It was smaller but it was a very

cool study where we like Leigh,

882

:

do you wanna talk more about that?

883

:

Again, clinically,

884

:

Dr. Charvet:

885

:

I, there's a high rate, no pun intended,

but there's a high rate of cannabis

886

:

use among people living with MS.

887

:

It almost has a health halo effect.

888

:

And so there's, people are surprised

and there's really no evidence-based

889

:

use outside of spasticity for cannabis.

890

:

And so a lot of it's used for symptoms

that don't have real clear benefit and.

891

:

There's more and more studies showing

that when you come off of cannabis living

892

:

for people who have heavy use, they

actually improve in terms of cognition

893

:

at least and wellbeing and depression.

894

:

And so how do you come off of it?

895

:

And so we, that was a question like,

it sounds great, but I, I'm in this

896

:

use cycle at the least, dependent.

897

:

And so there's a lot of interest in

the broad addiction field for use of

898

:

neurostimulation and tDCS in particular.

899

:

Again, partnering with people,

living with MS really as a model

900

:

for the addiction framework across.

901

:

Diseases.

902

:

And then nothing for cannabis.

903

:

So that was also a model

for something for cannabis.

904

:

We de designed a one month intervention

pairing tDCS with mindfulness

905

:

meditation to support the distress

that comes up when you withdraw

906

:

use that drives that use cycle.

907

:

And our pilot study was, a success

in terms of really proof of principle

908

:

is just you saying that people had

reduction in cannabis withdrawal

909

:

symptoms and in overall use as

well as in symptom burden, and they

910

:

improved in the SDMT, the cognitive

measure in MS as well at studying.

911

:

So again, preliminary pilot study, but

very exciting both for people living with

912

:

ms and also if we can generalize that.

913

:

To cannabis use, which is very badly

needed a tool for people who wanna

914

:

reduce their use and then to test

in other addiction models as well.

915

:

So that's a real exciting,

rapidly developing area too.

916

:

Mike: Amazing.

917

:

That's

918

:

Dr. Charvet:

919

:

has brought us across everywhere.

920

:

So

921

:

Mike: yeah,

922

:

Dr. Charvet:

923

:

it's a very interesting journey.

924

:

Mike: Definitely.

925

:

Yeah.

926

:

It really, that's incredible.

927

:

What a really amazing perhaps somewhat

unexpected kind of finding in terms

928

:

of the idea and then taking just the

experience, as you say, of what are

929

:

patients with MS doing historically

and what kinds of challenges are they

930

:

facing historically, and how might this

technology help with these other things?

931

:

It's, I love it.

932

:

How.

933

:

All these thoughts are leading to

new innovations and potentially

934

:

new therapeutic options for people.

935

:

Dr. Charvet:

936

:

Yeah, for sure.

937

:

And our wonderful collaborators.

938

:

So it's really a wonderful community

as you, I'm sure we brought us together

939

:

for the podcast, but it's just people

are so interested in designing and

940

:

advancing this new therapeutic area

to, to clinical use and to help people.

941

:

So it's a really exciting

time, I think for that.

942

:

Mike: Yeah.

943

:

Do you, do either of you have any kind

of closing thoughts around messaging that

944

:

you would wanna share with clinicians,

patients, policy makers about, your

945

:

work and the promise of this technology?

946

:

I.

947

:

Dr. Charvet:

948

:

For Paula, I, it should absolutely be

indicated for use in the United States.

949

:

That, the removing the cost

barrier for people to have access.

950

:

Now, I don't, there's no reason that tDCS,

especially for the treatment depression,

951

:

shouldn't be available now as an option.

952

:

It shouldn't, doesn't have to

replace anything, but it should

953

:

be an option because it's so

effective and deployable, right?

954

:

And

955

:

Dr. Pilloni:

956

:

it should be the first option.

957

:

Because like it's not, there

is no side effect behind like

958

:

Dr. Charvet:

959

:

and there's so many special populations

that can't or won't tolerate medications.

960

:

And so again, it just, there's

so many people in pain, uhhuh and

961

:

that's, so that, just being able to

have that as an option for people.

962

:

The message for the science community is

to keep going and to report dosing and

963

:

think about all the dosing parameters

and help us define dosing as a field

964

:

and to be consistent so we can compare

studies and to, to stu study more than 20

965

:

sessions to keep, to look at in that way.

966

:

Mike: Yeah.

967

:

It's really inspiring.

968

:

Yeah.

969

:

No I was initially, made aware of your

work at the Brain Stimulation Conference

970

:

in February in Japan, and so I appreciated

seeing the poster there and being

971

:

introduced to your work there as well.

972

:

But what you were just saying about

the issue around it should be approved

973

:

and then soon after, hopefully

covered by insurance companies.

974

:

Surely there are going to be increasing

studies coming out that can show or

975

:

support the cost benefit analysis in

terms of the improvement functioning.

976

:

Yeah.

977

:

Dr. Charvet:

978

:

Yeah, unfortunately that the reason that

we're an outlier is the FDA React, rules

979

:

on the basis of a marketing application.

980

:

So a company has to come forward and say,

we wanna market it for this indication.

981

:

So really approving marketing indications

versus ruling, whether it works or not.

982

:

And so that's unique to the

US market, and so it the.

983

:

tDCS is very hard to, as a defensible

technology for a single company.

984

:

And so that is really hard for somebody

to, one company to put forward and

985

:

defend right, once they pass that bar.

986

:

It is my understanding, I'm no expert

in that field, but that's one of the

987

:

unique features of the US marketplace.

988

:

So we wish that it was a governing

body that just said, oh, this is

989

:

effective, therefore it should

be available, which unfortunately

990

:

is not the case where we are.

991

:

Mike: I suppose as the pressure mounts

based on the growing evidence base, then

992

:

it hopefully would become inevitable.

993

:

But yeah, as much as we can do

to advocate in these small ways.

994

:

Dr. Charvet:

995

:

Yeah, absolutely.

996

:

Mike: Yeah, for sure.

997

:

Okay.

998

:

Is there anything else that either

of you wanted to talk about or

999

:

that we haven't touched on yet that

you think would be interesting?

:

00:50:31,868 --> 00:50:31,869

Dr. Pilloni:

:

00:50:31,869 --> 00:50:32,858

No, I think we covered.

:

00:50:34,268 --> 00:50:34,658

Mike: Perfect.

:

00:50:34,658 --> 00:50:34,898

Yeah.

:

00:50:34,938 --> 00:50:35,418

That's great.

:

00:50:35,418 --> 00:50:39,943

And I, again I really appreciate both

of your valuable time and spending

:

00:50:39,943 --> 00:50:41,983

that time here talking with us today.

:

00:50:41,983 --> 00:50:44,683

And for viewers and listeners,

again, I'm gonna put the

:

00:50:44,683 --> 00:50:46,003

relevant links in the show notes.

:

00:50:46,003 --> 00:50:47,893

I would really encourage you to, I.

:

00:50:48,263 --> 00:50:49,373

Check that out.

:

00:50:49,373 --> 00:50:53,923

And yeah, just explore more about

these researchers work and the clinical

:

00:50:53,983 --> 00:50:55,813

programs that are available as well.

:

00:50:56,173 --> 00:50:59,763

And yeah, hopefully we can connect

at a future conference maybe.

:

00:50:59,763 --> 00:51:00,063

And

:

00:51:00,183 --> 00:51:00,184

Dr. Charvet:

:

00:51:00,184 --> 00:51:03,243

so yeah, we really appreciate the

opportunity to share and discuss

:

00:51:03,243 --> 00:51:04,383

some of the, our work with you.

:

00:51:04,383 --> 00:51:05,193

So this is great.

:

00:51:05,463 --> 00:51:06,033

So thank you.

:

00:51:06,843 --> 00:51:07,503

Mike: Fantastic.

:

00:51:07,503 --> 00:51:08,463

Okay, thanks again.

:

00:51:08,463 --> 00:51:09,483

Have a great rest of the day.

:

00:51:09,603 --> 00:51:09,604

Dr. Charvet:

:

00:51:09,604 --> 00:51:10,263

Okay, you too.

:

00:51:10,278 --> 00:51:10,498

Bye.

:

00:51:10,768 --> 00:51:11,058

Mike: Okay,

:

00:51:12,757 --> 00:51:15,202

That wraps up our

conversation today with Dr.

:

00:51:15,202 --> 00:51:16,612

Charvet and Pelloni.

:

00:51:16,912 --> 00:51:21,430

A truly inspiring look at how remotely

delivered neurostimulation is not only

:

00:51:21,430 --> 00:51:26,245

scientifically sound, but also practically

feasible and clinically meaningful.

:

00:51:26,755 --> 00:51:30,955

Their research into RS tDCS for

people with multiple sclerosis

:

00:51:31,165 --> 00:51:32,935

reminds us of a broader truth.

:

00:51:33,235 --> 00:51:37,765

Accessibility and innovation can

go hand in hand in neuroscience.

:

00:51:38,275 --> 00:51:42,325

If you're a clinician, a researcher,

or somebody living with MS, I

:

00:51:42,325 --> 00:51:46,315

hope today's episode sparked new

ideas about what's possible when

:

00:51:46,315 --> 00:51:47,990

we bring therapy into the home.

:

00:51:48,865 --> 00:51:53,355

Don't forget to subscribe to this

podcast, share the show with someone

:

00:51:53,355 --> 00:51:57,555

that you think might be interested and

ask questions or leave comments or a

:

00:51:57,555 --> 00:51:59,595

review in the comment section below.

:

00:52:00,135 --> 00:52:04,005

For more resources, references,

and links to the published studies

:

00:52:04,005 --> 00:52:06,225

that we discussed, and to Dr.

:

00:52:06,225 --> 00:52:11,715

Charvet and Pelloni's work and other

research publications, please check

:

00:52:11,715 --> 00:52:13,155

out the links in the show notes.

:

00:52:13,475 --> 00:52:16,775

I really appreciate your time,

your attention and your interest,

:

00:52:17,015 --> 00:52:20,255

and I'll see you next time on

the Neurostimulation podcast.

Show artwork for The Neurostimulation Podcast

About the Podcast

The Neurostimulation Podcast
Welcome to The Neurostimulation Podcast, your go-to source for the latest in clinical neurostimulation! Here, we dive deep into the revolutionary techniques that are shaping the future of health care.

Whether you're a healthcare professional, a student, or simply passionate about neuroscience, this podcast will keep you informed, inspired, and connected with the evolving world of neurostimulation.

Subscribe for episodes that stimulate your mind and enhance your understanding of brain health and treatment.

podscan_YIPb4jA8fBJ5ino2RSuBo3BdjrOmPM6c

About your host

Profile picture for Michael Passmore

Michael Passmore

Dr. Michael Passmore is a psychiatrist based in Vancouver, BC, with expertise in neurostimulation therapies. Having completed specialized training in multiple neurostimulation modalities, including electroconvulsive therapy at Duke University and transcranial magnetic stimulation at Harvard University, Dr. Passmore brings a robust clinical and academic background to his practice. Formerly the head of the neurostimulation program in the department of Psychiatry at Providence Health Care, Dr. Passmore now serves as a clinical associate professor at the University of British Columbia’s Department of Psychiatry. From his clinic, ZipStim Neurostimulation (zipstim.com), Dr. Passmore offers private, physician-supervised, home-based transcranial direct current stimulation (tDCS) treatments tailored to clients across Canada.​