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
Welcome to the Neurostimulation Podcast.
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:I'm Dr.
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:Michael Passmore, clinical associate
professor in the Department of
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:Psychiatry at the University of
British Columbia in Vancouver, Canada.
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:The Neurostimulation Podcast is about
exploring the fascinating world of
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:neuroscience in general and clinical
neurostimulation in particular.
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:Every week we are going to explore
how neurostimulation works, what are
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:the latest research breakthroughs and
how that research is being translated
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:into real world treatments that
can improve health and wellbeing?
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:So whether you are a healthcare
professional, a researcher, a student, or
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:just somebody who's curious about how our
brains work and what we can do to help
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:them work better, this podcast is for you.
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:My mission is to make the
science accessible, inspiring,
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:and relevant to your life.
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:This podcast is separate from my clinical
and academic roles, and as part of my
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:personal effort to bring neuroscience
education to the general public.
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:Accordingly, I would like to emphasize
that the information shared here is
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:for educational purposes only and not
intended as medical advice or a substitute
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:for professional medical guidance.
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:Always consult with your healthcare
provider to discuss your specific
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:health needs and treatment options.
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:Today's episode is presented
by ZipStim Neurostimulation.
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:ZipStim is the neurostimulation
clinic that I operate.
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:You can find out more about our clinical
neurostimulation programs at zipstim.com.
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:That's Z-I-P-S-T-I-M.com.
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:Today's episode dives into one of the most
exciting frontiers in neurostimulation,
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:remote supervised transcranial direct
current stimulation, or RS-tDCS, and
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:in particular, we're going to have
a discussion today about RS-tDCS'
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:potential to transform care for
people living with multiple sclerosis.
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:I'm joined by two leading
voices in this space, Dr.
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:Charvet and Dr.
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:Pelloni, specializing in
neurostimulation research.
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:Together, they've led a series of class
1 sham-controlled trials evaluating
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:home-based tDCS paired with cognitive
and motor training for multiple sclerosis
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:symptoms like fatigue and hand dexterity.
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:Their work not only demonstrates
feasibility and safety, but it also lays
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:the foundation for scalable, accessible
and personalized neurostimulation
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:in the neurorehabilitation
field, delivered right from home.
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:In this conversation, we're going to
unpack the design of their study, the
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:results, challenges that they experienced,
and the real world implications of
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:their research and what it means for
the future of remote neurostimulation.
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:So stay tuned.
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:I think you're really going
to enjoy this conversation.
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:Welcome back to the
Neurostimulation podcast.
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:I'm really excited today
to be joined by Dr.
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:Leigh Charvet and Dr.
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:Guiseppina Pelloni.
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:Drs.
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:Charvet and Pelloni are lead authors on a
really interesting study entitled Remotely
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:Supervised Transcranial Direct Current
Stimulation: Results from two Class 1
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:sham-controlled home-based, randomized
controlled trials in multiple sclerosis.
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:Dr.
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:Charvet and Dr.
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:Pelloni, thanks so much
for joining me today.
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:Dr. Charvet:
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:Thanks so much for having us.
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:Yeah, thank you so much.
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:It's a pleasure.
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:Mike: Oh, great.
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:Maybe we could start by you introducing
yourselves, helping us to understand
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:more about your work and your background,
and then we can launch into a discussion
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:about this really interesting study.
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:Dr. Charvet:
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:I'll go ahead and start.
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:I'm older, so I'm a clinical
neuropsychologist by background and
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:have a long history working with people,
living with MS, and many other conditions.
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:And as a neuropsychologist my entire
clinical research program and career
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:has been driven by recommendations.
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:What can we do and say to help people
improve their quality of life now
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:living with burden of neurologic
disease or psychiatric disease.
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:And there's so many lifestyle
interventions and non-drug interventions
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:in particular that are really
interesting to me to see if we can
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:again, help people augment what their
therapies are to try to improve things.
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:And so I was an early adopter of
tele rehabilitation for cognitive
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:remediation doing cognitive
remediation to study it, but at home.
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:And I did a home-based tele
rehabilitation trial with brain training.
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:And that was a aha moment in that
we were overwhelmed really by
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:people who wanted to participate.
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:We rapidly enrolled and this trial
happened to be 60 hours of training over
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:12 weeks, and we had really high fidelity
to treatment, our completion rates.
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:And so I was convinced then that was
the way to go, was that people wanted,
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:these things that you have to do
repeatedly to get the benefit, need to
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:be at home right away to study even.
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:That's what brought me to tDCS.
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:After that trial, I was fortunate
to connect with biomedical
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:engineers, in particular Dr.
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:Marone Dixon at City College.
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:And he was very interested in home-based
tDCS, and so we partnered in that
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:way and developed our whole research
program that's 12 years old now which
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:we can't believe, and also has an
offshoot of a clinical telehealth
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:tDCS service we can tell you about.
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:But along in that journey, I was really
so fortunate to connect with biomedical
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:engineers as partners, and I call
it clinical biomedical engineering
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:because of the insights both with, from
engineering and from clinical care.
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:It's just a wonderful partnership.
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:And that's how I happened upon Dr.
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:Pelloni.
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:So I'll let her introduce herself.
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:Yeah.
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:Dr. Pilloni:
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:As Leigh mentioned, I'm a
biomedical engineer by background
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:and I study and train in Italy.
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:And during my master thesis, I like met
with a physical therapist from Brazil
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:that she showed me amazing result about
the application of tDCS in in like to
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:recover motor function in kids with
cerebral palsy and it was so fascinating.
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:And I come from a small island in
the middle of the Mediterranean
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:that is called Sardinia.
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:And unfortunately we have a very
high rate of multiple sclerosis.
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:And it was the time when I was
deciding, oh, should I pursue my faculty
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:career or like change in industry?
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:And I got the opportunity to apply
for PhD, scholarship in Sardinia and
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:propose my own project where I say let
me try, if I'm able to replicate such
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:an amazing result in SBR palsy, even
in patient with multiple sclerosis that
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:also report like moderate dysfunction,
especially in walking and hyper.
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:Upper extremity and during this journey
I was very fortunate and I think
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:the faith put me together with Dr.
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:Charvet.
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:And I was able to spend sometimes here
during my PhD where I did a parallel
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:study in patient with MS using tDCS.
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:This small study was actually
done here in clinic, but I
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:was very fascinating because.
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:I, I was the only one in the lab
seeing patient in person and I said
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:probably I should now translate this
one, this project, it was in clinic
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:where I was seeing everyday patient.
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:And I also understand what is
the challenge, especially in
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:big city like New York to come
every day for an intervention.
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:And I say probably we should re-propose
what I'm doing in home base setting.
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:And this is like how.
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:I was matched with Dr.
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:She and I think we have
very complimentary skills.
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:Mike: Yeah, definitely.
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:Thanks so much both of
you for that introduction.
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:It really, it basically covers one of the
first questions that I had, which was what
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:in particular inspired your both of you
and your team to pursue this therapeutic?
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:Option for folks with MS in particular.
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:But I guess the second question that
I had that follows on from what you
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:were just describing is that, with
neurological disorders in general,
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:but I think in particular, given the
burden of chronic symptoms in ms, like
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:fatigue and cognitive dysfunction,
and obviously the motor deficits.
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:Maybe could you explain for viewers
and listeners why it was particularly
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:important to explore a neuromodulation
solution that can be delivered remotely
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:Dr. Charvet:
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:Well, the remote part is for access,
deployability availability and
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:sufficient dosing, which is key.
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:So It's a fascinating, and
as rapidly evolving world and
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:non-invasive brain stimulation.
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:We're all the way on
the clinical end, right?
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:We're very eager for clinical application.
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:But if you look at the clinical
trials, we have thousands of
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:clinical trials in PubMed and really
still no, like definitive clinical
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:trials outside of depression.
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:And that's because.
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:low sample sizes, but also underdosing.
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:We really believe that you need
at least 20 consecutive sessions
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:to evaluate potential for benefit.
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:And the vast majority of trials are
10 sessions or less with a lot of five
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:session or less, or even single st
application clinical studies reporting.
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:And also with variable dosing
parameters, we believe very much
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:it should be a paired treatment.
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:So that tDCS is functionally targeted
to the region that's engaged in
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:a training exercise, even if it's
for something like depression.
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:And so that paired treatment
is really a critical part of
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:the dosing parameters as well.
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:And that's underdressed or under reported.
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:And so while we have this huge volume
of work, we, it's very hard to compare
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:across trials and it's very hard to have
these definitive trials to guide us.
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:To getting to something that we
can deploy to patients right away.
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:Mike: So the pairing, yeah it's very
interesting because I think it's
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:emerging, obviously as you're describing
that it's because the tDCS is more
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:of a priming, I suppose you'd say
in general terms mechanism that the
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:pairing then with whatever the, yeah.
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:Dr. Charvet:
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:Targeted.
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:Mike: Yeah.
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:Go ahead.
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:Dr. Charvet:
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:Yeah, like a boost, upregulating
and neuroplasticity and
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:reinforcing things That's why we
started with cognitive training.
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:So while the brain training
games do work it's a lot of work.
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:And so I was thinking could
we potentiate this, right?
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:It's get more out of less training
and have it more, be more durable.
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:And that's really the
whole start of everything.
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:And so tDCS added in our, over and over,
we see this boost added to cognitive
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:motor, upper or lower extremity motor
or speech and language training.
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:Any kind of training it
will reinforce and boost.
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:And then certainly we have other,
targets too as terms of depression
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:primarily, and, our work and
fatigue and that kind of thing.
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:Mike: So do you mind Yeah, maybe
talking more specifically about this
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:study in terms of broad thumbnail
sketch, and then we can talk a
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:bit more about the the details.
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:Dr. Charvet:
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:Yeah.
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:I'll start with the
broad sketch and then Dr.
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:Poney can start at the details,
but I so our whole goal, and truly
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:patient led right to, to try to
develop this in practical way.
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:Like how can we use
this in home right away?
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:And it was really.
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:A lot of work to develop this
very optimized home-based system.
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:And and in collaboration with our early
participants who really told us, I can do
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:this, I can't do this, that kind of thing.
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:So our goal was to facilitate
research to get these trials
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:to, that we need these class one
randomized, sham controlled trials.
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:And so we did that with the two
trials that we reported in this paper.
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:So we've had, so as a single
center nationally recruiting
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:for one of them, we've had two.
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:Large scale randomized sham controlled
trials one in fatigue and then the other
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:in upper extremity motor functioning.
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:Looking at that paired activity, we
have gone on unrelated to ms, but
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:we've also just last year had a proof
of principle that we can also be the
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:single site for delivery of treatment
in multicenter clinical trials
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:as well, which is very important.
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:So last year we were a single
treating site for the recovered
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:nihs, recovered neuros.
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:Study, which was evaluating treatments
for long COVID, the cognitive
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:involvement or aspects of long COVID,
of which tDCS was one treatment.
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:And so we were able to enroll 328 people
across 22 sites in the United States with
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:50 sessions of treatment all in one year.
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:So all of these, we just
really wanna advertise that we
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:believe going home right away.
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:First it's gonna be how ultimately
this equipment is used, but that
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:right away is a way to accelerate.
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:The clinical research that
we need to moving it to
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:clinical guidance and approval.
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:So
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:Mike: yeah
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:Dr. Charvet:
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:that's the broad overview.
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:So those are our two proof of
principle trials and MS with motor.
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:And then that we, the period
cognitive fatigue treatment and
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:then just also learning that we can
reach a lot of people in this way.
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:So it's a very feasible approach.
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:Yeah.
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:Mike: Yeah.
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:Thanks for that.
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:Before Dr.
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:Polone, before you maybe talk a bit
more about the specifics, I was just
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:curious for clarifying, so the class
one designation of the trials, what
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:does that refer to specifically?
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:Dr. Charvet:
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:Yeah, so that's based on the Prisma
guidance level of evidence, and so
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:you need two class one trials to meet
that level A requirement for being.
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:Considered to be definitively effective.
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:So that's parallel, for instance, to
phase three in the pharma industry.
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:So you, it needs to be, it needs to
meet certain re design requirements
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:and certain size requirements.
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:And that's why we refer to that pyramid
and level of evidence in that way.
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:Mike: Perfect.
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:Yeah.
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:Thank you.
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:That's I thought so, but I
just thank for clarifying that.
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:Dr. Charvet:
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:Yeah.
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:It's defined differently across
different disciplines but in
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:general, these are large definitive.
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:Sufficiently designed,
randomized controlled trials
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:that are sufficiently rigorous.
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:And those are few and far between.
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:Unfortunately, in the world of tDCS.
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:Mike: Yeah.
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:Congratulations for bringing that
together and certainly, so let's
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:find out more specifics about it.
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:Dr.
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:Polone, do you mind telling us a
bit more about the nuts and bolts of
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:the study in terms of the inception
and the design and the methodology?
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:Dr. Pilloni:
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:I.
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:Sure.
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:So the first study was for, it
was targeting patient with primary
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:progressive ms, but with primary
and secondary progressive ms.
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:So our patient that they have like
advanced disability, and generally they
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:report like limited upper upper limb.
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:Limitation in term of not only movement,
but also like manual disparity.
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:And so what I wanna also to
highlight that is that TVCS is not.
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:Mean to treat a disease per se, but
like we are more focused on treating
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:like symptoms related to the disease
and we, it depend on the symptoms
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:and on the proactivity that we decide
what kind of brain target we are
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:gonna the brain, we are gonna decide.
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:The brain target and then
also the electrode placement.
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:So for the for this first study
where we enroll primary where we
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:enroll progressive patients because
they were completing during the
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:tDCS intervention some dexterity
exercise they we decide to target.
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:The primary motor cortex placing the
anode that is the active electrode over
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:the primary motor, over the primary motor
cortex, and the return electrode over the
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:over the controlled supraorbital area.
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:So in this way basically our hypothesis
was like the tDCS should like.
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:Give a boost of the activation that was
generated by performing simultaneously.
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:This patient completed for this
study, 20 daily sessions each last
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:the tDCS component last 20 minutes,
but the exercise when we're about
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:30 minutes, so they have a little
bit of exercise without tDCS study.
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:Toward the end of the session.
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:And it was a randomized
sham control study.
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:So we have both participant assigned to
active and participant assigned to Sham.
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:And they were performing the TER exercise
with both the left and the right hand.
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:And was very interesting because
what we found was that patient with.
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:That was assigned to the active group,
reported an improvement in hand disparity.
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:But even if it was not clinical.
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:It was not meaningful from
a clinical point of view.
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:This improvement was like
a signal of improvement.
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:And this is very important for progressive
patient because they tend to progress.
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:So what the rehabilitation should
aim is like really try to preserve
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:function in this kind of patient.
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:And mainly this one for Leigh.
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:Do you wanna talk about the fatigue?
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:Mike: Sure, yeah, that'd be great.
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:Yeah, I appreciate that.
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:Yeah.
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:Dr. Charvet:
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:Yeah.
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:I also have to say, 'cause I'm
a very practical clinician, so
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:this was, typically older people
with higher burden of disability
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:and they were incredibly good.
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:Sports.
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:So I can't tell you the amount of
equipment that we sent home with
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:them, and that's these huge hand
kits and it was all very feasible.
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:So a lot of times early reviewers
would say, oh, people can't do this.
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:Or, a little bit ageist of older people
can't adopt technology and and we've
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:just, learned all of that is not,
we've had people who just are, have
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:never even really used a computer or
a laptop and we can get them through.
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:So it was really accessible.
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:So that was another thing that
we learned and that study is
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:just a very doable approach.
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:And so I, this.
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:Pair treatment.
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:So we're targeting here, the
dorsal lateral prefrontal cortex
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:left nodal is the go-to treatment
for cognitive functioning.
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:And the idea is that the frontal regions
are, the hub or of selective attention,
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:executive networks and that kind of thing.
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:In particularly.
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:Particularly relevant for people
with MS is that we like to
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:enhance speeded processing, right?
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:Because that's the first thing
that become slow and then it can
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:transfer to new learning and problem
solving and just to speed up things
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:to experience a cognitive benefit.
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:And that we see that over and over.
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:So we did pre speed of processing
training with Brain hq, which are
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:these online adaptive cognitive
training games with the frontal tDCS.
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:And that's become the standard treatment
really for all things cognition
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:across all disorders is what we used
with the long COVID study as well.
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:We did a pilot first when we were
developing the methods and while we were
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:looking, to add on, we saw just a, a, a.
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:Proof of principle signal and
computer-based measures already
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:at 10 sessions in our pilot study.
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:But our patients also were telling
us they were less fatigued.
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:So we in we then did a pilot, showed a
really nice drop with active versus sham
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:tDCS and fatigue with that same treatment.
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:So this trial was, the
primary outcome was fatigue.
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:So patients weren't recruited on the
basis of having cognitive impairment or
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:to targeted and the secondary outcome
was cognitive functioning of, so
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:really interested just to see as well.
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:And so there, this was.
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:A 30 session treatment, so for six
weeks, and they did that paired
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:cognitive with D-L-P-F-C-T-D-C-S.
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:In this trial we didn't see any
fatigue separate between the two
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:arms and, but both groups got better.
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:So the active dropped just as much in our
pilot as before, but also the sham did.
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:That's really an open question of why.
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:So it's interesting I'll mention this in
the podcast, is we had an unusual sham.
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:It was a very robust, we were
very excited to be, sure that
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:we were very much shammed.
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:And so over those 20 minutes and each
session there was three injections
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:of current ramp up, ramp down.
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:So that may have actually mimicked.
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:Some active or at least a low dose,
so that could have been one of the
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:reasons why we saw a sham response.
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:Another reason would be that
the active component could have
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:been the cognitive training.
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:Also unusual for fatigue trials.
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:We excluded on the basis
of depression, so it.
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:Could be that depression is mediating.
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:What the, we see a lot in
these fatigue benefits.
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:So really interesting.
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:Everybody got better with fatigue.
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:Cognitive though the groups did separate
out, so there was a clear significant
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:cognitive benefit for active versus
sham tDCS on things like MS specific
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:cognitive batteries at the study end.
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:Even though we didn't recruit.
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:On the basis of, or role on the
basis of cognitive impairment.
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:And interestingly, the cognitive
benefit was greater for people
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:with more severe disabilities.
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:So higher EDSS scores.
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: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
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:studies, looking at depression and for
instance, in MCI, early Alzheimer's.
385
:Looking at that preservation of function
and prevention of decline, yeah.
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: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
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:and prevent decline versus looking
at full recovery back to baseline.
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:Mike: Yeah, that's, yeah,
there's a lot there.
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:It's complicated.
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:I appreciate that.
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:That final kind of summary too, 'cause
that's a, I'll start with a question about
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:what you were mentioning just before that,
and then maybe we'll just quickly touch
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:on that last piece 'cause Yeah, that's
it's subtle, but it's really important.
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:The thing that I was wondering about
initially has to do with that difficulty
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:in, in distinguishing between these
overlap symptoms like the fatigue, the
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: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.