Remotely supervised transcranial direct current stimulation: A feasibility study for amyotrophic lateral sclerosis

BACKGROUND: Transcranial direct current stimulation (tDCS) has been investigated as a therapeutic neuromodulation tool in several neurological disorders. However, evidence supporting its efficacy in disorders such as amyotrophic lateral sclerosis (ALS) is limited possibly due to limited patient accessibility for research, particularly for individuals with advanced disease progression. Telerehabilitation using home-based protocols allows for remote supervision of tDCS over longer durations, thereby increasing participation, compliance and adherence. In this study, we explored the safety, feasibility and preliminary effects of a remotely supervised tDCS (RS-tDCS) protocol in ALS. MATERIAL AND METHODS: In this pre-post case series study, two individuals with ALS completed 24 remotely supervised anodal tDCS sessions (20 minutes, 2 mA). Outcomes included adherence, compliance, disease progression, walking speed, risk of fall, endurance, fatigue and depression. RESULTS: Both participants successfully completed the study without any major adverse effects. Minor side effects included mild sensations of itching and throbbing under the electrodes during stimulation. Clinical outcomes showed minimal to no change for any of the measures. CONCLUSIONS: Preliminary findings suggest that the RS-tDCS protocol is safe and feasible in individuals with ALS. Our protocol serves as a model for future long-term studies to evaluate the clinical and neurophysiological effects of tDCS using a telerehabilitation protocol in ALS.