Faculty Bibliography

The coronavirus disease 19 (COVID-19) pandemic has resulted in the urgent need to develop and deploy treatment approaches that can minimize mortality and morbidity. As infection, resulting illness, and the often prolonged recovery period continue to be characterized, therapeutic roles for transcranial electrical stimulation (tES) have emerged as promising non-pharmacological interventions. tES techniques have established therapeutic potential for managing a range of conditions relevant to COVID-19 illness and recovery, and may further be relevant for the general management of increased mental health problems during this time. Furthermore, these tES techniques can be inexpensive, portable, and allow for trained self-administration. Here, we summarize the rationale for using tES techniques, specifically transcranial Direct Current Stimulation (tDCS), across the COVID-19 clinical course, and index ongoing efforts to evaluate the inclusion of tES optimal clinical care.

BACKGROUND/UNASSIGNED:Cognitive impairment occurs in approximately one-third of pediatric-onset multiple sclerosis (POMS) patients. The Symbol Digit Modalities Test (SDMT), a widely used cognitive screen in adults, has yet to be incorporated early into the standard care of POMS. OBJECTIVE/UNASSIGNED:To screen for cognitive impairment early in the course of POMS and analyze predictive factors. METHODS/UNASSIGNED:Of the 955 POMS or clinically isolated syndrome (CIS) patients prospectively assessed from March 2014 to July 2018, 500 POMS and 116 CIS patients met inclusion criteria (disease onset before the age of 18, one or more SDMTs, and 8 years or older at the time of testing). Those with relapse were analyzed separately from those who were relapse-free. RESULTS/UNASSIGNED: = 383, mean follow-up: 1.8 years), 14.1% had clinically meaningful decline predicted by older age of multiple sclerosis (MS) onset and male gender. Disease relapse or steroid use led to transient worsening on the SDMT. CONCLUSION/UNASSIGNED:Early in the disease, some POMS and CIS patients are at risk for cognitive impairment and subsequent decline.

Introduction: Cognitive impairment in pediatric onset multiple sclerosis (POMS) occurs in up to one third of cases.
Objective(s): To screen for cognitive impairment early in the disease course of POMS, measure predictive factors, and determine the effect of relapse on cognitive processing speed.
Aim(s): To identify cognitive processing speed impairment among POMS and pediatric clinically isolated (CIS) patients enrolled in the US Pediatric MS and Other Demyelinating Disease Registry. In March 2014, the Symbol Digit Modalities Test (SDMT) scores were analyzed from March 2014, when the SDMT was added to the clinical evaluation through July 2018, when the data set was locked.
Method(s): SDMT raw scores were converted to age-normative z-scores using validated age and sex adjusted means. Processing speed impairment was defined with z-score increments of-1.0. Clinically meaningful decline in longitudinal analyses was defined by a z-score decrease of 1.0 or more.
Result(s): For the POMS (n=500) and CIS (n=116) with at least one SDMT, the mean age at symptom onset was 13.5 years and the mean (+SD) disease duration at the initial SDMT assessment was 3.0 + 2.9 years. A total of 23.4% of MS and 16.4% of CIS patients had impaired processing speed at initial assessment. SDMT impairment was predicted by worse EDSS, longer disease duration, and lower level of mother's educational achievement. On longitudinal follow-up (n=383, mean follow-up: 1.8 years), 14.1% had clinically meaningful decline predicted by older age of MS onset, male gender, and longer test-retest interval. Disease relapse and steroid use were associated with transient SDMT worsening.
Conclusion(s): Early in the disease course, a subgroup of POMS patients are at risk for cognitive impairment and subsequent decline. Screening for cognitive slowing is critical for prompt identification of potential cognitive deficits and initiation of additional services