2026 American Academy of Neurology Abstract Website

Objective:

To identify baseline predictors and affective correlates of withdrawal improvement among women with multiple sclerosis (MS) and cannabis use disorder (CUD) receiving active remotely supervised transcranial direct current stimulation (RS-tDCS), and to assess the durability of response through three months post-treatment.

Background:

tDCS targeting the dorsolateral prefrontal cortex (DLPFC) has shown promise for reducing craving and withdrawal in CUD by modulating neural circuitry underlying withdrawal-related distress, as described in the Koob and Volkow cycle of addiction. People with MS are at high risk for CUD, which is associated with cognitive and mood disturbances. To address this need, we developed a home-based DLPFC RS-tDCS intervention paired with mindfulness meditation to support reduction of cannabis use. In prior trials, RS-tDCS significantly reduced cannabis withdrawal symptoms.

Design/Methods:

This secondary analysis included women with MS and CUD assigned to the active RS-tDCS arm (n = 22). Participants completed 4-weeks of stimulation paired with mindfulness meditation audiotracks. The Cannabis Withdrawal Scale (CWS), Kessler Psychological Distress Scale (K10), Positive Affect and Negative Affect Schedule (PANAS), and SymptoMScreen were administered at baseline, post-treatment, and 3-month follow-up. Predictors included age, disease duration, use of cannabis before MS, duration of cannabis use, baseline K10, and baseline CWS. The primary outcome was change in CWS. Correlations examined co-movement of affective change with withdrawal improvement.

Results:

CWS improved significantly from baseline to post-treatment (from 61.2±31.4 to 38.8±28.7; mean change = 22.4±30.7; p=.001) and these gains were maintained 3-months post-intervention. Longer disease duration predicted greater improvement (r=0.43, p=.05) while age, baseline distress, and cannabis history were insignificant. Changes in affect were small and uncorrelated with CWS improvement, suggesting withdrawal relief occurred independently of mood effects.

Conclusions:

Among women with MS receiving active treatment, cannabis withdrawal was significantly and durably reduced. Effects appeared independent of mood, suggesting that RS-tDCS may directly modulate neural circuits underlying withdrawal-related distress.