Transcranial Direct Current Stimulation for Post Treatment Lyme Disease

Inclusion Criteria:

• History of diagnosis of Lyme disease by a health care provider, meeting criteria foreither definite or probable or possible LD

• Willingness to provide documentation of prior LD testing and/or related medicalrecords

• Total prior antibiotic treatment for LD was at least 2 courses of antibiotic therapy

• Have cognitive symptoms attributed to Lyme disease that have persisted or returneddespite antibiotic therapy

• Current cognitive symptoms interfere with function and/or cause distress

• Have evidence of slowed processing speed on a screening measure

• Participant is willing to be off of antibiotic treatment for tick-borne disease forat least 4 weeks prior to final determination of study eligibility and for theduration of the 12-week study.

• Participant expresses willingness to not start new medications that might affecttreatment outcome during the trial (unless medically necessary), and willingness toinform study staff regarding any changes in medication

• Live in the US or Canada and comfortable speaking English

• Age 18-65

• Stable and continuous access to internet service

• Adequate home facilities (enough space, access to quiet and distraction free area)

• Able to commit to the 12-week study period (4 weeks of training sessions and an 8-week post treatment visit)

• Estimated intellectual ability >= 85

Exclusion Criteria:

• Medical Illness: Any of the following: a. Unstable non-Lyme-related chronic medicalillness over the last 12 months (e.g., cancer, acute myocardial infarction, labilehypertension) b. Any severe skin disorder or skin sensitive area near stimulationlocations (e.g. forehead)

Neurologic: Any of the following:

• History of traumatic brain injury with persistent post-concussive symptoms

• History of seizure disorder or recent (<5 years) seizure history

• History of neurosurgery to the head

• Chronic headaches or migraines of moderate to severe intensity within the last month

• Post stroke deficits that may interfere with assessment

• Any progressive neurodegenerative disorder or other neurological disorders that mayinterfere with assessment at discretion of the investigator.

Psychiatric: Any of the following:

• History of intellectual disability, or other developmental neurological conditionassociated with cognitive impairment

• Current primary psychiatric disorder that would interfere with ability toparticipate

• Current alcohol or other substance use disorder

• Current suicide risk as assessed by the C-SSRS (any level)

• History of suicidal behavior over the last year

• History of a diagnosis of a psychotic disorder, mania or bipolar disorder

• Depression rating of moderate or severe at screening

• Currently taking opiate-based medications, dissociative drugs (prescribed orillicit), or other medication considered likely to interfere with treatmentoutcome at the discretion of the investigator. The use of a stable dose ofbenzodiazepines, anticholinergic agents and non-narcotic pain medications ispermitted. The use of an occasional dose of these medications is alsopermitted, but not within 48 hours of neurocognitive study assessments.

• Participants whose current daily medication regimen has not been stable for aminimum of 4 weeks prior to final determination of study eligibility

• Medical device implanted in the head (such as a Deep Brain Stimulator) or inthe neck (such as a Vagus Nerve Stimulator), or metal implants in the head orneck

• Inadequate visual or motor skills needed for regular computer use or to operatestudy equipment, or inability to provide informed consent

• Individuals who are pregnant or breastfeeding or planning to become pregnant

• Lifestyle Considerations: Participants not willing to refrain from beginning,resuming or increasing non study cognitive training or cognitive enhancingsupplements/medications or other therapies that might affect treatment outcome