Remotely Supervised tDCS for Slowing ALS Disease Progression

Inclusion Criteria: * Diagnosis of possible, probable, or definite amyotrophic lateral sclerosis according to El Escorial revised criteria * Spinal onset ALS with initial weakness in the upper or lower extremity. * Diagnosed with ALS within the past 5 years * 1-2 point change in pre-slope of the ALSFRS-R at time of enrollment (ratio of drop in score from 48 to the duration in months from onset of weakness) * Score ≥ 2 for "swallowing" of the ALSFRS-R * Score ≥ 2 for "walking" of the ALSFRS-R * Able to provide informed consent * Stable dose of riluzole, edaravone, AMX0035 (Relyvrio) or no medications * Availability of a caregiver for remote administration of tDCS Exclusion Criteria: * Subject has bulbar onset ALS * Any neurological diagnosis other than ALS * Psychiatric disorders * Any other concomitant disease that affects prognosis of ALS inclusive of systemic disease, cardiovascular disease, hepatic or renal disorder * Tracheostomal or noninvasive ventilation for more than 12 hours per day * Enrollment in an on-going ALS pharmaceutical trial * Subject plans on moving within 6 months. TMS Exclusion Criteria: * Implanted cardiac pacemaker * Metal implants in the head or face * Unexplained, recurring headaches * History of seizures or epilepsy * Currently under medication that could increase motor excitability and lower seizure threshold * Skull abnormalities or fractures * Concussion within the last 6 months * Currently pregnant * tDCS Exclusion Criteria: * Skin hypersensitivity * History of contact dermatitis * History of allodynia and/or hyperalgesia * Any other skin or scalp condition that could be aggravated by tDCS