Transcranial Direct Current Stimulation Reduces Fatigue in Multiple Sclerosis

An estimated 75% of patients with multiple sclerosis report fatigue among their most disabling disease symptoms.

New findings indicate Transcranial direct current stimulation (tDCS) reduces fatigue associated with multiple sclerosis (MS).

Fatigue is a common symptom among patients with MS and an effective treatment remains elusive. An estimated 75% or more of patients report fatigue among the most debilitating issues associated with MS, and 55% indicate it to be the worst symptom.

Although a wide variety of treatments have been tested to reduce MS-associated fatigue, none have been found to be consistently effective. In a study published in the Multiple Sclerosis Journal, investigators sought to determine whether tDCS could reduce fatigue in MS.

This non-invasive method is a relatively recent therapeutic development that utilizes low-amplitude direct currents to “induce changes in cortical excitability,” according to the study.

The advantages of using tDCS compared with other stimulation methods include ease of use, lower cost, and greater safety and tolerability, according to the authors.

For the study, investigators used remotely administered tDCS in 2 separate cohorts of patients with MS. Study 1 was an open-label trial of 10 sessions delivered over 2 weeks. Study 2 was subsequent randomized sham-controlled trial of 20 sessions delivered over 4 weeks.

The controlled study included 27 individuals with MS who were randomized to receive either tDCS or a placebo while playing a cognitive training game. The game targets processing speed and working memory.

The participants completed 20-minute sessions in their homes 5 days per week. The study kit for at-home use included a laptop computer with a mouse and charger, tDCS device and headset, sponges, and extra saline solution.

“Each remote session is self-administered with real-time guidance from a study technician; subjects are supervised at all times during sessions via videoconferencing software,” the authors wrote. “Extensive safety measures are taken including strict and well-defined study stop criteria and a device customized for remote use to prevent adverse events and misuse of the device.”

The device is locked to the participant until they receive a one-time use “dose code” that unlocks the device for the programmed dose given to the participant, preventing misuse, the study noted.

There were 15 patients who received tDCS and 12 who received the placebo. After 20 sessions, the participants reported their level of fatigue using the Patient-Reported Outcomes Measurement Information System, which grades fatigue on a score up to 32.

The results of the study showed a statistically significant reduction in patients who underwent tDCS compared with the placebo arm. On average, participants in the tDCS arm experienced a 5.6-point drop in fatigue compared with a 0.9-point increase in fatigue in the control arm.

Participants with the highest levels of fatigue at baseline experienced the greatest benefits. According to the authors, many patients experienced an even more marked benefit that returned their fatigue to near normal levels.

The findings suggest that an increase in treatment may lead to greater benefit, with the decrease in fatigue greater after 20 sessions compared with 10 sessions in an initial study, according to a press release.

“These data are a hopeful sign that we can use tDCS to help patients with MS manage their fatigue, and that continuing the treatment may show even better results,” lead study author Leigh Charvet, PhD, said in the release. “Importantly, tDCS can be delivered remotely to patients at home, offering a practical option for patients, especially those with travel limitations and MS-related disability.”