Non-invasive brain stimulation reduces fatigue in multiple sclerosis (MS) patients, concludes a study by researchers at New York University (NYU).
Their study, “Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial,” appeared in the Multiple Sclerosis Journal.
Fatigue is one the most disabling symptoms of MS, affecting roughly 75 percent of people with the disease. Doctors often prescribe drugs to treat narcolepsy, as well as behavior-based treatments and exercise programs, but their benefits have not been consistent.
“Fatigue is one of the most common symptoms affecting quality of life for MS patients, and practitioners have lacked good treatment options,” Dr. Lauren Krupp, the study’s senior author and director of the Multiple Sclerosis Comprehensive Care Center at NYU Langone Health, said in a press release.
This led scientists to study a technique of brain stimulation called transcranial direct current stimulation (tDCS), which had shown positive results in earlier neurology studies, including improvements of cognitive symptoms in MS.
In tDCS, doctors place electrodes on the scalp via a headset to apply a low-amplitude electrical current at the dorsolateral prefrontal cortex — a brain region believed to play a role in fatigue and cognitive symptoms. The technique has been proven safe and tolerable.
The NYU study randomly assigned 27 MS patients to receive either tDCS (15 patients) or placebo (12 patients). Patients got treatment while playing a cognitive game directed at the brain’s processing speed and working memory. Sessions lasted 20 minutes each and took place five days a week, at patients’ homes.
Participants reported their level of fatigue after 20 sessions, using a scale known as the Patient-Reported Outcomes Measurement Information System (PROMIS) that grades fatigue on a score of up to 32. A higher score correlates with more fatigue.
The results showed a significant 5.6-point drop with tDCS, compared to a 0.9 point increase in the placebo group.
Furthermore, patients may benefit from more sessions, since those who underwent 20 sessions reduced fatigue more than those who did only 10. The study also showed that patients with the most fatigue at baseline saw the biggest improvements.
Remarkably, many participants reduced their fatigue to near-normal levels, researchers observed.
“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,” said the study’s lead author, Dr. Leigh Charvet, an associate professor of neurology and director of MS research at NYU Langone Health. “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.”
Further studies are needed to ascertain the precise mechanism behind tDCS. Scientists believe it changes the brain’s excitability, which improves connections and facilitates learning. Meanwhile, the study’s authors strongly advise MS patients not to try over-the-counter stimulation technologies outside of a reliable research setting.
“The positive results from our study suggest that tDCS might offer benefit in fatigue reduction,” said Krupp. “The next step is to see if these benefits can be replicated and sustained in larger studies. But our initial findings are very promising.”
The research team plans to test tDCS in larger clinical trials for MS-related fatigue, motor and cognitive symptoms. Currently, the Multiple Sclerosis Comprehensive Care Center at NYU Langone Health is the only one in the United States to offer tDCS to MS patients.