Brain stimulation with cognitive training fails to lower MS fatigue
Similar reductions in fatigue observed with cognitive training alone
A noninvasive brain stimulation technique called transcranial direct current stimulation (tDCS) doesn’t seem to ease fatigue in adults with multiple sclerosis (MS) when given at home with computer-based cognitive training, according to one of the largest studies of its kind.
While the home-based intervention was deemed feasible, combining daily tDCS with cognitive training for six weeks led to similar reductions in fatigue as cognitive training alone.
“This suggests that tDCS does not provide any additional benefit over cognitive training alone in reducing fatigue, but confirms the feasibility and tolerance of this home-based intervention,” the study’s researchers said. The study, “Home-based transcranial direct current stimulation paired with cognitive training to reduce fatigue in multiple sclerosis,” was published in Scientific Reports.
For many people with MS, fatigue is considered the most debilitating symptom, one characterized by an overwhelming feeling of tiredness, exhaustion, or loss of energy. It can arise as a consequence of the inflammatory nerve cell damage that underlies MS, or secondary to MS treatments, or the stress of living with a chronic disease.
In tDCS, a low electrical current is delivered to specific regions of the brain via electrodes placed on the scalp. It’s been shown to improve walking, boost the benefits of physical therapy, and ease muscle spasticity in MS patients.
Declines in fatigue
The study (NCT03838770) to test if home-based tDCS, paired with computer-based cognitive training, could reduce MS-related fatigue was conducted by researchers at the New York University Grossman School of Medicine. A total of 117 MS adults with at least moderate fatigue, but without signs of depression, were randomly assigned to either active tDCS or low-dose (sham) tDCS. Of them, 105 (90%) completed all the assessments and were included in the final analysis.
Over six weeks, the participants underwent 30 remotely supervised tDCS sessions from home on consecutive weekdays. These lasted 20 minutes and during that period patients completed cognitive training exercises using BrainHQ, a computer-based program that’s been shown to improve cognition in MS patients.
The primary outcome was a change in PROMIS Fatigue scores after six weeks. This measure includes eight items that participants rate based on the previous week’s experiences. Scores range from 8 to 40, with higher scores indicating more fatigue. A drop of 4.5 points is considered clinically meaningful.
After six weeks, both active and sham treatment groups saw similar declines in their PROMIS Fatigue scores — by 18% and 19%, indicating a similar reduction in fatigue. The results were similar when the participants were stratified by disease severity.
A similar pattern was seen using the Modified Fatigue Impact Scale, another self-reported fatigue measure. Here, an easing of fatigue, as indicated by lower scores, was also similar between active tDCS and sham groups (15% vs. 17%).
At a three-month follow-up, both groups showed a sustained reduction in fatigue, with similar decreases in PROMIS Fatigue scores. The two groups had no significant differences in sex, age, ethnicity, or PROMIS Fatigue scores before treatment.
No serious adverse events were reported throughout the intervention, which was well tolerated. Across both groups, nine adverse events were rated above 7 in a pain scale of 1 to 10. The discomfort eased in all the cases and the session resumed. One participant discontinued one session due to discomfort. Otherwise, all the side effects were reported as mild in intensity and resolved at the end of the session.
“Both the active and sham tDCS groups experienced reductions in fatigue, with no significant difference between the two groups, suggesting that tDCS does not provide any additional benefit over cognitive training alone in reducing fatigue,” the researchers wrote.
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