Impact of transcranial direct current stimulation on fatigue in multiple sclerosis

Restor Neurol Neurosci. 2014;32(3):423-36. doi: 10.3233/RNN-130372.


Purpose: Fatigue is a frequent and difficult to treat symptom affecting patients with multiple sclerosis (MS) with a profound negative impact on quality of life. Fatigue has been associated with functional and structural abnormalities of the frontal cortex, including frontal hypo-activation. The aim of this exploratory study was to assess whether fatigue symptoms can be reduced by excitability-enhancing anodal transcranial direct current stimulation (tDCS).

Methods: In this sham-controlled, double-blind intervention study, tDCS was applied over the left prefrontal cortex of MS patients with fatigue for five consecutive days. Symptoms were tracked for 1 month via questionnaires. Lesion load at baseline was calculated for each patient and correlated with fatigue levels and responsiveness to stimulation.

Results: In the whole group analysis the scores of the fatigue scales were not altered by tDCS. However, in an exploratory analysis we found a correlation between response to the stimulation regarding subjectively perceived fatigue and lesion load in the left frontal cortex: patients responding positively to anodal tDCS had higher lesion load, compared to non-responding patients.

Conclusion: We conclude that in patient subgroups discernible by specific morphological alterations, tDCS may be a tool for MS fatigue management.

Keywords: MRI; Multiple sclerosis; fatigue; lesion load; tDCS.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Depression / physiopathology
  • Depression / therapy
  • Double-Blind Method
  • Fatigue / physiopathology
  • Fatigue / therapy*
  • Female
  • Frontal Lobe / pathology
  • Functional Laterality
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multiple Sclerosis / drug therapy
  • Multiple Sclerosis / pathology
  • Multiple Sclerosis / physiopathology
  • Multiple Sclerosis / therapy*
  • Prefrontal Cortex
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Transcranial Direct Current Stimulation / methods*
  • Treatment Outcome