Comparison of the effects of transcranial direct current stimulation and mindfulness-based stress reduction on mental fatigue, quality of life and aggression in mild traumatic brain injury patients: a randomized clinical trial

Abstract

Background The rate of traumatic brain injuries (TBIs) due to the accidents is high around the world. Patients with mild TBIs may suffer from some psychological disorders, including aggression, and mental fatigue, and thus their quality of life decreased. Among different treatments for TBI, two treatments, namely transcranial direct current stimulation (tDCS), and mindfulness-based stress reduction (MBSR) have shown to be effective. Therefore, this study aimed to compare the effects of these two treatments on mental fatigue, aggression and quality of life in mTBI patients. Materials and methods This randomized controlled trial study was conducted on 48 TBI patients referred to emergency and neurosurgery departments of Shahid Beheshti Hospital, Kashan, Iran. They were selected using the convenience sampling method. Data were collected using the mental fatigue scale, the World Health Organization Quality of Life-BREF (short version), and the Buss–Perry Aggression Questionnaires. Then, the data were analyzed using a Mixed Repeated Measures ANOVAs, and the Levene and Kolmogorov–Smirnov tests by SPSS-23 software. Results The mean age of patients in the three groups of MBSR, tDCS and control were 69.38 + 6.11 (25% male), 25.40 + 12.11 (25% male) and 69.37 + 0.2 (18.8% male), respectively. There was no significant difference between the three groups in terms of mental fatigue, quality of life and aggression (P < 0.05). In addition, the results showed that there was a significant difference between the main effect of time and the interaction between time and group (P < 0.001). Conclusions Both MBSR and tDCS methods are effective in reducing the mental fatigue and aggression and increasing quality of life of mTBI patients; MBSR treatment, as indicated in the present study, can be more effective than tDCS in patients with mTBI. Trial registration : Thailand Registry of Clinical Trials, TCTR20180827003 Registered on August 24, 2018.

Inflammation, brain connectivity, and neuromodulation in post-traumatic headache

“…For example, a study investigating patients with chronic pelvic pain showed that a single session of anodal tDCS applied to two brain regions, the DLPFC and primary motor cortex, reduced pain and improved quality of life and disability measures ( Divandari et al, 2019 ). tDCS has also been shown to improve TBI-related symptoms ( Kang et al, 2012 ; O'Neil-Pirozzi et al, 2017 ; Shirvani et al, 2021 ). Anodal tDCS applied to the PFC is effective in reducing mental fatigue, increasing the quality of life of mild TBI patients, and improving the working memory of severe TBI patients ( Kang et al, 2012 ; O'Neil-Pirozzi et al, 2017 ; Shirvani et al, 2021 ).…”

Transcranial direct current stimulation for fatigue in neurological conditions: A systematic scoping review

“…Among 14 parallel-arm studies, six studies (43%) (Acler et al, 2013;Charvet et al, 2018;Forogh et al, 2017;Pilloni et al, 2020;Sharma et al, 2019Sharma et al, , 2020 reported improvement only in the tDCS group, five studies (36%) (De Doncker et al, 2021;Dong et al, 2021;Hanken et al, 2016;Mortezanejad et al, 2020;Shirvani et al, 2021) reported an improvement between the groups, two studies (14%) (Gandiga et al, 2006;Ulrichsen et al, 2022) did not report any improvement in either group, and one study (7%) (Charvet et al, 2018) reported inconclusive results due to inadequate data. All the pre-post studies (Chan et al, 2017;Dobbs et al, 2017;Malik et al, 2016;Padalino et al, 2021;Tecchio et al, 2022;Walton Masters et al, 2020) observed a reduction in the fatigue scores post tDCS, except for one (Dobbs et al, 2018) which did not show any improvement.…”

“…(1-2 months) was assessed in only three studies (De Doncker et al, 2021;Dong et al, 2021;Shirvani et al, 2021). The diversity observed among these studies highlights that the precise target region for each neurological condition is still subject to question.…”

“…Out of the 67 studies, 42 (63%) were interventional studies(Acler et al, 2012(Acler et al, , 2013Ayache et al, 2016Bockbrader, 2017;Cancelli et al, 2018; Chalah et al, 2017a Chalah et al, , 2017bChalah et al, , 2020Chan et al, 2017;Charvet et al, 2018;De Doncker et al, 2021;Dobbs et al, 2017Dobbs et al, , 2018Dong et al, 2021;Ferrucci et al, 2014;Fiene et al, 2018;Forogh et al, 2017;Gandiga et al, 2006;Hanken et al, 2016;Malik et al, 2016;Mortezanejad et al, 2020;Padalino et al, 2021;Pilloni et al, 2020;Porcaro et al, 2019a;Proessl et al, 2018;Saiote et al, 2014;Sbragia et al, 2020;Sharma et al, 2019Sharma et al, , 2020Shirvani et al, 2021;Sivaramakrishnan et al, 2019;Sun et al, 2022;Tecchio et al, 2014Tecchio et al, , 2015Tecchio et al, , 2022Ulrichsen et al, 2022;Vannorsdall et al, 2015;Walton Masters et al, 2020;Workman et al, 2020Workman et al, , 2023, 18 (27%) were reviews(Ashrafi et al, 2020;Capone et al, 2020;…”

“… Chalah et al, 2017aChalah et al, , 2020Ferrucci et al, 2014;Fiene et al, 2018;Porcaro et al, 2019a;Proessl et al, 2018;Saiote et al, 2014;Sbragia et al, 2020;Tecchio et al, 2014Tecchio et al, , 2015Vannorsdall et al, 2015;Workman et al, 2020Workman et al, , 2023, 14 (34%) were parallelgroup RCTs(Acler et al, 2013;Charvet et al, 2018;De Doncker et al, 2021;Dong et al, 2021;Forogh et al, 2017;Gandiga et al, 2006;Hanken et al, 2016;Mortezanejad et al, 2020;Pilloni et al, 2020;Sharma et al, 2019Sharma et al, , 2020Shirvani et al, 2021;Ulrichsen et al, 2022), seven (17%) were pre-post studies(Chan et al, 2017;Dobbs et al, 2017Dobbs et al, , 2018Malik et al, 2016;Padalino et al, 2021;Tecchio et al, 2022;Walton Masters et al, 2020), three (7%) were case studiesBockbrader, 2017;, one (2%) was a case series(Sivaramakrishnan et al, 2019), and one (2%) was a parallel-group study protocol(Sun et al, 2022). The full texts were available for 24 studies(Acler et al, 2013;Ayache et al, 2016;Cancelli et al, 2018; Chalah et al, 2017a…”