No add‐on effect of tDCS on fatigue and depression in chronic stroke patients: A randomized sham‐controlled trial combining tDCS with computerized cognitive training

Abstract

Background Fatigue and emotional distress rank high among self‐reported unmet needs in life after stroke. Transcranial direct current stimulation (tDCS) may have the potential to alleviate these symptoms for some patients, but the acceptability and effects for chronic stroke survivors need to be explored in randomized controlled trials. Methods Using a randomized sham‐controlled parallel design, we evaluated whether six sessions of 1 mA tDCS (anodal over F3, cathodal over O2) combined with computerized cognitive training reduced self‐reported symptoms of fatigue and depression. Among the 74 chronic stroke patients enrolled at baseline, 54 patients completed the intervention. Measures of fatigue and depression were collected at five time points spanning a 2 months period. Results While symptoms of fatigue and depression were reduced during the course of the intervention, Bayesian analyses provided evidence for no added beneficial effect of tDCS. Less severe baseline symptoms were associated with higher performance improvement in select cognitive tasks, and study withdrawal was higher in patients with more fatigue and younger age. Time‐resolved symptom analyses by a network approach suggested higher centrality of fatigue items (except item 1 and 2) than depression items. Conclusion The results reveal no add‐on effect of tDCS on fatigue or depression but support the notion of fatigue as a relevant clinical symptom with possible implications for treatment adherence and response.

Effect of cognitive training on patients with breast cancer reporting cognitive changes: a systematic review and meta-analysis

“…At the same time, we found that cognitive training did not significantly alleviate fatigue in breast cancer survivors which is consistent with previous study. 57 In both treatment period and recovery period, cancer treatment, such as chemoradiotherapy, mastectomy, breast reconstruction and so on, can lead to breast cancer survivors more frequently encountered many difficulties associated with disease or treatment, such as cancer symptoms and postchemoradiotherapy physical fatigue. This difficulty may persist even after treatment has ended.…”

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.…”

“… 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…”

“…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;…”

Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable

“…In stroke patients in the late subacute (>3 months) or chronic stroke phases (>6 months) Modafinil is effective 12 for PSF, but only in those with fronto-striatal dysfunction. 13 In a similar population, neuromodulation interventions 14,15 show mixed results, due to differences in methodologies, with bilateral cortical sensorimotor targets providing robust reduction in fatigue, and unilateral dorsolateral pre-frontal targets showing no effects. Furthermore, participants in the sensorimotor cohort were minimally impaired with no depression, while in the dorsolateral pre-frontal cohort although minimally impaired, depressed individuals were not excluded.…”