Personalized, bilateral whole-body somatosensory cortex stimulation to relieve fatigue in multiple sclerosis

Cancelli, Andrea; Cottone, Carlo; Giordani, Alessandro; Migliore, Simone; Lupoi, Domenico; Porcaro, Camillo; Mirabella, Massimiliano; Rossini, Paolo Maria; Filippi, M; Tecchio, Franca

doi:10.1177/1352458517720528

Cited by 56 publications

(89 citation statements)

References 37 publications

(61 reference statements)

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“…Other studies in PwMS also showed no significant improvements on fatigue questionnaires from unilateral prefrontal or parietal tDCS stimulation applied daily for five consecutive days [29][30][31]. However, tDCS applied daily for five consecutive days over the primary somatosensory cortex (S1) bilaterally [32][33][34], the primary motor cortex (M1) bilaterally [35], and the sensorimotor cortex bilaterally [33], showed significant fatigue improvements. The discrepancy in the results might be related to the differences in stimulation targets, protocol duration (single session vs. five daily sessions) and the adapted current intensity applied in these studies (e.g., all of these protocols used intensities ≤2 mA).…”

Section: Introductionmentioning

confidence: 91%

The Tolerability and Efficacy of 4 mA Transcranial Direct Current Stimulation on Leg Muscle Fatigability

2019

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Transcranial direct current stimulation (tDCS) modulates cortical excitability and affects a variety of outcomes. tDCS at intensities ≤2 mA is well-tolerated, but the tolerability and efficacy of tDCS at intensities >2 mA merits systematic investigation. The study objective was to determine the tolerability and effects of 4 mA tDCS on leg muscle fatigability. Thirty-one young, healthy adults underwent two randomly ordered tDCS conditions (sham, 4 mA) applied before and during an isokinetic fatigue test of the knee extensors and flexors. Subjects reported the severity of the sensations felt from tDCS. Primary outcomes were sensation tolerability and the fatigue index of the knee extensors and flexors. A repeated-measures ANOVA determined statistical significance (p < 0.05). Sensation severity at 4 mA tDCS was not substantially different than sham. However, two subjects reported a moderate–severe headache, which dissipated soon after the stimulation ended. The left knee flexors had significantly greater fatigability with 4 mA tDCS compared with sham (p = 0.018). tDCS at 4 mA was well-tolerated by young, healthy subjects and increased left knee flexor fatigability. Exploration of higher intensity tDCS (>2 mA) to determine the potential benefits of increasing intensity, especially in clinical populations with decreased brain activity/excitability, is warranted.

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Section: Introductionmentioning

confidence: 91%

The Tolerability and Efficacy of 4 mA Transcranial Direct Current Stimulation on Leg Muscle Fatigability

2019

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“…The group of Tecchio et al focused on a personalized anodal tDCS approach targeting the whole-body primary somatosensory areas (S1) bilaterally, following the evidence of S1 reduced excitability and M1 hyperexcitability in PwMS with fatigue (109)(110)(111)(112). They used a tailored procedure with personalized electrodes based on the patients' brain MRI located in place through an MRI-guided neuronavigation system.…”

Section: Neurophysiology As Innovative Treatment For Fatigue In Ms Pamentioning

confidence: 99%

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

et al. 2020

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Fatigue is a very common symptom among people with multiple sclerosis (MS), but its management in clinical practice is limited by the lack of clear evidence about the pathogenic mechanisms, objective tools for diagnosis, and effective pharmacological treatments. In this scenario, neurophysiology could play a decisive role, thanks to its ability to provide objective measures and to explore the peripheral and the central structures of the nervous system. We hereby review and discuss current evidence about the potential role of neurophysiology in the management of MS-related fatigue. In the first part, we describe the use of neurophysiological techniques for exploring the pathogenic mechanisms of fatigue. In the second part, we review the potential application of neurophysiology for monitoring the response to pharmacological therapies. Finally, we show data about the therapeutic implications of neurophysiological techniques based on non-invasive brain stimulation.

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“…In addition, performance fatigability is the magnitude or rate of change in performance over a given time relative to a reference value. The effects of tDCS on performance fatigability in healthy participants [14][15][16] and in people with neurological impairments [17][18][19][20][21][22] has been previously investigated and has yielded ambiguous findings. The mixed results might be from a lack of standardized protocols and inconsistent definitions of fatigue, which makes comparison of fatigue outcomes between studies more challenging.…”

Section: Introductionmentioning

confidence: 99%

Transcranial Direct Current Stimulation at 4 mA Induces Greater Leg Muscle Fatigability in Women Compared to Men

2020

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Transcranial direct current stimulation (tDCS) has previously shown different cortical excitability and neuropsychological effects between women and men. However, the sex-specific effects of tDCS on leg muscle fatigability has not been investigated. The purpose of this study was to determine the effects of a single session of 2 mA and 4 mA primary motor cortex tDCS on leg muscle fatigability in healthy young men and women in a crossover design. Twenty participants (women = 10) completed isokinetic fatigue testing (40 maximal reps, 120°/s) of the knee extensors and flexors in conjunction with sham, 2 mA, and 4 mA tDCS in a double-blind, randomized design. The fatigue index from each condition was calculated. Women had significantly greater knee extensor fatigability in the 4 mA condition compared to men (57.8 ± 6.8% versus 44.1 ± 18.4%; p = 0.041, d = 0.99). This study provides additional evidence that responses to tDCS may be sex-specific and highlights the necessity of accounting and powering for sex differences in future investigations.

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Personalized, bilateral whole-body somatosensory cortex stimulation to relieve fatigue in multiple sclerosis

Abstract: This second result in an independent group of patients supports the idea that neuromodulation interventions that properly select a personalized target might be a suitable non-pharmacological treatment for MS fatigue.

Cited by 56 publications

References 37 publications

The Tolerability and Efficacy of 4 mA Transcranial Direct Current Stimulation on Leg Muscle Fatigability

The Tolerability and Efficacy of 4 mA Transcranial Direct Current Stimulation on Leg Muscle Fatigability

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

Transcranial Direct Current Stimulation at 4 mA Induces Greater Leg Muscle Fatigability in Women Compared to Men

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