Walking in multiple sclerosis improves with tDCS: a randomized, double‐blind, sham‐controlled study

Abstract

Objective: To evaluate whether multiple sessions of transcranial direct current stimulation (tDCS) applied to the primary motor (M1) cortex paired with aerobic exercise can improve walking functions in multiple sclerosis (MS). Methods: MS participants were recruited for a double-blind, parallel-arm, randomized, sham-controlled trial and assigned to 10 sessions (5 d/wk for 2 weeks) of either active or sham tDCS paired with unloaded cycling for 20 minutes. Stimulation was administered over the left M1 cortex (2.5 mA; anode over C3/cathode over FP2). Gait spatiotemporal parameters were assessed using a wearable inertial sensor (10-meter and 2-minute walking tests). Measurements were collected at baseline, end of tDCS intervention, and 4-week postintervention to test for duration of any benefits. Results: A total of 15 participants completed the study, nine in the active and six in the sham condition. The active and sham groups were matched according to gender (50% vs. 40% female), neurologic disability (median EDSS 5.5 vs. 5), and age (mean 52.1 AE 12.9 vs. 53.7 AE 9.8 years). The active group had a significantly greater increase in gait speed (0.87 vs. 1.20 m/s, p < 0.001) and distance covered during the 2-minute walking test (118.53 vs. 133.06 m, p < 0.001) at intervention end compared to baseline. At 4-week follow-up, these improvements were maintained (baseline vs. follow-up: gait speed 0.87 vs. 1.18 m/s, p < 0.001; distance traveled 118.53 vs. 143.82 m, p < 0.001). Interpretation: Multiple sessions of tDCS paired with aerobic exercise lead to cumulative and persisting improvements in walking and endurance in patients with MS.

The Effects of Neuromodulators on Spasticity, Balance, and Gait in Patients with MS: A Systematic Review and Meta-Analysis Study

“…3). At follow-up, these improvements were even maintained in this study [30]. It seems that being more studies which conducted by multi-session tDCS might change the result of this meta-analysis (Fig.…”

Efficacy of transcranial direct current stimulation in people with multiple sclerosis: a review

“…In order to improve comparability across studies, it would be ideal for each study to include at least one measure of short‐distance walk (25FWT [51]), one measure of long‐distance walk (2‐min walking test/6MWT [52]) and one measure of postural control such as timed up and go [53] in the screening evaluation prior to the study and as outcome measures. As opposed to the three other studies examined, the results of both studies performed by Pilloni et al [48,49] are encouraging. They underlined that PwMS with Expanded Disability Severity Scale above 4 are more likely to benefit from multiple sessions of atDCS.…”

Influence of Transcranial Direct Current Stimulation and Exercise on Fatigue and Quality of Life in Multiple Sclerosis

“…On the other hand, the benefits suggested by the application of tDCS on the left DLPFC area on quality of life may be interesting to study in the future, along with its effectiveness and potential in larger samples, and to check, if appropriate, if the application on this area shows better results than in other areas, such as the primary motor cortex. Nevertheless, in line with the suggestions of other studies, such as the review by Giuseppina et al [46], the combination of tDCS and exercise with prolonged treatment with multiple sessions would be optimal to generate measurable benefits.…”