The following is a summary of “Vigilance Improves in People with Multiple Sclerosis (MS) and Fatigue following Repeated Dorsolateral Prefrontal Cortex Transcranial Direct Current Stimulation (tDCS) Sessions Paired with Cognitive Training Delivered at Home,” published by Charvet, et al.
To evaluate the effectiveness of transcranial direct current stimulation (tDCS) for MS-related tiredness in a home setting. Individuals with multiple sclerosis (MS) typically report experiencing cognitive fatigue. An objective indicator of self-reported cognitive tiredness is attentional vigilance, quantified by response time and its fluctuation throughout sustained work. The dorsolateral prefrontal cortex (DLPFC) has been linked to feelings of tiredness and alertness. In an open-label study, participants with MS and fatigue (Fatigue Severity Scale>36) but not severe cognitive impairment (z-score Symbol Digit Modality Test [SDMT] > -3.0) received tDCS and aCT (adaptive cognitive training, Posit Science’s BrainHQ) in the comfort of their own homes under remote supervision. The lateral prefrontal cortex (DLPFC; anode F3, cathode F4) was stimulated at 2.0 mA for 20 minutes.
Measures of attentional alertness included reaction time and variability on tasks requiring continuous performance (Cogstate). One total vigilance z-score was calculated after correcting for age using normative z-scores. N=24 people took part (63% were women, ages ranged from 22 to 71, and the median Expanded Disability Status Scale (EDSS) score was 3.2 [1.0-6.5]). Twenty-three out of twenty-four participants (96%) completed all 20 sessions, indicating that the intervention was well tolerated and safe. At the end of the intervention, there was no statistically significant improvement in SDMT (-0.53±1.50 vs. -0.24±-1.45, P=0.101). However, the combined intervention of active tDCS and aCT led to an improvement in vigilance composite score (time and variability, mean z-score improvement: -0.89±1.94, P=0.036) as well as reaction time specific (mean detection (DET) z-score improvement: -0.46±1.02, P=0.038; mean identification (IDN) z-score improvement: -0.83±1.28, P=0.04). MS patients who suffer from tiredness may benefit from a home-based strategy consisting of left DLPFC tDCS and aCT. Hence, vigilance can objectively indicate mental tiredness in MS patients.
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