Primary studies included in this systematic review

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Impact of transcranial direct current stimulation on fatigue in multiple sclerosis.

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Journal Restorative neurology and neuroscience
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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PURPOSE: Fatigue is a frequent and difficult to treat symptom affecting patients with multiple sclerosis (MS) with a profound negative impact on quality of life. Fatigue has been associated with functional and structural abnormalities of the frontal cortex, including frontal hypo-activation. The aim of this exploratory study was to assess whether fatigue symptoms can be reduced by excitability-enhancing anodal transcranial direct current stimulation (tDCS). METHODS: In this sham-controlled, double-blind intervention study, tDCS was applied over the left prefrontal cortex of MS patients with fatigue for five consecutive days. Symptoms were tracked for 1 month via questionnaires. Lesion load at baseline was calculated for each patient and correlated with fatigue levels and responsiveness to stimulation. RESULTS: In the whole group analysis the scores of the fatigue scales were not altered by tDCS. However, in an exploratory analysis we found a correlation between response to the stimulation regarding subjectively perceived fatigue and lesion load in the left frontal cortex: patients responding positively to anodal tDCS had higher lesion load, compared to non-responding patients. CONCLUSION: We conclude that in patient subgroups discernible by specific morphological alterations, tDCS may be a tool for MS fatigue management.

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Electroconvulsive therapy in patient with psychotic depression and multiple sclerosis.

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Journal Neurocase
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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Safety of electroconvulsive therapy (ECT) in depressive patients with multiple sclerosis (MS) is still discussed and based solely on case reports. This kind of therapy was used in both unipolar depression and depression in bipolar disorder. It was suggested that ECT might cause the deterioration of neurological state (new MS lesions in magnetic resonance imaging). Moreover, there were also data indicating some anesthesiological complications and difficulties in patients with MS. We have presented a case of a patient who was treated with ECT and developed grand mal seizure after 14th electroconvulsive treatment.

Primary study

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Transcranial direct current stimulation (tDCS) for fatigue in multiple sclerosis.

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Journal NeuroRehabilitation
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: The debilitating fatigue that patients with multiple sclerosis (MS) commonly experience during day-to-day living activities responds poorly to current therapeutic options. Direct currents (DC) delivered through the scalp (transcranial DC stimulation or tDCS) at weak intensities induce changes in motor cortical excitability that persist for almost an hour after current offset and depend on current polarity. tDCS successfully modulates cortical excitability in various clinical disorders but no information is available for MS related fatigue. OBJECTIVE: In this study we aimed to assess fatigue symptom after five consecutive sessions of anodal tDCS applied over the motor cortex in patients with MS. METHODS: We enrolled 25 patients with MS all of whom experienced fatigue. We delivered anodal and sham tDCS in random order in two separate experimental sessions at least 1 month apart. The stimulating current was delivered for 15 minutes once a day for 5 consecutive days. In each session the Fatigue Impact Scale (FIS) and the Back Depression Inventory (BDI) were administered before the treatment (baseline), immediately after treatment on day five (T1), one week (T2) and three weeks (T3) after the last tDCS session. RESULTS: All patients tolerated tDCS well without adverse events. The fatigue score significantly decreased after anodal tDCS in 65% of the patients (responders). After patients received tDCS for 5 days their FIS scores improved by about 30% and the tDCS-induced benefits persisted at T2 and T3. CONCLUSION: Our preliminary findings suggest that anodal tDCS applied over the motor cortex, could improve fatigue in most patients with MS.

Primary study

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A single session of 1 mA anodal tDCS-supported motor training does not improve motor performance in patients with multiple sclerosis.

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Journal Restorative neurology and neuroscience
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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PURPOSE: To assess the effects of atDCS on motor performance in patients with multiple sclerosis (MS). Previously, anodal transcranial direct current stimulation (atDCS) has been shown to improve motor performance in healthy subjects and neurodegenerative populations. However, the effect of atDCS on motor performance is not examined in MS. METHODS: In the current study, a sham controlled double-blind crossover design was used to evaluate the effect of 20 minutes of 1 mA atDCS or sham tDCS (stDCS) on a unimanual motor sequence-training task, consisting of sequential finger presses on a computer keyboard with the most impaired hand. Patients received stimulation (atDCS or stDCS) during motor training. tDCS was applied over the primary motor cortex contralateral to the most impaired hand. Motor performance was assessed immediately before, during and 30 minutes after stimulation. RESULTS: Although we need to be careful with the interpretation of the data due to lack of power, our results showed no significant effect of atDCS on motor performance. CONCLUSIONS: Our findings indicate that atDCS-supported motor training was not able to improve motor performance more than sham-supported motor training. Possibly, the effects of atDCS are mediated by specific MS-related characteristics. Furthermore, increasing atDCS intensity and offering multiple stimulation sessions might be necessary to optimize motor performance resulting from atDCS-supported motor training.

Primary study

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Anodal tDCS increases corticospinal output and projection strength in multiple sclerosis.

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Journal Neuroscience letters
Year 2013
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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The application of anodal transcranial direct current stimulation (atDCS) to the human brain has been shown to elicit corticospinal (CS) excitability changes. This study evaluated the effect of a single session of atDCS on CS excitability in patients with multiple sclerosis (MS). atDCS and sham tDCS (stDCS) were applied to the primary motor cortex (M1) contralateral to the more severely impaired hand for 20min in a double-blinded crossover design. Changes in CS excitability were assessed using transcranial magnetic stimulation (TMS). The area under the recruitment curves increased significantly after application of atDCS (+56.58%, p=0.023) but not after stDCS. A sigmoidal curve-analysis revealed a higher plateau of the curve after atDCS (+22.2%, p<0.001). Our results showed that atDCS over M1 has the ability to increase CS output and projection strength in MS-patients, suggesting that atDCS can be considered during neural rehabilitation to facilitate motor recovery in MS.

Primary study

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Transcranial direct current stimulation ameliorates tactile sensory deficit in multiple sclerosis.

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Journal Brain stimulation
Year 2013
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Deficit of tactile sensation in patients with MS is frequent and can be associated with interference with daily life activities. Transcranial direct current stimulation (tDCS) showed to increase tactile discrimination in healthy subjects. OBJECTIVE: In the present study, we investigated whether tDCS may be effective in ameliorating tactile sensory deficit in MS patients. METHODS: Patients received sham or real anodal tDCS of the somatosensory cortex for 5 consecutive days in a randomized, double blind, sham-controlled study. Discrimination thresholds of spatial tactile sensation were measured using the grating orientation task (GOT). As secondary outcomes we also measured subjective perception of tactile sensory deficit through a visual analog scale (VAS), quality of life and overall disability to evaluate the impact of the treatment on patients daily life. Evaluations were performed at baseline and during a 4-week follow-up period. RESULTS: Following anodal but not sham tDCS over the somatosensory cortex, there was a significant improvement of discriminatory thresholds at the GOT and increased VAS for sensation scores. Quality of life, and disability changes were not observed. CONCLUSION: Our results indicate that a five day course of anodal tDCS is able to ameliorate tactile sensory loss with long-lasting beneficial effects and could thus represent a therapeutic tool for the treatment of tactile sensory deficit in MS patients.

Primary study

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Transcranial magnetic stimulation primes the effects of exercise therapy in multiple sclerosis.

Journal Journal of neurology
Year 2011
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This article is included in 3 Systematic reviews Systematic reviews (3 references)

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Exercise therapy (ET) can be beneficial in disabled multiple sclerosis (MS) patients. Intermittent transcranial magnetic theta burst stimulation (iTBS) induces long-term excitability changes of the cerebral cortex and may ameliorate spasticity in MS. We investigated whether the combination of iTBS and a program of ET can improve motor disability in MS patients. In a double-blind, sham-controlled trial, 30 participants were randomized to three different interventions: iTBS plus ET, sham stimulation plus ET, and iTBS alone. Before and after 2 weeks of treatment, measures of spasticity through the modified Ashworth scale (MAS) and the 88 items Multiple Sclerosis Spasticity Score questionnaire (MSSS-88), fatigue through the Fatigue Severity Scale (FSS), daily living activities (ADL) through the Barthel index and health-related quality of life (HRQoL) through the 54 items Multiple Sclerosis Quality of life inventory (MSQoL-54) were collected. iTBS plus ET reduced MAS, MSSS-88, FSS scores, while in the Barthel index and MSQoL-54, physical composite scores were increased. iTBS alone caused a reduction of the MAS score, while none of the measured scales showed significant changes after sham iTBS plus ET. iTBS associated with ET is a promising tool for motor rehabilitation of MS patients.

Primary study

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Effects of intermittent theta burst stimulation on spasticity in patients with multiple sclerosis.

Journal European journal of neurology : the official journal of the European Federation of Neurological Societies
Year 2010
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND AND PURPOSE: Spasticity is a common disorder and a major cause of long-term disability in patients with multiple sclerosis (MS). Our aim was to evaluate whether a recently developed repetitive transcranial magnetic stimulation protocol, the intermittent theta burst stimulation (iTBS) is effective in modulating lower limb spasticity in MS patients. METHODS: Twenty MS patients were pseudorandomized to undergo a 2-week daily sessions of real or sham iTBS protocol. The H/M amplitude ratio of the Soleus H reflex, a reliable neurophysiological index of spinal excitability and the Modified Ashworth Scale (MAS) for spasticity were evaluated by blinded raters before and after the stimulation protocols. RESULTS: Patients receiving real iTBS showed a significant reduction of H/M amplitude ratio and MAS scores 1 week after the stimulation and persisting up to 2 weeks after the end of stimulation protocol. There were no significant effects for sham stimulation. CONCLUSIONS: These results show that iTBS, a safe, non-invasive, well-tolerated and feasible protocol, is a promising tool for the treatment of spasticity in MS.

Primary study

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Effects of Anodal Transcranial Direct Current Stimulation on Chronic Neuropathic Pain in Patients With Multiple Sclerosis

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Journal The journal of pain : official journal of the American Pain Society
Year 2010
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Neuropathic pain in patients with MS is frequent and is associated with a great interference with daily life activities. In the present study, we investigated whether anodal transcranial direct current stimulation (tDCS) may be effective in reducing central chronic pain in MS patients. Patients received sham tDCS or real tDCS in a 5-day period of treatment in a randomized, double blind, sham-controlled study. Pain was measured using visual analog scale (VAS) for pain and the short form McGill questionnaire (SF-MPQ). Quality of life was measured using the Multiple Sclerosis Quality of Life-54 scale (MSQoL-54). Depressive symptoms and anxiety were also evaluated as confounding factors using the Beck Depression Inventory (BDI) and VAS for anxiety. Evaluations were performed at baseline, immediately after the end of treatment, and once a week during a 3-week follow-up period. Following anodal but not sham tDCS over the motor cortex, there was a significant pain improvement as assessed by VAS for pain and McGill questionnaire, and of overall quality of life. No depression or anxiety changes were observed. Our results show that anodal tDCS is able to reduce pain-scale scores in MS patients with central chronic pain and that this effect outlasts the period of stimulation, leading to long-lasting clinical effects. Perspective: This article presents a new, noninvasive therapeutic approach to chronic, central neuropathic pain in multiple sclerosis, poorly responsive to current conventional medications. tDCS is known to cause long-lasting changes of neuronal excitability at the site of stimulation and in the connected areas in healthy subjects. This led us to hypothesize that pain decrease may be the result of functional plastic changes in brain structures involved in the pathogenesis of chronic neuropathic pain. © 2010 American Pain Society.

Primary study

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Electroconvulsive therapy in a patient with multiple sclerosis and recurrent catatonia.

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Authors Pontikes TK , Dinwiddie SH
Journal The journal of ECT
Year 2010
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Catatonia is a rare complication of multiple sclerosis (MS). We present a case of a 28-year-old inpatient with MS successfully treated with electroconvulsive therapy (ECT) after developing a catatonic syndrome. A subsequent relapse also responded to ECT, after which the patient received maintenance ECT for 13 months without complications. Follow-up 18 months later did not reveal any evidence of neurological deterioration. We conclude that ECT was a safe and effective treatment in this MS patient.