title: Transcranial direct current stimulation (tDCS) for fatigue in multiple sclerosis.
abstract: 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.
  
  
  CONCLUSIONS
  Our preliminary findings suggest that anodal tDCS applied over the motor cortex, could improve fatigue in most patients with MS.
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ferrucci
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vergari
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cogiamanian
authors.affiliation: Dipartimento di Neuroscienze, Unità di Neurologia, Università degli Studi di Pisa, Pisa, Italy Dipartimento di Neuroscienze, Neurologia e Neurofisiologia Clinica, Università degli Studi di Siena, Siena, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bocci
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ciocca
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Tomasini
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: De Riz
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Scarpini
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Priori
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D005221:Fatigue / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Multiple sclerosis; fatigue; motor cortex; tDCS; treatments