title: Impact of transcranial direct current stimulation on fatigue in multiple sclerosis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  We conclude that in patient subgroups discernible by specific morphological alterations, tDCS may be a tool for MS fatigue management.
authors: Department of Clinical Neurophysiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
authors: Catarina
authors: C
authors: Saiote
authors: Department of Clinical Neurophysiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors: Thomas
authors: T
authors: Goldschmidt
authors: Department of Clinical Neurophysiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
authors: Charles
authors: C
authors: Timäus
authors: Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors: Martijn D
authors: MD
authors: Steenwijk
authors: Department of Clinical Neurophysiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
authors: Alexander
authors: A
authors: Opitz
authors: Department of Clinical Neurophysiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
authors: Andrea
authors: A
authors: Antal
authors: Department of Clinical Neurophysiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
authors: Walter
authors: W
authors: Paulus
authors: Department of Clinical Neurophysiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
authors: Michael A
authors: MA
authors: Nitsche
mesh_terms: D000328:Adult; D003863:Depression / Q000503:physiopathology / Q000628:therapy; D004311:Double-Blind Method; D005221:Fatigue / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D017397:Prefrontal Cortex; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: MRI; Multiple sclerosis; fatigue; lesion load; tDCS