title: Brain Plasticity Effects of Neuromodulation Against Multiple Sclerosis Fatigue.
abstract: BACKGROUND
  We recently reported on the efficacy of a personalized transcranial direct current stimulation (tDCS) treatment in reducing multiple sclerosis (MS) fatigue. The result supports the notion that interventions targeted at modifying abnormal excitability within the sensorimotor network could represent valid non-pharmacological treatments.
  
  
  OBJECTIVE
  The present work aimed at assessing whether the mentioned intervention also induces changes in the excitability of sensorimotor cortical areas.
  
  
  METHODS
  Two separate groups of fatigued MS patients were given a 5-day tDCS treatments targeting, respectively, the whole body somatosensory areas (S1wb) and the hand sensorimotor areas (SM1hand). The study had a double blind, sham-controlled, randomized, cross-over (Real vs. Sham) design. Before and after each treatment, we measured fatigue levels (by the modified fatigue impact scale, mFIS), motor evoked potentials (MEPs) in response to transcranial magnetic stimulation and somatosensory evoked potentials (SEPs) in response to median nerve stimulation. We took MEPs and SEPs as measures of the excitability of the primary motor area (M1) and the primary somatosensory area (S1), respectively.
  
  
  RESULTS
  The Real S1wb treatment produced a 27% reduction of the mFIS baseline level, while the SM1hand treatment showed no difference between Real and Sham stimulations. M1 excitability increased on average 6% of the baseline in the S1wb group and 40% in the SM1hand group. Observed SEP changes were not significant and we found no association between M1 excitability changes and mFIS decrease.
  
  
  CONCLUSIONS
  The tDCS treatment was more effective against MS fatigue when the electrode was focused on the bilateral whole body somatosensory area. Changes in S1 and M1 excitability did not correlate with symptoms amelioration.
  
  
  CONCLUSIONS
  The neuromodulation treatment that proved effective against MS fatigue induced only minor variations of the motor cortex excitability, not enough to explain the beneficial effects of the intervention.
authors.affiliation: Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Tecchio
authors.affiliation: Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cancelli
authors.affiliation: Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cottone
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ferrucci
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vergari
authors.affiliation: Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Zito
authors.affiliation: Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pasqualetti
authors.affiliation: AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy.
authors.forename: Maria Maddalena
authors.initials: MM
authors.lastname: Filippi
authors.affiliation: Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Ghazaryan
authors.affiliation: AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Lupoi
authors.affiliation: University of Amsterdam , Amsterdam , Netherlands.
authors.forename: Fenne M
authors.initials: FM
authors.lastname: Smits
authors.affiliation: Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordani
authors.affiliation: University of Campus Biomedico, Psychology Service , Rome , Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Migliore
authors.affiliation: Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Institute of Neuroscience, Medical School, Newcastle University , Newcastle upon Tyne , UK.
authors.forename: Camillo
authors.initials: C
authors.lastname: Porcaro
authors.affiliation: Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salustri
authors.affiliation: Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy ; Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy.
authors.forename: Paolo M
authors.initials: PM
authors.lastname: Rossini
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Priori
keywords: electrode personalization; electroencephalography; fatigue in multiple sclerosis; magnetic resonance imaging; transcranial direct current stimulation; transcranial magnetic stimulation