Transcranial Direct Current Stimulation for Fatigue, Mood, and Cognition in Multiple Sclerosis
Transcranial Direct Current Stimulation for Fatigue, Mood, and Cognition in Multiple Sclerosis: A Randomized, Double-Blind, Sham-Controlled, Crossover Trial
Multiple sclerosis (MS) is a chronic, inflammatory and disabling disease of the Cnetral Nervous System characterized by relapsing and / or progressive somatosensory, motor and vestibular clinical manifestations. Moreover, fatigue, depression, anxiety, and cognitive impairment are also present in most MS patients. These symptoms substantially impact quality of life and often show limited response to conventional pharmacological treatment.
Transcranial direct current stimulation (tDCS) is a non-invasive technique that applies a weak direct current to the scalp via surface electrodes, modulating cortical excitability in a polarity-dependent manner.
The objective of this study is to evaluate the efficacy and safety of tDCS for fatigue, depression, anxiety, and cognitive performance in patients with relapsing or progressive MS.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
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Mexico City, Mexico, 11580
- Neurociencia Clínica Integral
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Age 18-55 years at the time of enrollment
- Clinical diagnosis of Relapsing Multiple Sclerosis (RMS) or Progressive Multiple Sclerosis (PMS), with or without active progression, established per the 2014 McDonald diagnostic criteria
- Expanded Disability Status Scale (EDSS) score of 0-3 at the time of screening
- Time since initial MS diagnosis of at least 6 months
- Active fatigue symptoms reported by the participant for at least the 6 months prior to enrollment
Exclusion Criteria:
- History of neuropsychiatric illness (including major depression, bipolar disorder, schizophrenia, or any anxiety disorder) prior to the onset of multiple sclerosis
- Diagnosis of neuromyelitis optica spectrum disorder (Devic's disease)
- Presence of any other central nervous system disease
- Disease duration greater than 10 years combined with an EDSS score of ≤ 2
- Visual impairment secondary to optic neuritis, internuclear ophthalmoplegia (oculomotor disorder), or any other uncorrected visual impairment that would affect task performance on cognitive assessments
- Current pharmacological treatment for fatigue or depression
- Current neuropsychiatric pharmacological treatment, including any antidepressant, anxiolytic, neuroleptic, or anticonvulsant medication
- Clinical relapse requiring corticosteroid treatment in the 3 months prior to enrollment
- Severe upper-limb motor deficit that would prevent task performance on neuropsychological assessments
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Crossover opgave
- Maskning: Firedobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
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Eksperimentel: Active, F3 anode, F4 cathode, 20 minutes, 4 mA, transcranial direct current stimulation
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Transcranial direct current stimulation (tDCS) is a non-invasive technique that applies a weak direct current to the scalp via surface electrodes, modulating cortical excitability in a polarity-dependent manner.
tDCS has an established safety profile across the populations and protocols studied to date.
This study uses an anodal stimulation montage of the dorsolateral prefrontal cortex (DLPFC).
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Sham-komparator: Sham, F3 anode, F4 cathode, 20 minutes, 0 mA, transcranial direct current stimulation simulation
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Sham Comparator: Sham, F3 anode, F4 cathode, 20 minutes, transcranial direct current stimulation simulation
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Modified Fatigue Impact Scale (MFIS) - Total Score
Tidsramme: Assessed at baseline (Day 0), immediately following the first 5-day stimulation block (Day 5), and immediately following the second 5-day stimulation block (Day 26 after washout)
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The MFIS is a 21-item multidimensional self-report scale assessing the impact of fatigue on physical (9 items), cognitive (10 items), and psychosocial (2 items) functioning over the past 4 weeks.
Each item is scored 0-4; total score ranges from 0 to 84.
Higher scores indicate greater fatigue impact.
The primary comparison is post-active-tDCS total score versus post-sham total score.
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Assessed at baseline (Day 0), immediately following the first 5-day stimulation block (Day 5), and immediately following the second 5-day stimulation block (Day 26 after washout)
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Modified Fatigue Impact Scale (MFIS) - Physical Subscale
Tidsramme: Baseline, Day 5, Day 26
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Physical subscale of the MFIS (9 items; range 0-36).
Assesses impact of fatigue on physical functioning.
Compared between active tDCS and sham conditions.
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Baseline, Day 5, Day 26
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Modified Fatigue Impact Scale (MFIS) - Cognitive Subscale
Tidsramme: Baseline, Day 5, Day 26
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Cognitive subscale of the MFIS (10 items; range 0-40).
Assesses impact of fatigue on cognitive functioning.
Compared between active tDCS and sham conditions.
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Baseline, Day 5, Day 26
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Modified Fatigue Impact Scale (MFIS) - Psychosocial Subscale
Tidsramme: Baseline, Day 5, Day 26
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Psychosocial subscale of the MFIS (2 items; range 0-8).
Assesses impact of fatigue on psychosocial functioning.
Compared between active tDCS and sham conditions.
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Baseline, Day 5, Day 26
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Hospital Anxiety and Depression Scale (HADS) - Anxiety Subscale
Tidsramme: Baseline, Day 5, Day 26
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7-item subscale of the HADS assessing anxiety symptom severity.
Each item is scored 0-3; subscale range 0-21.
Higher scores indicate greater anxiety.
Compared between active tDCS and sham conditions.
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Baseline, Day 5, Day 26
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Hospital Anxiety and Depression Scale (HADS) - Depression Subscale
Tidsramme: Baseline, Day 5, Day 26
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7-item subscale of the HADS assessing depression symptom severity.
Each item is scored 0-3; subscale range 0-21.
Higher scores indicate greater depression.
Compared between active tDCS and sham conditions.
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Baseline, Day 5, Day 26
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Visual Analog Scale (VAS) - Fatigue
Tidsramme: Baseline, Day 5, Day 26
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Participant-rated 0-10 point visual analog scale for subjective fatigue severity (0 = no fatigue, 10 = worst imaginable fatigue).
Used as a brief supplementary measure alongside the MFIS.
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Baseline, Day 5, Day 26
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Visual Analog Scale (VAS) - Depression
Tidsramme: Baseline, Day 5, Day 26
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Participant-rated 0-10 point visual analog scale for subjective depression severity (0 = no depression, 10 = worst imaginable depression).
Used as a brief supplementary measure alongside the HADS.
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Baseline, Day 5, Day 26
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Symbol Digit Modalities Test (SDMT)
Tidsramme: Baseline, Day 5, Day 26
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Validated test of information-processing speed and working memory, part of the Brief International Cognitive Assessment for MS (BICAMS).
The participant substitutes symbols for digits within 90 seconds; higher scores indicate better performance.
Compared between active tDCS and sham conditions.
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Baseline, Day 5, Day 26
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California Verbal Learning Test-II (CVLT-II)
Tidsramme: Baseline, Day 5, Day 26
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Standardized measure of short-term verbal learning and memory, part of the BICAMS battery.
Assessed as total correct recall across learning trials; higher scores indicate better performance.
Compared between active tDCS and sham conditions.
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Baseline, Day 5, Day 26
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Brief Visuospatial Memory Test-Revised (BVMT-R)
Tidsramme: Baseline, Day 5, Day 26
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Standardized measure of short-term visuospatial memory and learning, part of the BICAMS battery.
Assessed as total correct recall across learning trials; higher scores indicate better performance.
Compared between active tDCS and sham conditions.
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Baseline, Day 5, Day 26
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Andre resultatmål
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Adverse events - frequency and type
Tidsramme: After each of the 10 stimulation sessions (Days 1-5 and Days 22-26)
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Adverse events assessed by structured interview after each stimulation session, including tingling, stinging, burning, headache, dizziness, numbness, forgetfulness, difficulty concentrating, blurred vision, muscle spasms, nausea, and difficulty breathing.
Frequencies compared between active and sham conditions using McNemar's test.
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After each of the 10 stimulation sessions (Days 1-5 and Days 22-26)
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: ASDRUBAL R HUERTA GALLANGO, MD / PhD, Universidad de Almeria
- Ledende efterforsker: Luis Fernando Sánchez-Santed, PhD, Universidad de Almeria
Publikationer og nyttige links
Generelle publikationer
- Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, Mourdoukoutas AP, Kronberg G, Truong D, Boggio P, Brunoni AR, Charvet L, Fregni F, Fritsch B, Gillick B, Hamilton RH, Hampstead BM, Jankord R, Kirton A, Knotkova H, Liebetanz D, Liu A, Loo C, Nitsche MA, Reis J, Richardson JD, Rotenberg A, Turkeltaub PE, Woods AJ. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul. 2016 Sep-Oct;9(5):641-661. doi: 10.1016/j.brs.2016.06.004. Epub 2016 Jun 15.
- Stagg CJ, Antal A, Nitsche MA. Physiology of Transcranial Direct Current Stimulation. J ECT. 2018 Sep;34(3):144-152. doi: 10.1097/YCT.0000000000000510.
- Benedict RH, Amato MP, Boringa J, Brochet B, Foley F, Fredrikson S, Hamalainen P, Hartung H, Krupp L, Penner I, Reder AT, Langdon D. Brief International Cognitive Assessment for MS (BICAMS): international standards for validation. BMC Neurol. 2012 Jul 16;12:55. doi: 10.1186/1471-2377-12-55.
- Hsu WY, Cheng CH, Zanto TP, Gazzaley A, Bove RM. Effects of Transcranial Direct Current Stimulation on Cognition, Mood, Pain, and Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol. 2021 Mar 8;12:626113. doi: 10.3389/fneur.2021.626113. eCollection 2021.
- Compston A, Coles A. Multiple sclerosis. Lancet. 2002 Apr 6;359(9313):1221-31. doi: 10.1016/S0140-6736(02)08220-X.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Sygdomme i nervesystemet
- Patologiske processer
- Kronisk sygdom
- Sygdomsegenskaber
- Autoimmune sygdomme
- Sygdomme i immunsystemet
- Demyeliniserende autoimmune sygdomme, CNS
- Autoimmune sygdomme i nervesystemet
- Demyeliniserende sygdomme
- Patologiske tilstande, tegn og symptomer
- Tegn og symptomer
- Multipel sclerose
- Træthed
- Multipel sklerose, recidiverende-remitterende
- Multipel sklerose, kronisk progressiv
- Terapeutik
- Adfærdsdiscipliner og aktiviteter
- Elektrisk stimuleringsterapi
- Kvulterende terapi
- Psykiatriske somatiske terapier
- Elektroshock
- Psykologiske teknikker
- Transkraniel jævnstrømstimulering
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- TDCSMS-001
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
IPD-delingstidsramme
IPD-delingsadgangskriterier
IPD-deling Understøttende informationstype
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
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