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. 2020 Mar 23;10(3):185.
doi: 10.3390/brainsci10030185.

Effects of Transcranial Direct Current Stimulation on Hand Dexterity in Multiple Sclerosis: A Design for a Randomized Controlled Trial

Samar S Ayache  1   2 , Naji Riachi  3   4 , Rechdi Ahdab  3   4 , Moussa A Chalah  1   2
Affiliations

Effects of Transcranial Direct Current Stimulation on Hand Dexterity in Multiple Sclerosis: A Design for a Randomized Controlled Trial

Samar S Ayache et al. Brain Sci. .

Abstract

Background: Cerebellar and motor tracts are frequently impaired in multiple sclerosis (MS). Altered hand dexterity constitutes a challenge in clinical practice, since medical treatment shows very limited benefits in this domain. Cerebellar control is made via several cerebellocortical pathways, of which the most studied one links the cerebellum to the contralateral motor cortex via the contralateral ventro-intermediate nucleus of the thalamus influencing the corticospinal outputs. Modulating the activity of the cerebellum or of the motor cortex could be of help.

Method: The main interest here is to evaluate the efficacy of transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique, in treating altered dexterity in MS. Forty-eight patients will be recruited in a randomized, double-blind, sham-controlled, and crossover study. They will randomly undergo one of the three interventions: anodal tDCS over the primary motor area, cathodal tDCS over the cerebellum, or sham. Each block consists of five consecutive daily sessions with direct current (2 mA), lasting 20 min each. The primary outcome will be the improvement in manual dexterity according to the change in the time required to complete the nine-hole pegboard task. Secondary outcomes will include fatigue, pain, spasticity, and mood. Patients' safety and satisfaction will be rated.

Discussion: Due to its cost-effective, safe, and easy-to-use profile, motor or cerebellar tDCS may constitute a potential tool that might improve dexterity in MS patients and therefore ameliorate their quality of life.

Keywords: cerebellum; hand dexterity; motor cortex; multiple sclerosis; tDCS; transcranial direct current stimulation.

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Conflict of interest statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. SSA declares having received travel grants or compensation from Genzyme, Biogen, Novartis, and Roche. NR declares having received travel grants or compensation from Genzyme, Biogen, Novartis, Roche, Sanofi, and Merck. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An illustration of a tDCS setup (Sooma Oy, Helsinki, Finland). a. Battery-driven stimulator. b. Anode. c. Cathode. * The reference electrode over the shoulder is not shown.
Figure 2
Figure 2
Flow chart of the study protocol.
Figure 3
Figure 3
The schematic diagram of the study protocol. 9-HPT: Nine-Hole Peg Test; CGI: Clinical Global Impression; CRQ: Comfort Rating Questionnaire; HADS: Hospital Anxiety and Depression Scale; MAS: Modified Ashworth scale; MFIS: Modified Fatigue Impact Scale; VAS*: Visual Analogue Scale for the pain recorded one week before and after the beginning of each block.
See this image and copyright information in PMC

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