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Case Reports
. 2024 Nov 20;16(11):e74105.
doi: 10.7759/cureus.74105. eCollection 2024 Nov.

Reduction of Chronic Fatigue Through Transcranial Direct Current Stimulation and Low-Intensity Aerobic Exercise: A Case Study of Two Patients With Granulomatosis With Polyangiitis

Alexandre M Dos Santos  1 , Vanessa P De Andrade  1 , Paulo Roberto S Silva  2 , Marcus V Grecco  2 , Julia Maria D'Andrea Greve  2 , Samuel K Shinjo  1
Affiliations
Case Reports

Reduction of Chronic Fatigue Through Transcranial Direct Current Stimulation and Low-Intensity Aerobic Exercise: A Case Study of Two Patients With Granulomatosis With Polyangiitis

Alexandre M Dos Santos et al. Cureus. .

Abstract

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that can lead to persistent pain and fatigue, significantly impacting patients' quality of life. This study assessed the effects of transcranial direct current stimulation (tDCS) combined with aerobic exercise as a non-pharmacological intervention for managing fatigue in GPA patients. Two patients were randomly assigned to receive either active tDCS or simulated tDCS stimulation (sham) during low-intensity aerobic exercise. The assessments included body mass index, fat and lean mass percentages, waist-to-hip ratio, C-reactive protein, erythrocyte sedimentation rate, and disease activity using the Birmingham Vasculitis Activity Score. Chronic fatigue was measured using the Modified Fatigue Impact Scale, the Fatigue Severity Scale, and the visual analog scale for fatigue. Sleep quality, activities of daily living, and functional capacity were evaluated through standardized tests. Results indicated that tDCS significantly reduced chronic fatigue by approximately 60%, nearly twice as much as the sham patient. Additionally, the tDCS patient showed improvements in physical activity levels, functional capacity, handgrip strength, daily activities, and sleep quality. In contrast, the sham patient showed declines in physical activity and minimal improvement in chronic fatigue. Overall, tDCS appears to be a promising intervention to enhance chronic fatigue and the quality of life in patients with GPA without causing disease reactivation or adverse effects.

Keywords: aerobic exercises; anca-associated vasculitis; chronic fatigue; granulomatosis with polyangiitis; neuromodulation.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Comitê de Ética em Pesquisa do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (CEP-HC/FMUSP) issued approval 41762820.1.0000.0068. We declare that this research was approved by the Research Ethics Committee of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (CEP-HC/FMUSP) and that all guidelines for research involving human subjects, as established by the Declaration of Helsinki, were strictly followed. This study was registered in the Brazilian Registry of Clinical Trials (REBEC) under the registration number RBR-9n4z2hh. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flowchart of tests, assessments, and intervention
GPA: granulomatosis with polyangiitis; sham: simulated tDCS stimulation; tDCS: transcranial direct current stimulation Image Credit: Authors
Figure 2
Figure 2. Radar chart of fatigue, daily activities, and sleep quality of sham patient
FSS: Fatigue Severity Score; HAQ: Health Assessment Questionnaire; MFIS: Modified Fatigue Impact Scale; PSQI: Pittsburgh Sleep Quality Index; VAS: visual analog scale, sham: simulated tDCS stimulation Image Credit: Authors
Figure 3
Figure 3. Radar chart of fatigue, daily activities, and sleep quality of tDCS patient
FSS: Fatigue Severity Score; HAQ: Health Assessment Questionnaire; MFIS: Modified Fatigue Impact Scale; PSQI: Pittsburgh Sleep Quality Index; VAS: visual analog scale, tDCS: transcranial direct current stimulation Image Credit: Authors
See this image and copyright information in PMC

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