Electric vs. magnetic: Which brain stimulation wins for bothering symptoms in multiple sclerosis?

Abstract

Background: Multiple sclerosis (MS) is a chronic disease marked by fatigue, pain, cognitive impairment, and mood disorders. Pharmacological treatments often provide limited relief and have side effects, prompting interest in non-invasive neuromodulation techniques like transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). We aimed to compare the short-term efficacy of tDCS and TMS in alleviating fatigue, pain, depression, and cognitive impairment in MS patients.

Methods: In a randomized, single-blinded, three-arm trial, 30 patients with relapsingremitting MS were assigned to active tDCS, active TMS, or placebo. The tDCS group received 2 mA anodal stimulation over the motor cortex for 20 min daily for five days, while the TMS group received 10 Hz stimulation at 80 % of the resting motor threshold for the same duration. The placebo group received sham stimulation. Outcomes were assessed using the Fatigue Severity Scale (FSS), Visual Analogue Scale (VAS) for pain, Beck Depression Inventory (BDI), and Brief International Cognitive Assessment for MS (BICAMS).

Results: Both tDCS and TMS groups showed significant improvements in fatigue, pain, and depression compared to placebo (p < 0.05). No significant cognitive changes were observed in any group.

Conclusion: Short-term tDCS and TMS are effective for reducing fatigue, pain, and depression in MS patients, with tDCS showing potential for home use and TMS for clinical settings. Cognitive improvements may require longer treatment durations or combined therapies.

Keywords: Cognitive functions; Depression; Fatigue; Multiple sclerosis; Pain; TMS; tDCS.