Effects of Transcranial Direct Current Stimulation on Cognition, Mood, Pain, and Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis

Overview

Journal Front Neurol

Specialty Neurology

Date 2021 Mar 25

PMID 33763014

Citations 11

Authors

Wan-Yu Hsu

Chia-Hsiung Cheng

Theodore P Zanto

Adam Gazzaley

Riley M Bove

Affiliations

Soon will be listed here.

Abstract

The study aimed to evaluate the effects of transcranial direct current stimulation (tDCS) on cognition, mood disturbance, pain, and fatigue in people with multiple sclerosis (PwMS). A literature search was performed on articles published between January 1990 and May 2020 in Pubmed, Medline, and Web of Science using the following keywords and their abbreviation in combinations: multiple sclerosis and transcranial direct current stimulation. Mean effect size (ES) and 95% confidence interval were calculated for each domain of interest. Seventeen articles with a total of 383 PwMS were included in this analysis. For cognition, a strong effect size was found for the trial administering the Symbol Digit Modalities Test (ES: 1.15), whereas trials applying the Attention Network Test showed a negative effect size of -0.49. Moderate to strong effect sizes were observed for mood disturbance (mean ES: 0.92), pain (mean ES: 0.59), and fatigue (mean ES: 0.60). Further subgroup analyses for MS-related fatigue showed that both high and low intensities of stimulation lead to nearly the same degree of favorable effects. More pronounced effects were observed in studies administering the Fatigue Severity Scale compared with studies using other fatigue measures such as the Modified Fatigue Impact Scale. These results provide preliminary evidence that tDCS has a favorable effect on cognitive processing speed, mood disturbance, pain, and fatigue in MS. However, the effects on cognition and fatigue vary based on the specific assessment used.

Citing Articles

Home-based transcranial direct current stimulation paired with cognitive training to reduce fatigue in multiple sclerosis.

Charvet L, Goldberg J, Li X, Best P, Lustberg M, Shaw M Sci Rep. 2025; 15(1):4551.

PMID: 39915560 PMC: 11802740. DOI: 10.1038/s41598-025-88255-2.

Population imaging of internal state circuits relevant to psychiatric disease: a review.

Silva S, McDonald N, Chamaria A, Stujenske J Neurophotonics. 2025; 12(Suppl 1):S14607.

PMID: 39872404 PMC: 11772092. DOI: 10.1117/1.NPh.12.S1.S14607.

The Potential of Transcranial Direct Current Stimulation (tDCS) in Improving Quality of Life in Patients with Multiple Sclerosis: A Review and Discussion of Mechanisms of Action.

Chmiel J, Kurpas D, Stepien-Slodkowska M J Clin Med. 2025; 14(2).

PMID: 39860377 PMC: 11766291. DOI: 10.3390/jcm14020373.

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Neuropsychiatric Symptoms in Multiple Sclerosis (MS)-A Review and Insight into Possible Mechanisms of Action.

Chmiel J, Stepien-Slodkowska M J Clin Med. 2025; 13(24.

PMID: 39768715 PMC: 11728448. DOI: 10.3390/jcm13247793.

Effects of Transcranial and Trans-Spinal Direct Current Stimulation Combined with Robot-Assisted Gait Training on Gait and Fatigue in Patients with Multiple Sclerosis: A Double-Blind, Randomized, Sham-Controlled Study.

Cinbaz G, Sari Z, Oguz S, Tombul T, Hanoglu L, Fernandez-Perez J J Clin Med. 2025; 13(24.

PMID: 39768555 PMC: 11728183. DOI: 10.3390/jcm13247632.

References

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Mattioli F, Bellomi F, Stampatori C, Capra R, Miniussi C . Neuroenhancement through cognitive training and anodal tDCS in multiple sclerosis. Mult Scler. 2015; 22(2):222-30. DOI: 10.1177/1352458515587597. View

Chalah M, Riachi N, Ahdab R, Mhalla A, Abdellaoui M, Creange A . Effects of left DLPFC versus right PPC tDCS on multiple sclerosis fatigue. J Neurol Sci. 2016; 372:131-137. DOI: 10.1016/j.jns.2016.11.015. View

Sokolov A, Grivaz P, Bove R . Cognitive Deficits in Multiple Sclerosis: Recent Advances in Treatment and Neurorehabilitation. Curr Treat Options Neurol. 2018; 20(12):53. DOI: 10.1007/s11940-018-0538-x. View

Winker C, Rehbein M, Sabatinelli D, Junghofer M . Repeated noninvasive stimulation of the ventromedial prefrontal cortex reveals cumulative amplification of pleasant compared to unpleasant scene processing: A single subject pilot study. PLoS One. 2020; 15(1):e0222057. PMC: 6974138. DOI: 10.1371/journal.pone.0222057. View

Charvet L, Shaw M, Dobbs B, Frontario A, Sherman K, Bikson M . Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis. Neuromodulation. 2017; 21(4):383-389. PMC: 5975186. DOI: 10.1111/ner.12583. View

Birnbaum G . Current and future treatments for relapsing-remitting multiple sclerosis. Curr Opin Drug Discov Devel. 2010; 13(2):214-25. View

Porcaro C, Cottone C, Cancelli A, Rossini P, Zito G, Tecchio F . Cortical neurodynamics changes mediate the efficacy of a personalized neuromodulation against multiple sclerosis fatigue. Sci Rep. 2019; 9(1):18213. PMC: 6890667. DOI: 10.1038/s41598-019-54595-z. View

Moher D, Schulz K, Altman D . The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA. 2001; 285(15):1987-91. DOI: 10.1001/jama.285.15.1987. View

10.

Palm U, Ayache S, Padberg F, Lefaucheur J . Non-invasive brain stimulation therapy in multiple sclerosis: a review of tDCS, rTMS and ECT results. Brain Stimul. 2014; 7(6):849-54. DOI: 10.1016/j.brs.2014.09.014. View

11.

Achiron A, Barak Y . Cognitive impairment in probable multiple sclerosis. J Neurol Neurosurg Psychiatry. 2003; 74(4):443-6. PMC: 1738365. DOI: 10.1136/jnnp.74.4.443. View

12.

OConnor A, Schwid S, Herrmann D, Markman J, Dworkin R . Pain associated with multiple sclerosis: systematic review and proposed classification. Pain. 2007; 137(1):96-111. DOI: 10.1016/j.pain.2007.08.024. View

13.

Charvet L, Dobbs B, Shaw M, Bikson M, Datta A, Krupp L . Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial. Mult Scler. 2017; 24(13):1760-1769. PMC: 5975187. DOI: 10.1177/1352458517732842. View

14.

Mortezanejad M, Ehsani F, Masoudian N, Zoghi M, Jaberzadeh S . Comparing the effects of multi-session anodal trans-cranial direct current stimulation of primary motor and dorsolateral prefrontal cortices on fatigue and quality of life in patients with multiple sclerosis: a double-blind, randomized,.... Clin Rehabil. 2020; 34(8):1103-1111. DOI: 10.1177/0269215520921506. View

15.

Lefaucheur J, Chalah M, Mhalla A, Palm U, Ayache S, Mylius V . The treatment of fatigue by non-invasive brain stimulation. Neurophysiol Clin. 2017; 47(2):173-184. DOI: 10.1016/j.neucli.2017.03.003. View

16.

Pope P, Brenton J, Miall R . Task-Specific Facilitation of Cognition by Anodal Transcranial Direct Current Stimulation of the Prefrontal Cortex. Cereb Cortex. 2015; 25(11):4551-8. PMC: 4816797. DOI: 10.1093/cercor/bhv094. View

17.

Ayache S, Chalah M . Stem Cells Therapy in Multiple Sclerosis - A New Hope for Progressive Forms. J Stem Cells Regen Med. 2016; 12(1):49-51. PMC: 4929895. View

18.

Andrews S, Hoy K, Enticott P, Daskalakis Z, Fitzgerald P . Improving working memory: the effect of combining cognitive activity and anodal transcranial direct current stimulation to the left dorsolateral prefrontal cortex. Brain Stimul. 2011; 4(2):84-9. DOI: 10.1016/j.brs.2010.06.004. View

19.

Bikson M, Grossman P, Thomas C, Zannou A, Jiang J, Adnan T . Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul. 2016; 9(5):641-661. PMC: 5007190. DOI: 10.1016/j.brs.2016.06.004. View

20.

Hanken K, Bosse M, Mohrke K, Eling P, Kastrup A, Antal A . Counteracting Fatigue in Multiple Sclerosis with Right Parietal Anodal Transcranial Direct Current Stimulation. Front Neurol. 2016; 7:154. PMC: 5030283. DOI: 10.3389/fneur.2016.00154. View