Frontal Transcranial Direct Current Stimulation as a Potential Treatment of Parkinson’s Disease-Related Fatigue

Abstract

In contrast to motor symptoms, non-motor symptoms in Parkinson’s disease (PD) are often poorly recognized and inadequately treated. Fatigue is one of the most common non-motor symptoms in PD and affects a broad range of everyday activities, causes disability, and substantially reduces the quality of life. It occurs at every stage of PD, and once present, it often persists and worsens over time. PD patients attending the 2013 World Parkinson Congress voted fatigue as the leading symptom in need of further research. However, despite its clinical significance, little progress has been made in understanding the causes of Parkinson’s disease-related fatigue (PDRF) and developing effective treatment options, which argues strongly for a greater effort. Transcranial direct current stimulation (tDCS) is a technique to non-invasively modulate cortical excitability by delivering low electrical currents to the cerebral cortex. In the past, it has been consistently evidenced that tDCS has the ability to induce neuromodulatory changes in the motor, sensory, and cognitive domains. Importantly, recent data present tDCS over the frontal cortex as an effective therapeutic option to treat fatigue in patients suffering from multiple sclerosis (MS). The current opinion paper reviews recent data on PDRF and the application of tDCS for the treatment of fatigue in neuropsychiatric disorders to further develop an idea of using frontal anodal tDCS as a potential therapeutic strategy to alleviate one of the most common and severe non-motor symptoms of PD.

The therapeutic potential of non-invasive brain stimulation for the treatment of Long-COVID-related cognitive fatigue

“…Repetitive anodal tDCS stimulations over the left DLPFC also positively affected fatigue ratings in people with Parkinsons-related fatigue that lasted up to three months ( 104 ). Another study demonstrated that repetitive anodal tDCS sessions over the left DLPFC in a home-treatment context were well tolerated and positively affected subjective fatigue in people with Parkinsons-related fatigue ( 105 ), also see Zaehle ( 106 ) for a recent review.…”

Anodal Transcranial Direct Current Stimulation Could Modulate Cortical Excitability and the Central Cholinergic System in Akinetic Rigid-Type Parkinson's Disease: Pilot Study

“…Several studies have emphasized that motor symptoms, such as those affecting the isometric grip test and hand dexterity, were improved after anodal tDCS of the motor cortex ( 15 , 46 , 47 ). However, non-motor symptoms of PD, such as depression, fatigue, and frontal executive function, were improved after anodal tDCS on the frontal cortices ( 19 ). In addition to the stimulation site, stimulation intensity, duration, and polarity could differentially affect cortical excitability.…”

“…Therefore, tDCS has been widely studied for its efficacy in various neurodegenerative disorders ( 12 ). Many studies have shown the beneficial effects of tDCS on various symptoms in PD ( 9 , 13 – 19 ). Ishikuro et al reported that anodal tDCS in the frontal polar area improved the motor and executive function of patients with PD, and some meta-analytic studies have indicated that tDCS could have a positive effect on locomotive and gait function in PD, despite insufficient sample power to draw firm conclusions in most studies ( 15 , 18 , 20 ).…”

Effect of Transcranial Direct Current Stimulation (tDCS) on Depression in Parkinson’s Disease—A Narrative Review

“…As a technique, tDCS has been extensively studied in the context of PD and numerous studies have demonstrated its effectiveness in improving various aspects of the disease, such as gait [34], cognitive deficits [35], fatigue [36], and balance and functional mobility [37]. However, it is important to note that the effectiveness of tDCS specifically for treating depression in PD has not been thoroughly investigated.…”