Transcranial Direct Current Stimulation (tDCS) for sleep disturbances and fatigue in patients with post-polio syndrome

Abstract

Purpose: Post-polio syndrome develops about 20-40 years after acute paralytic poliomyelitis, and manifests with progressively deteriorating muscle strength and endurance. Here, we assessed whether transcranial direct current stimulation (tDCS) improves sleep and fatigue symptoms in patients with post-polio syndrome. Methods: We enrolled 32 patients with a diagnosis of post-polio syndrome. tDCS (1.5 mA, 15 min) was delivered by a direct current stimulator connected to three electrodes: two anodal electrodes on the scalp over the right and left pre-motor cortex and the other above the left shoulder (cathode). 16 patients received anodal tDCS and the remainder sham tDCS. We evaluated changes induced by tDCS (daily for five days a week, for three weeks) on clinical scales (Short Form Health Survey [SF-36], Piper Fatigue Scale [PFS], Fatigue Severity Scale [FSS], 101-Point Numerical Rating [PNR-101], Hamilton Rating Scale for Depression [HRSD], Pittsburgh Sleep Quality Index [PSQI]) at baseline (T 0 ) and three weeks later (T 1 ). Results: At T 1 SF-36 sub-items physical functioning, role physical, vitality, social functioning and role emotional improved significantly more in patients who received tDCS (p < 0.01) than in sham-treated patients. Also, PSQI scores improved more in treated patients (p < 0.05, two-way ANOVA with "stimulation" and "time" as factors: p < 0.01). tDCS-induced benefits were more pronounced in patients who were younger at primary infection (p < 0.05). Conclusion: Anodal tDCS over the pre-motor areas for fifteen days improved sleep and fatigue symptoms in patients with post-polio syndrome. tDCS could be a non-invasive and valuable new tool for managing post-polio patients.

Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): Review and recommendations from an expert panel

“…In the application to manage tinnitus, anodal tDCS reduces the intensity of this symptoms with a SE of 0.77 (95% CI= 0.23-1.31) (83). Finally, anodal tDCS over the pre-motor areas also improves sleep and fatigue symptoms in patients with post-polio syndrome (84). …”

Remotely-supervised transcranial direct current stimulation (tDCS) for clinical trials: guidelines for technology and protocols

“…Neurophysiologic and clinical trials with tDCS increasingly reinforce that efficacy increases with multiple sessions (Mori et al, 2010 , 2013 ; Acler et al, 2013 ; Ferrucci et al, 2014 ; Meesen et al, 2014 ; Tecchio et al, 2014 ), with effects thought to be cumulative. Many clinical investigators apply tDCS in conjunction with a behaviorally-based treatment approach to improve outcome (Demirtas-Tatlidede et al, 2013 ; Martin et al, 2013b ; Brunoni and Vanderhasselt, 2014 ; Brunoni et al, 2014 ; Flöel, 2014 ), which must be repeated alongside tDCS.…”

“…tDCS can influence sensory, motor, cognitive and psychiatric processes that could be applied directly to the treatment of common yet refractory symptoms that represent major areas of unmet treatment need, such as depressed mood, pain, fatigue, sensory and motor recovery, and cognitive impairment (Ball et al, 2002 ; Fregni et al, 2006 ; Mori et al, 2010 , 2013 ; Andrews et al, 2011 ; Acler et al, 2013 ; Brunoni et al, 2013b ; Cuypers et al, 2013 ; Bennabi et al, 2014 ), typically occurring in the context of a neurologic or psychiatric condition.…”

Post‐polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis

“…Transcranial direct current stimulation has been suggested to improve fatigue and sleep symptoms at 3 weeks. 109 However, all subjects also received daily physical therapy and had received IVIg before to entry into the study. 47 Given the multiple interventions and the unknown effectiveness of IVIg, it is difficult to assess the long-term effectiveness of the single intervention without comparison to placebo, usual care, or no treatment.…”