For people with multiple sclerosis — the incurable autoimmune disease that damages nerves — fatigue is often a daily challenge. “More than three-quarters of patients report fatigue among their most troubling symptoms, and there’s not much we can routinely offer them to treat it,” says Dr. Leigh Charvet, associate professor of neurology and director of MS research at NYU Langone Medical Center.
MS-related fatigue can leave people feeling exhausted after exerting small amounts of energy. It can worsen other symptoms of the disease, such as problems with cognition or walking, and it can make it impossible to maintain a job or do household chores.
But what if we could “zap” away MS-related fatigue with a jolt of low-level electrical energy to the brain? Charvet and other scientists are investigating that possibility with a treatment called transcranial direct current stimulation, or tDCS. It’s an experimental form of noninvasive electrical brain stimulation that’s not yet approved by the Food and Drug Administration.
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About tDCS
To undergo tDCS, a patient dons headgear reminiscent of something worn in a sci-fi movie. Electrodes on the headgear — which is powered by a small, battery-operated device — deliver low-level electrical current to the scalp. The current is about 2 milliamps, or roughly the equivalent of a 9-volt battery. Various brain areas can be targeted. A standard session lasts 20 minutes.
So far, we don’t have enough clinical evidence about how tDCS affects the brain and whether it’s effective or safe, although Charvet says research suggests it’s safe and well-tolerated in the short term. That makes it tantalizing enough for scientists to investigate if tDCS can treat many conditions, including neurological disease (such as MS and Parkinson’s), brain and spinal cord injury, depression, anxiety, chronic pain and poor cognition.
MS and tDCS
Charvet wants to determine if tDCS can reduce MS-related fatigue and cognition problems. She is targeting the dorsolateral prefrontal cortex. “That part of the brain is associated with aspects of cognitive processing, mood and fatigue,” Charvet says. But she also points out that no one actually knows what causes MS-related fatigue. Theories include poor electrical signaling in the brain, and a brain that’s overworked because of MS, according to Cleveland Clinic.
[See: 5 Ways to Cope With Mild Cognitive Impairment.]
How might tDCS help? “We believe that as electrical current goes through the dorsolateral prefrontal cortex, it primes the neurons and makes them more likely to fire. We think that might strengthen connections, especially if you enhance those connections with cognitive training,” Charvet says. “That may help people feel more alert and increase arousal of energy.” It will take a large, randomized controlled trial to confirm it.
Looking for Answers
To prepare for a larger experiment, Charvet has been conducting small studies to see if video conferencing is an effective way for clinicians to supervise patients using portable tDCS and cognitive training computer equipment at home.
Larry Irving, 51, got to take part in one of Charvet’s studies from his home in Elmont, New York. He’s been struggling with MS-related fatigue and cognition problems so severe that he had to give up his career in finance in 2010. After 20 tDCS sessions, each lasting 20 minutes, over four weeks last August, Irving noticed a big change. “I felt like myself again. I was sleeping better, and I didn’t have a lot of fatigue like I did before the study. And as far as my cognition, I felt like a changed person. I was able to recall certain things at a greater speed than I did prior to the study,” he says.
Irving’s results lasted only about a week after his participation in the study ended. But Charvet says his improvements were similar to those she has observed in other patients (one study is ongoing). The treatment appears “to help people feel better and be more alert and active,” Charvet says. She is encouraged by other small European studies examining tDCS for MS fatigue that have also appeared to be promising, though not conclusive.
Not So Fast
Despite encouraging results, it’s far too early to assume tDCS will ever be an option for MS-related fatigue, warns Dr. Robert Shin, a professor of neurology at MedStar Georgetown University Hospital. “Saying it’s promising is no guarantee that it will even pan out in the future. Many, many extremely promising things don’t work out once we try them in a lot of people or test them in another way. Sometimes these things turn out to be harmful,” he says.
Charvet agrees with most skeptics. “We’re coming from an abundance of caution. It’s exciting, but it’s definitely still investigational. We need more studies in place,” she says.
However, tDCS has caught on as a “home remedy” on the internet, with some websites plugging do-it-yourself home versions of electrical stimulation to the brain and commercial websites hawking their own untested, unapproved versions of tDCS gadgets for a wide variety of conditions. “You don’t know what you’re buying. Those devices are not at the level we’re using. We don’t know how long the stimulation should be or how many sessions are safe and effective. We need to measure these things in the context of clinical service, and you can’t do that at home,” Charvet says.
What You Can Do
While we don’t know if tDCS will pan out, we do know about other ways to treat MS-related fatigue. Shin feels one of the most important steps is finding underlying conditions that may be causing or contributing to MS exhaustion, such as:
— Sleep apnea (frequent pauses in breathing caused by blocked airways during sleep)
— Depression
— Muscle spasticity, making it harder and more tiring to get around
— Thyroid disorders
[See: Coping With Depression at Work.]
Shin also recommends certain medications to treat MS-related fatigue, although none are approved by the FDA for that purpose. He says prescription drugs that may help include:
— Amantadine (Symmetrel), an anti-viral that has been found to help reduce MS fatigue.
— Modafinil (Provigil), a prescription drug used to treat the sleep disorder narcolepsy. “It seems to block sleepiness by acting in the central nervous system,” Shin says.
— Methylphenidate (Ritalin), a stimulant used to treat attention deficit hyperactivity disorder. “I tend not to use stimulants because they can make people jittery,” Shin says.
Finally, Shin suggests energy management strategies, such as:
— Sitting down when doing kitchen work
— Going upstairs just once during the day, not many times
— Scheduling things strategically, before a time of day when you know you’ll be tired
“I think of people with MS as having a battery that’s smaller. You run out of charge sooner. But if you recharge throughout the day, you can get things done. You just have to outsmart your MS,” Shin says.
But he feels that using DIY low-level electrical stimulation is not smart at this point. “Be patient and wait,” he says, “If it’s a breakthrough, let’s wait for the studies to prove it.”
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Can a Jolt of Electricity Zap MS-Related Fatigue? originally appeared on usnews.com
