Ayache Samar S, Chalah Moussa A
Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri-Mondor, AP-HP, Creteil, France; EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Creteil, France; Neurology Division, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon.
Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri-Mondor, AP-HP, Creteil, France; EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Creteil, France.
J Clin Neurosci. 2018 Sep;55:10-12. doi: 10.1016/j.jocn.2018.06.002. Epub 2018 Jun 15.
Multiple sclerosis (MS) is a neurological disease of the central nervous system characterized by inflammation, demyelination and neurodegeneration. Throughout the disease process, patients may complain of a panel of sensory, motor, cognitive and behavioral symptoms. Fatigue is a debilitating manifestation of central nervous system diseases with physical, cognitive and psychosocial dimensions. In MS, fatigue could be very frequent concerning up to 90% of patients and may have a drastic impact on their quality of life. Based on neuroimaging studies, a 'cortico-striato-thalamo-cortical' loop seems to underlie this symptom. Despite the availability of pharmacological molecules, the majority of them fail to bring satisfactory outcomes mainly because of the numerous related side-effects. Therefore, finding a safe, easy to implement, and effective alternative therapy is highly needed. These properties appear to match those of noninvasive brain stimulation techniques such as transcranial direct current stimulation (tDCS). tDCS consists of placing two electrodes over cortical sites, such as those that take part in MS fatigue loop. Here, tDCS protocols targeting MS fatigue are revisited. Their short and long-term effects are discussed. The majority of the available protocols have applied 5 consecutive daily 20-min sessions of anodal tDCS over specific cortical sites and yielded beneficial effects on MS fatigue. Finally, the recent emergence of remotely supervised tDCS protocols are also tackled in this work aiming to address the future possibility of translating the current research data into routine clinical practice. This may lead to optimize patients' care and improve their quality of life.
多发性硬化症（MS）是一种中枢神经系统的神经疾病，其特征为炎症、脱髓鞘和神经退行性变。在整个疾病过程中，患者可能会出现一系列感觉、运动、认知和行为症状。疲劳是中枢神经系统疾病的一种使人衰弱的表现，具有身体、认知和社会心理等方面。在MS中，疲劳可能非常常见，高达90%的患者会出现，并且可能对他们的生活质量产生巨大影响。基于神经影像学研究，一种“皮质-纹状体-丘脑-皮质”环路似乎是这种症状的基础。尽管有多种药理分子可供使用，但大多数都未能带来令人满意的结果，主要是因为有许多相关的副作用。因此，迫切需要找到一种安全、易于实施且有效的替代疗法。这些特性似乎与非侵入性脑刺激技术如经颅直流电刺激（tDCS）相匹配。tDCS包括将两个电极放置在皮质部位，例如那些参与MS疲劳环路的部位。在此，重新审视了针对MS疲劳的tDCS方案。讨论了它们的短期和长期效果。大多数可用方案在特定皮质部位连续5天每天进行20分钟的阳极tDCS，并对MS疲劳产生了有益效果。最后，这项工作还探讨了最近出现的远程监督tDCS方案，旨在解决将当前研究数据转化为常规临床实践的未来可能性。这可能会优化患者护理并提高他们的生活质量。
