Federal University of Paraíba, João Pessoa, Brazil.
Center of Mathematics, Computing and Cognition, Federal University of ABC, Santo André, Brazil.
Brain Stimul. 2023 Jan-Feb;16(1):100-107. doi: 10.1016/j.brs.2023.01.1672. Epub 2023 Jan 21.
BACKGROUND: and purpose: Fatigue is among the most common persistent symptoms following post-acute sequelae of Sars-COV-2 infection (PASC). The current study investigated the potential therapeutic effects of High-Definition transcranial Direct Current Stimulation (HD-tDCS) associated with rehabilitation program for the management of PASC-related fatigue. METHODS: Seventy patients with PASC-related fatigue were randomized to receive 3 mA or sham HD-tDCS targeting the left primary motor cortex (M1) for 30 min paired with a rehabilitation program. Each patient underwent 10 sessions (2 sessions/week) over five weeks. Fatigue was measured as the primary outcome before and after the intervention using the Modified Fatigue Impact Scale (MFIS). Pain level, anxiety severity and quality of life were secondary outcomes assessed, respectively, through the McGill Questionnaire, Hamilton Anxiety Rating Scale (HAM-A) and WHOQOL. RESULTS: Active HD-tDCS resulted in significantly greater reduction in fatigue compared to sham HD-tDCS (mean group MFIS reduction of 22.11 points vs 10.34 points). Distinct effects of HD-tDCS were observed in fatigue domains with greater effect on cognitive (mean group difference 8.29 points; effect size 1.1; 95% CI 3.56-13.01; P < .0001) and psychosocial domains (mean group difference 2.37 points; effect size 1.2; 95% CI 1.34-3.40; P < .0001), with no significant difference between the groups in the physical subscale (mean group difference 0.71 points; effect size 0.1; 95% CI 4.47-5.90; P = .09). Compared to sham, the active HD-tDCS group also had a significant reduction in anxiety (mean group difference 4.88; effect size 0.9; 95% CI 1.93-7.84; P < .0001) and improvement in quality of life (mean group difference 14.80; effect size 0.7; 95% CI 7.87-21.73; P < .0001). There was no significant difference in pain (mean group difference -0.74; no effect size; 95% CI 3.66-5.14; P = .09). CONCLUSION: An intervention with M1 targeted HD-tDCS paired with a rehabilitation program was effective in reducing fatigue and anxiety, while improving quality of life in people with PASC.
背景：目的：疲劳是 SARS-CoV-2 感染后急性后遗症（PASC）后最常见的持续性症状之一。本研究旨在调查高清晰度经颅直流电刺激（HD-tDCS）联合康复方案治疗与 PASC 相关的疲劳的潜在治疗效果。
方法：70 例 PASC 相关疲劳患者随机分为 3 mA 或假刺激 HD-tDCS 组，刺激靶点为左侧初级运动皮层（M1），持续 30 分钟，同时接受康复方案。每位患者接受 10 次治疗（每周 2 次），共 5 周。干预前后采用改良疲劳影响量表（MFIS）作为主要结局指标评估疲劳程度。分别通过麦吉尔疼痛问卷、汉密尔顿焦虑量表（HAM-A）和世界卫生组织生活质量量表（WHOQOL）评估疼痛程度、焦虑严重程度和生活质量。
结果：与假刺激 HD-tDCS 相比，真刺激 HD-tDCS 可显著降低疲劳程度（平均组 MFIS 降低 22.11 分 vs. 10.34 分）。HD-tDCS 对疲劳各维度均有明显影响，对认知（平均组差异 8.29 分；效应量 1.1；95%置信区间 3.56-13.01；P<0.0001）和心理社会（平均组差异 2.37 分；效应量 1.2；95%置信区间 1.34-3.40；P<0.0001）维度的影响更大，而在躯体子量表上两组间无显著差异（平均组差异 0.71 分；效应量 0.1；95%置信区间 4.47-5.90；P=0.09）。与假刺激相比，真刺激 HD-tDCS 组的焦虑程度也显著降低（平均组差异 4.88 分；效应量 0.9；95%置信区间 1.93-7.84；P<0.0001），生活质量也显著提高（平均组差异 14.80 分；效应量 0.7；95%置信区间 7.87-21.73；P<0.0001）。疼痛无显著差异（平均组差异 -0.74 分；无效应量；95%置信区间 3.66-5.14；P=0.09）。
结论：M1 靶向 HD-tDCS 联合康复方案干预可有效降低 PASC 患者的疲劳和焦虑程度，提高生活质量。
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