RESUMEN
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system, characterized by the accumulation of numerous neurological symptoms and signs throughout its course. Fatigue is one of the most distressing complaints that MS patients may experience over their lifetime. In spite of its high prevalence, the pathophysiology of MS fatigue is far from being fully elucidated and a constellation of mechanisms seems implicated in this setting. Several factors could contribute to its development and/or exacerbation, and this requires a careful workup in order to search for all possible underlying causes, such as sleep disturbances, endocrine dysfunction and mood disorders, to cite a few. The aim of this review is to revisit the definition of MS fatigue, provide an overview of its pathophysiology, and reappraise its clinical, structural and functional correlates. Additionally, we discuss the available assessment tools, as well as the various management strategies including pharmacological and non-pharmacological interventions. Special emphasis will be placed on the role of noninvasive brain stimulation techniques in this field. Finally, we propose a "road map" to facilitate the diagnosis and guide the therapeutic regimens of this multifactorial and multidimensional construct.
Asunto(s)
Depresión/complicaciones , Fatiga/complicaciones , Esclerosis Múltiple/complicaciones , Encuestas y Cuestionarios , Estimulación Encefálica Profunda/métodos , Depresión/diagnóstico , Humanos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: Since 2006 transcranial direct current stimulation (tDCS) has been investigated in the treatment of depression. In this review, we discuss the implications and clinical perspectives that tDCS may have as a therapeutic tool in depression from the results reported in this domain. METHODS: A comprehensive literature review has found nearly thirty articles - all in English - on this topic, corresponding to clinical studies, placebo-controlled or not, case reports and reviews. RESULTS: Several meta-analyses showed that the antidepressant effects of active tDCS are significant against placebo, but variable, mainly due to the heterogeneity of the patients included in the studies, for example regarding the resistance to antidepressant treatment. CONCLUSIONS: Specific recommendations for the use of tDCS in treating depression may not yet be available, but some elements of good practice can be highlighted. Of particular note is that anodal tDCS of the left prefrontal cortex at 2mA for 20 minutes per day has a potential therapeutic value without risk of significant side effects: tDCS offers safe conditions for clinical use in the treatment of depression.