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Cited by 52Transcranial Magnetic Stimulation StudiesLong-Term Effects of COVID-19Traumatic Brain Injury Research

Non-invasive brain stimulation for fatigue in post-acute sequelae of SARS-CoV-2 (PASC)

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Santana, Kelly, França, Eduardo, Sato, João, Silva, Ana, Queiroz, Maria, de Farias, Julia, Rodrigues, Danniely, Souza, Iara +7 more·2023·Brain Stimulation
DOI 10.1016/j.brs.2023.01.1672PMC PMC9867562
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Abstract

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.

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  • tDCS may counteract the frontal hypoactivity observed in long COVID patients and therefore impact the cortico-striato-thalamo-cortical network, a circuit closely linked to fatigue.

    “tDCS may counteract the frontal hypoactivity observed in long COVID patients and therefore impact the cortico-striato-thalamo-cortical networka circuit closely linked to fatigue [7,8].”

    From Evaluating the efficacy of repetitive anodal transcranial direct current stimulation on cognitive fatigue in long COVID: A randomized controlled trial (2025) · cites this paper as [7]

    The Discussion (page not provided) says frontal and central areas are dysfunctional after COVID-19 and that HD-tDCS can affect cortical and subcortical circuits. The Introduction and Conclusion link motor-cortex stimulation to improvement in PASC-related fatigue. The paper does not specify frontal hypoactivity or identify the cortico-striato-thalamo-cortical network as the circuit affected. (LLM, conf=0.84)

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Authors
Santana, K., França, E., Sato, J., Silva, A., Queiroz, M., de Farias, J., Rodrigues, D., Souza, I., Ribeiro, V., Caparelli-Dáquer, E., Teixeira, A. L., Charvet, L., Datta, A., Bikson, M., & Andrade, S.
Affiliations
  • Universidade Federal da Paraíba (BR)
  • Universidade Federal do ABC (BR)
  • Governo do Estado de Paraíba (BR)
  • Universidade do Estado do Rio de Janeiro (BR)
  • NYU Langone Health (US)
  • City College of New York (US)
Corresponding author
Andrade, Suellen
ORCID
Venue
Brain Stimulation
Publisher
Elsevier BV
Published
2023-01
Volume
16
Issue
1
Pages
100-107
ISSN
  • 1876-4754 (ISSN-L)
  • 1935-861X
DOI
10.1016/j.brs.2023.01.1672
PMC
PMC9867562
OpenAlex
W4317677548
Cited by
52
References
1
Citations by year
2026: 7 · 2025: 20 · 2024: 17 · 2023: 7 · 2021: 1
FWCI
5.26
Type
journal article
Language
en
Open access
Licence
Locations
  • Brain stimulation (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Commons-TMC (Texas Medical Center) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
long COVID, fatigue, high-definition transcranial direct current stimulation, non-invasive brain stimulation, primary motor cortex, rehabilitation, anxiety, quality of life, pain, mental fatigue, psychosocial fatigue, Modified Fatigue Impact Scale, COVID-19 rehabilitation, neuromodulation therapy, post-COVID-19 rehabilitation
MeSH terms
COVID-19, SARS-CoV-2, Post-Acute COVID-19 Syndrome, Brain, Fatigue, Humans, Pain, Quality of Life, Transcranial Direct Current Stimulation

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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