Transcranial direct current stimulation as a strategy to manage disorders generated by COVID-19: feasibility study

Abstract

Background: different long-lasting (>3months) physical and mental disorders, such as pain, fatigue and depression, and cognitive impairment may be triggered by coranavirus infection (ProjectCovid data). Transcranial direct current stimulation (tDCS), an easy-to-apply, nonpharmacology, and safe technique, have been used to attenuate these disorders caused by other disease. Our hypothesis is that tDCS could also improve these disorders generated by COVID-19. In addition, a persistent inflammatory state observed post COVID-19 would be related to negative symptoms progression. As tDCS can also attenuate excessive acute and chronic inflammation, it is reasonable to consider whether it may be useful tool to increase immune function and reduce the morbidity of COVID-19 patients.Objective: to determine the feasibility and the preliminary efficacy of tDCS as a strategy to manage brain disorders post-COVID-19 in order to guide the design of a randomised clinical trial.Design: pre/post, single-subject design. Setting: Departamento de Educação Física da FCT/UNESP e Departamento de Fisioterapia da UFPEParticipants: Twelve patients for each specific post-COVID-19 sequeale (pain, fatigue, depression and cognitive impairment)Interventions: tDCS (30min;2mA) on primary motor cortex (pain and fatigue) and left dorsolateral prefrontal cortex (depression and cognitive impairment) for two weeks (5 sessions/week) combined with physical (pain and fatigue) or cognitive training (depression and cognitive impairment).Main outcome measures: feasibility indicadors: i) Process (recruitment rate, consent rate, retention rate, and perceived satisfaction); ii) Resources (adherence rate, session length, intervention burden and management participant processing time), and iii)Treatment: safety (intervention); treatment outcomes: i) Fatigue severity scale (Fatigue); ii) Brief Pain Inventory and Visual Analogue Scale for pain (pain); iii) HADS (depression); iv) Stroop Color and Word Test and Digit span (cognitive impairment); v) Cell culture, colorimetric and enzyme-linked immunosorbent assay (ELISA) analyses (serum inflammatory and metabolic parameters, cytokine production from liposaccharide (LPS)-stimulated whole blood cultures and LPS and Phorbol 12-myristate 13-acetate (PMA)-stimulated PBMC cultures) (AU)