Abstract

Keywords: Multiple sclerosis, tDCS, exergaming, cognitive fatigue, neurorehabilitation

Background: Cognitive fatigue and balance disturbances are persistent challenges in individuals with multiple sclerosis (MS), significantly affecting functionality and quality of life. Non-invasive neuromodulation, such as transcranial direct current stimulation (tDCS), aNoninvasive digital exergaming are emerging interventions in neurorehabilitation. Hwever, evidence on their combined, impact, especially across MS subtypes, remains limited.

Materials and Methods: This case study included six MS patients—four with relapsing-remitting MS (RRMS) and two with secondary progressive MS (SPMS). Each participant completed 10 sessions of anodal tDCS (2 mA, 20 minutes) over the left dorsolateral prefrontal cortex, followed by 30 minutes of interactive exergaming, over a two-week period. Cognitive fatigue and balance were measured using the Fatigue Severity Scale (FSS) and Berg Balance Scale (BBS) at three time points (pre, post, and 1-month follow-up). Qualitative data were collected via semi-structured interviews and therapist observation logs, and analysed thematically.

Results: All participants experienced subjective and objective improvements in fatigue levels, with more pronounced improvements in RRMS cases. Balance enhancements were substantial in RRMS and moderate but stable in SPMS cases. Qualitative themes included increased body awareness, emotional engagement, and enhanced treatment motivation. No adverse effects were observed.

Conclusion: The integration of tDCS and exergaming appears feasible, safe, and potentially effective for fatigue and balance management in MS. Subtype-specific differences suggest the need for tailored therapeutic strategies. This preliminary report supports further randomized investigations.