Effect of transcranial direct current stimulation combined with a virtual reality exercise on balance in a patient with multiple sclerosis: a case report

To investigate the effects of training with videogame (VG) combined with transcranial direct current (tDCS) stimulation on balance, fatigue, and quality of life in an individual with multiple sclerosis. A 51-year-old male patient reported a history of progressive loss of muscle strength in the left lower limb from 37 years of age. Equilibrium, fatigue, and quality of life were evaluated before and after two treatment protocols, with the 14-day interval between them: Protocol 1: VG + sham tDCS (five consecutive sessions) and Protocol 2: VG + tDCS active (five consecutive sessions). Each session lasted 20 min, with 2 mA intensity. After Protocol 1, the patient presented improvement in balance, fatigue, and quality of life, but these improvements were not maintained in the follow-up evaluation. After Protocol 2, an improvement in balance was not clinically important and the results of the low post-intervention and follow-up were found in relation to fatigue and quality of life. The most promising clinical changes were found when the VG was combined with the sham tDCS compared to the combination of VG and active tDCS.