1448 - Understanding Neural Mechanisms and the Use of Targeted Non-Invasive Brain Stimulation for Treatment of Post-Stroke Fatigue: A Scoping Review

Objectives: Poststroke fatigue (PSF) is a common and debilitating symptom of stroke that has lasting effects on functional outcome. Despite a growing body of research, its pathophysiology is still poorly understood. Neuroimaging and non-invasive brain stimulation (NIBS) has also emerged as a potential non-pharmacological treatment for various neurological conditions. The objective of this review is (1) to evaluate the current literature on neuroimaging regarding PSF to deduce potential neural mechanisms and (2) assess the use of NIBS as a possible treatment option for PSF.

Design: A systematic search was conducted for the databases PubMed, Embase, Scopus, CINAHL and Cochrane. Studies were included based on the following inclusion criteria: adult participants (greater than 18 years of age) with post-stroke fatigue at acute, subacute, and chronic phase and use of neuroimaging. The data extracted included specific details about the participants, concept, context, study methods and key findings relevant to the review questions.

Results: A total of 32 studies met the inclusion criteria and were included in the review. Most of the neuroimaging papers that used MRI as a modality found no correlation between lesion size and side and PSF. NIBS papers revealed cortical excitability and a disruption in interhemispheric inhibitory balance as contributors. Of the six articles that used transcranial direct current stimulation (tDCS) as a treatment, only two reported statistically significant reductions in the severity of PSF. .

Conclusions: Structural characteristics of stroke lesions were found to have no significant effect while NIBS studies contributed cortical excitability and interhemispheric inhibitory balance to the development of PSF. Current clinical trials have shown inconsistent findings on the effectiveness of tDCS on PSF which could partly be explained by the use of varying methodologies. More investigations are needed to determine if NIBS could be a potential treatment to alleviate the effects of PSF.