Exploring the Effects of Remotely Supervised Transcranial Direct Current Stimulation on Motor Outcomes in Multiple Sclerosis: A Systematic Review.

Abstract

BackgroundMultiple sclerosis (MS) is an autoimmune, inflammatory, progressive neurological disease. Individuals with MS frequently experience muscle weakness, limited walking endurance, and impaired balance, which collectively reduce functional independence and quality of life. Remotely supervised transcranial direct current stimulation (RS-tDCS) has emerged as a potential adjunct neuromodulation technique to enhance neuroplasticity and improve motor outcomes. However, the effectiveness of RS-tDCS on motor performance in MS remains insufficiently understood.ObjectiveTo systematically evaluate the effects, feasibility, and reporting quality of RS-tDCS interventions targeting motor outcomes in individuals with MS.MethodsA systematic review of the scientific literature from 2015 to 2025 was carried out, using engines of PubMed, EBSCO, CENTRAL, and Web of Science. We identified studies that implemented RS-tDCS to improve motor function or reduce fatigue in MS population. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-I. Intervention reporting quality was evaluated using the TIDieR checklist. A synthesis of the results was conducted following the Synthesis without Meta-Analysis (SWiM) guidelines.ResultsFive studies met the inclusion criteria four randomized controlled trials and one non-randomized study, totaling 370 participants. Reports revealed improvements in gait performance, balance, and manual dexterity, whereas findings related to functional mobility and fatigue were mixed.ConclusionRS-tDCS appears feasible and may benefit select motor domains in MS; however, current evidence remains preliminary. This review highlights key methodological gaps and provides direction for future trials to establish the clinical relevance and scalability of decentralized neuromodulation in MS rehabilitation.