{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:50:11Z","timestamp":1778604611988,"version":"3.51.4"},"reference-count":139,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Multiple sclerosis (MS) is the most prevalent incurable nontraumatic neurological disability in young individuals. It causes numerous symptoms, including tingling, fatigue, muscle spasms, cognitive deficits, and neuropsychiatric disorders. This disease significantly worsens quality of life (QoL), and this dimension of general functioning provides valuable information about the effectiveness of treatment and well-being. There are psychological interventions that can improve QoL, but their number is limited. Therefore, searching for new methods that are as effective and safe as possible is ongoing. Methods: This review examines the potential effectiveness of transcranial direct current stimulation (tDCS) in improving the quality of life in patients with MS. Searches were conducted in the PubMed\/Medline, Research Gate, and Cochrane databases. Results: The search yielded seven studies in which QoL was a primary or secondary outcome. Stimulation protocols displayed heterogeneity, especially concerning the choice of the stimulation site. Four studies demonstrated the effectiveness of tDCS in improving QoL, all of which (two) used anodal stimulation of the left DLPFC. Stimulation of the motor cortex has produced mixed results. The potential mechanisms of action of tDCS in improving QoL in MS are explained. These include improved synaptic plasticity, increased cerebral blood flow, salience network engagement through tDCS, and reduction of beta-amyloid deposition. The limitations are also detailed, and recommendations for future research are made. Conclusions: While the evidence is limited, tDCS has shown potential to improve QoL in MS patients in some studies. Prefrontal stimulation appears promising, and further research is recommended to explore this approach.<\/jats:p>","DOI":"10.3390\/jcm14020373","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T07:00:47Z","timestamp":1736406047000},"page":"373","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Potential of Transcranial Direct Current Stimulation (tDCS) in Improving Quality of Life in Patients with Multiple Sclerosis: A Review and Discussion of Mechanisms of Action"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5320-3658","authenticated-orcid":false,"given":"James","family":"Chmiel","sequence":"first","affiliation":[{"name":"Faculty of Physical Culture and Health, Institute of Physical Culture Sciences, University of Szczecin, Al. Piast\u00f3w 40B Block 6, 71-065 Szczecin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6996-8920","authenticated-orcid":false,"given":"Donata","family":"Kurpas","sequence":"additional","affiliation":[{"name":"Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wroc\u0142aw Medical University, 51-618 Wroc\u0142aw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5005-6721","authenticated-orcid":false,"given":"Marta","family":"St\u0119pie\u0144-S\u0142odkowska","sequence":"additional","affiliation":[{"name":"Faculty of Physical Culture and Health, Institute of Physical Culture Sciences, University of Szczecin, Al. Piast\u00f3w 40B Block 6, 71-065 Szczecin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1177\/1352458517694432","article-title":"New insights into the burden and costs of multiple sclerosis in Europe","volume":"23","author":"Kobelt","year":"2017","journal-title":"Mult. Scler."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"10647","DOI":"10.3390\/ijms130810647","article-title":"Molecular mechanisms of oligodendrocyte injury in multiple sclerosis and experimental autoimmune encephalomyelitis","volume":"13","author":"Patel","year":"2012","journal-title":"Int. J. Mol. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.3390\/cimb45020094","article-title":"Multiple Sclerosis: Inflammatory and Neuroglial Aspects","volume":"45","author":"Papiri","year":"2023","journal-title":"Curr. Issues Mol. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"17562864211007687","DOI":"10.1177\/17562864211007687","article-title":"Inflammation in multiple sclerosis","volume":"14","author":"Haase","year":"2021","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.ncl.2010.12.009","article-title":"The immunopathophysiology of multiple sclerosis","volume":"29","author":"Wu","year":"2011","journal-title":"Neurol. Clin."},{"key":"ref_6","first-page":"e24294","article-title":"Multiple Sclerosis and Autoimmunity: A Veiled Relationship","volume":"14","author":"Barkhane","year":"2022","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lo Sasso, B., Agnello, L., Bivona, G., Bellia, C., and Ciaccio, M. (2019). Cerebrospinal Fluid Analysis in Multiple Sclerosis Diagnosis: An Update. Medicina, 55.","DOI":"10.3390\/medicina55060245"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"282","DOI":"10.21037\/atm-21-3073","article-title":"Application of oligoclonal bands and other cerebrospinal fluid variables in multiple sclerosis and other neuroimmunological diseases: A narrative review","volume":"11","author":"Jin","year":"2023","journal-title":"Ann. Transl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Deisenhammer, F., Zetterberg, H., Fitzner, B., and Zettl, U.K. (2019). The Cerebrospinal Fluid in Multiple Sclerosis. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.00726"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.clim.2015.06.015","article-title":"Biomarkers in multiple sclerosis","volume":"161","author":"Housley","year":"2015","journal-title":"Clin. Immunol."},{"key":"ref_11","first-page":"1","article-title":"Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy","volume":"19","author":"Ghasemi","year":"2017","journal-title":"Cell J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1080\/14737175.2021.1978843","article-title":"Role of environmental factors in multiple sclerosis","volume":"21","author":"Zarghami","year":"2021","journal-title":"Expert Rev. Neurother."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ferr\u00e8, L., Filippi, M., and Esposito, F. (2020). Involvement of Genetic Factors in Multiple Sclerosis. Front. Cell. Neurosci., 14.","DOI":"10.3389\/fncel.2020.612953"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"a028951","DOI":"10.1101\/cshperspect.a028951","article-title":"Genetics of Multiple Sclerosis: An Overview and New Directions","volume":"8","author":"Patsopoulos","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1038\/s41579-022-00770-5","article-title":"Epstein-Barr virus and multiple sclerosis","volume":"21","author":"Soldan","year":"2023","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_16","first-page":"e9564","article-title":"Role of Smoking in the Pathogenesis of Multiple Sclerosis: A Review Article","volume":"12","author":"Nishanth","year":"2020","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s40120-017-0086-4","article-title":"Vitamin D and Multiple Sclerosis: A Comprehensive Review","volume":"7","author":"Sintzel","year":"2018","journal-title":"Neurol. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.29245\/2572.942X\/2016\/7.1064","article-title":"Obesity and Multiple Sclerosis Susceptibility: A Review","volume":"1","author":"Gianfrancesco","year":"2016","journal-title":"J. Neurol. Neuromed."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1001\/archneurol.2009.122","article-title":"Smoking and disease progression in multiple sclerosis","volume":"66","author":"Healy","year":"2009","journal-title":"Arch. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s10787-011-0084-6","article-title":"Paradigms in multiple sclerosis: Time for a change, time for a unifying concept","volume":"19","author":"Krone","year":"2011","journal-title":"Inflammopharmacology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.4065\/82.10.1229","article-title":"Clinical Significance Consensus Meeting Group. Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice","volume":"82","author":"Guyatt","year":"2007","journal-title":"Mayo Clin. Proc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/1477-7525-2-32","article-title":"Patients\u2019 needs, satisfaction, and health related quality of life: Towards a comprehensive model","volume":"2","author":"Tamburini","year":"2004","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"137","DOI":"10.31887\/DCNS.2014.16.2\/mbullinger","article-title":"Quality of life as patient-reported outcomes: Principles of assessment","volume":"16","author":"Bullinger","year":"2014","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1177\/1559827620907309","article-title":"Quality of Life: The Primary Goal of Lifestyle Intervention","volume":"14","author":"Daundasekara","year":"2020","journal-title":"Am. J. Lifestyle Med."},{"key":"ref_25","first-page":"11","article-title":"Quality of life in patients with chronic diseases","volume":"35","author":"Kaas","year":"2014","journal-title":"Neuro Endocrinol. Lett."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1164\/rccm.2112043","article-title":"Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease","volume":"166","author":"Lamarca","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1001\/jama.281.14.1298","article-title":"Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery","volume":"281","author":"Rumsfeld","year":"1999","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1001\/archinte.165.11.1274","article-title":"Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure","volume":"165","author":"Pascual","year":"2005","journal-title":"Arch. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1001\/archotol.132.1.27","article-title":"Does quality of life predict long-term survival in patients with head and neck cancer?","volume":"132","author":"Mehanna","year":"2006","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/S0959-8049(02)00098-9","article-title":"Baseline quality of life predicts survival in patients with advanced colorectal cancer","volume":"38","author":"Maisey","year":"2002","journal-title":"Eur. J. Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1093\/ndt\/gfp671","article-title":"Quality of life predicts risks of end-stage renal disease and mortality in patients with chronic kidney disease","volume":"25","author":"Tsai","year":"2010","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/00132586-200012000-00006","article-title":"Health-Related Quality of Life As a Predictor of Mortality Following Coronary Artery Bypass Graft Surgery","volume":"44","author":"Rumsfeld","year":"2000","journal-title":"Surv. Anesthesiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Phyo, A.Z.Z., Freak-Poli, R., Craig, H., Gasevic, D., Stocks, N.P., Gonzalez-Chica, D.A., and Ryan, J. (2020). Quality of life and mortality in the general population: A systematic review and meta-analysis. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09639-9"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.dhjo.2017.04.008","article-title":"People with multiple sclerosis report significantly worse symptoms and health related quality of life than the US general population as measured by PROMIS and NeuroQoL outcome measures","volume":"11","author":"Amtmann","year":"2018","journal-title":"Disabil. Health J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1023\/A:1020734901150","article-title":"Quality of life and multiple sclerosis: Comparison between people with multiple sclerosis and people from the general population","volume":"9","author":"McCabe","year":"2002","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_36","first-page":"S139","article-title":"Improving quality of life in multiple sclerosis: An unmet need","volume":"17","author":"Zwibel","year":"2011","journal-title":"Am. J. Manag. Care"},{"key":"ref_37","first-page":"352","article-title":"Quality of life in multiple sclerosis","volume":"3","author":"Opara","year":"2010","journal-title":"J. Med. Life"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"34","DOI":"10.7224\/1537-2073-12.1.34","article-title":"Quality of life in patients with multiple sclerosis. Assessing Quality of Life in Patients with Multiple Sclerosis","volume":"12","author":"Bandari","year":"2010","journal-title":"Int. J. MS Care"},{"key":"ref_39","first-page":"524894","article-title":"Measuring the quality of life in patients with multiple sclerosis in clinical practice: A necessary challenge","volume":"2013","author":"Baumstarck","year":"2013","journal-title":"Mult. Scler. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1191\/1352458504ms1116rr","article-title":"Quality of life measures for the palliative care of people severely affected by multiple sclerosis: A systematic review","volume":"10","author":"Gruenewald","year":"2004","journal-title":"Mult. Scler."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1000461","DOI":"10.4172\/2329-9096.1000461","article-title":"Changing Lifestyle of Persons with Multiple Sclerosis: Development, Feasibility and Preliminary Results of a Novel High-Impact Collaborative Intervention in Leisure Environments","volume":"6","author":"Mendozzi","year":"2018","journal-title":"Int. J. Phys. Med. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1177\/1352458516687404","article-title":"Wellness and multiple sclerosis: The National MS Society establishes a Wellness Research Working Group and research priorities","volume":"24","author":"Motl","year":"2018","journal-title":"Mult. Scler."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s11910-019-1002-3","article-title":"Exercise as Medicine in Multiple Sclerosis\u2014Time for a Paradigm Shift: Preventive, Symptomatic, and Disease-Modifying Aspects and Perspectives","volume":"19","author":"Dalgas","year":"2019","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_44","first-page":"55","article-title":"Interventions to Improve Quality of Life in Multiple Sclerosis: New Opportunities and Key Talking Points","volume":"13","author":"Faraclas","year":"2023","journal-title":"Degener. Neurol. Neuromuscul. Dis."},{"key":"ref_45","first-page":"339","article-title":"Evaluation of quality of life in multiple sclerosis patients: Impact of fatigue, anxiety and depression","volume":"26","author":"Silva","year":"2019","journal-title":"Int. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"237","DOI":"10.37897\/RJN.2020.4.4","article-title":"New insights on depression in multiple sclerosis\u2014A literature review","volume":"19","author":"Schreiner","year":"2020","journal-title":"Rom. J. Neurol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1007\/s00415-022-11451-x","article-title":"A systematic review and meta-analysis exploring the efficacy of mindfulness-based interventions on quality of life in people with multiple sclerosis","volume":"270","author":"Simpson","year":"2023","journal-title":"J. Neurol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1136\/jnnp-2018-320165","article-title":"Mindfulness-based interventions for mental well-being among people with multiple sclerosis: A systematic review and meta-analysis of randomised controlled trials","volume":"90","author":"Simpson","year":"2019","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Willekens, B., Perrotta, G., Cras, P., and Cools, N. (2018). Into the Moment: Does Mindfulness Affect Biological Pathways in Multiple Sclerosis?. Front. Behav. Neurosci., 12.","DOI":"10.3389\/fnbeh.2018.00103"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.rehab.2018.10.002","article-title":"Psychological interventions in multiple sclerosis: Improving cognition and quality of life","volume":"63","author":"Harand","year":"2020","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.brs.2008.06.004","article-title":"Transcranial direct current stimulation: State of the art 2008","volume":"1","author":"Nitsche","year":"2008","journal-title":"Brain Stimul."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1152\/jn.00608.2009","article-title":"Time course of the induction of homeostatic plasticity generated by repeated transcranial direct current stimulation of the human motor cortex","volume":"105","author":"Fricke","year":"2011","journal-title":"J. Neurophysiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/YCT.0000000000000510","article-title":"Physiology of transcranial direct current stimulation","volume":"34","author":"Stagg","year":"2018","journal-title":"J. ECT"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1111\/j.1469-7793.2000.t01-1-00633.x","article-title":"Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation","volume":"527","author":"Nitsche","year":"2000","journal-title":"J. Physiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1113\/jphysiol.2003.049916","article-title":"Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans","volume":"553","author":"Nitsche","year":"2003","journal-title":"J. Physiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.brs.2009.04.002","article-title":"Anodal skin lesions after treatment with transcranial direct current stimulation","volume":"3","author":"Frank","year":"2010","journal-title":"Brain Stimul."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1002\/hbm.25700","article-title":"The use of noninvasive brain stimulation techniques to improve reading difficulties in dyslexia: A systematic review","volume":"43","author":"Turker","year":"2022","journal-title":"Hum. Brain Mapp."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1007\/s10072-023-07162-4","article-title":"Transcranial direct current stimulation for global cognition in Alzheimer\u2019s disease: A systemic review and meta-analysis","volume":"45","author":"Wang","year":"2024","journal-title":"Neurol. Sci."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e2724","DOI":"10.1002\/brb3.2724","article-title":"A systematic review of randomized controlled trials on efficacy and safety of transcranial direct current stimulation in major neurodevelopmental disorders: ADHD, autism, and dyslexia","volume":"12","author":"Salehinejad","year":"2022","journal-title":"Brain Behav."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12984-024-01311-2","article-title":"Effects of transcranial direct current stimulation alone and in combination with rehabilitation therapies on gait and balance among individuals with Parkinson\u2019s disease: A systematic review and meta-analysis","volume":"21","author":"Nguyen","year":"2024","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jocn.2020.04.106","article-title":"The effect of tDCS on the fatigue in patients with multiple sclerosis: A systematic review of randomized controlled clinical trials","volume":"78","author":"Ashrafi","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"101375","DOI":"10.1016\/j.msard.2019.08.017","article-title":"Non-invasive brain stimulation for fatigue in multiple sclerosis patients: A systematic review and meta-analysis","volume":"36","author":"Liu","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"20406223211069198","DOI":"10.1177\/20406223211069198","article-title":"Effects of non-invasive brain stimulation in multiple sclerosis: Systematic review and meta-analysis","volume":"13","author":"Kan","year":"2022","journal-title":"Ther. Adv. Chronic Dis."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Hsu, W.Y., Cheng, C.H., Zanto, T.P., Gazzaley, A., and Bove, R.M. (2021). Effects of Transcranial Direct Current Stimulation on Cognition, Mood, Pain, and Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.626113"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"411","DOI":"10.2217\/nmt-2018-0028","article-title":"The place of transcranial direct current stimulation in the management of multiple sclerosis-related symptoms","volume":"8","author":"Ayache","year":"2018","journal-title":"Neurodegener. Dis. Manag."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1111\/ene.15163","article-title":"Efficacy of transcranial direct current stimulation in people with multiple sclerosis: A review","volume":"29","author":"Hiew","year":"2022","journal-title":"Eur. J. Neurol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s12984-023-01266-w","article-title":"Effectiveness of transcranial direct current stimulation on balance and gait in patients with multiple sclerosis: Systematic review and meta-analysis of randomized clinical trials","volume":"20","year":"2023","journal-title":"J. NeuroEngineering Rehabil."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1177\/0269215520921506","article-title":"Comparing the effects of multi-session anodal trans-cranial direct current stimulation of primary motor and dorsolateral prefrontal cortices on fatigue and quality of life in patients with multiple sclerosis: A double-blind, randomized, sham-controlled trial","volume":"34","author":"Mortezanejad","year":"2020","journal-title":"Clin. Rehabil."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jpain.2009.08.011","article-title":"Effects of anodal transcranial direct current stimulation on chronic neuropathic pain in patients with multiple sclerosis","volume":"11","author":"Mori","year":"2010","journal-title":"J. Pain"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"3451","DOI":"10.1093\/pm\/pnaa128","article-title":"The Effect of Transcranial Direct Current Stimulation on Chronic Neuropathic Pain in Patients with Multiple Sclerosis: Randomized Controlled Trial","volume":"21","author":"Young","year":"2020","journal-title":"Pain Med."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz-Paredes, I., Herrero, A.J., Rom\u00e1n-Nieto, N., Pe\u00f1a-Gomez, A.M., and Seco-Calvo, J. (2022). Influence of Transcranial Direct Current Stimulation and Exercise on Fatigue and Quality of Life in Multiple Sclerosis. Healthcare, 11.","DOI":"10.3390\/healthcare11010084"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"202","DOI":"10.7224\/1537-2073.2021-004","article-title":"Effects of Nonconsecutive Sessions of Transcranial Direct Current Stimulation and Stationary Cycling on Walking Capacity in Individuals with Multiple Sclerosis","volume":"24","author":"Rahimibarghani","year":"2022","journal-title":"Int. J. MS Care"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.brs.2012.10.003","article-title":"Transcranial direct current stimulation ameliorates tactile sensory deficit in multiple sclerosis","volume":"6","author":"Mori","year":"2013","journal-title":"Brain Stimul."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"569","DOI":"10.32598\/irj.20.4.1699.1","article-title":"The Comparable Effect of tDCS and Core Exercises on Balance and Mobility in Patients with Multiple Sclerosis","volume":"20","author":"Mohammadkhanbeigi","year":"2022","journal-title":"Iran. Rehabil. J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1186\/s12955-021-01857-y","article-title":"Viability of a MSQOL-54 general health-related quality of life score using bifactor model","volume":"19","author":"Giordano","year":"2021","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2220","DOI":"10.1016\/S1388-2457(03)00235-9","article-title":"Safety criteria for transcranial direct current stimulation (tDCS) in humans","volume":"114","author":"Nitsche","year":"2003","journal-title":"Clin. Neurophysiol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1038\/s41386-022-01370-w","article-title":"Synaptic plasticity and mental health: Methods, challenges and opportunities","volume":"48","author":"Appelbaum","year":"2023","journal-title":"Neuropsychopharmacology"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Milewska-J\u0119drzejczak, M., and G\u0142\u0105bi\u0144ski, A. (2023). The Influence of Conventional and Innovative Rehabilitation Methods on Brain Plasticity Induction in Patients with Multiple Sclerosis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12051880"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/1073858410386614","article-title":"Physiological basis of transcranial direct current stimulation","volume":"17","author":"Stagg","year":"2011","journal-title":"Neuroscientist."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/j.1469-7793.2001.0285f.x","article-title":"Three Ca2+ levels affect plasticity differently: The LTP zone, the LTD zone and no man\u2019s land","volume":"532","author":"Lisman","year":"2001","journal-title":"J. Physiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"19112","DOI":"10.1523\/JNEUROSCI.2536-13.2013","article-title":"Synaptic Plasticity and PDGF Signaling Defects Underlie Clinical Progression in Multiple Sclerosis","volume":"33","author":"Mori","year":"2013","journal-title":"J. Neurosci."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1586\/14737175.8.10.1585","article-title":"Cognitive changes in multiple sclerosis","volume":"8","author":"Amato","year":"2008","journal-title":"Expert Rev. Neurother."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1177\/1352458515622696","article-title":"Regional reduction in cortical blood flow among cognitively impaired adults with relapsing-remitting multiple sclerosis patients","volume":"22","author":"Hojjat","year":"2016","journal-title":"Mult. Scler."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1038\/jcbfm.2012.192","article-title":"Heterogeneity of cortical lesions in multiple sclerosis: An MRI perfusion study","volume":"33","author":"Peruzzo","year":"2013","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3174\/ajnr.A3148","article-title":"Robust perfusion deficits in cognitively impaired patients with secondary-progressive multiple sclerosis","volume":"34","author":"Francis","year":"2013","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1148\/radiol.2313030996","article-title":"Microvascular abnormality in relapsing-remitting multiple sclerosis: Perfusion MR imaging findings in normal-appearing white matter","volume":"231","author":"Law","year":"2004","journal-title":"Radiology"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.neuroimage.2006.08.008","article-title":"Pattern of hemodynamic impairment in multiple sclerosis: Dynamic susceptibility contrast perfusion MR imaging at 3.0 T","volume":"33","author":"Adhya","year":"2006","journal-title":"Neuroimage"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"16477","DOI":"10.1038\/srep16477","article-title":"Reduced cortical microvascular oxygenation in multiple sclerosis: A blinded, case-controlled study using a novel quantitative near-infrared spectroscopy method","volume":"5","author":"Yang","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"106028","DOI":"10.1016\/j.nbd.2023.106028","article-title":"How does neurovascular unit dysfunction contribute to multiple sclerosis?","volume":"178","author":"Cashion","year":"2023","journal-title":"Neurobiol. Dis."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.neuroimage.2011.06.018","article-title":"Effects of transcranial direct current stimulation (tDCS) on human regional cerebral blood flow","volume":"58","author":"Zheng","year":"2011","journal-title":"Neuroimage"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Hu, S., Zheng, T., Dong, Y., Du, J., and Liu, L. (2018). Effect of Anodal Direct-Current Stimulation on Cortical Hemodynamic Responses with Laser-Speckle Contrast Imaging. Front. Neurosci., 12.","DOI":"10.3389\/fnins.2018.00503"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Workman, C.D., Ponto, L.L.B., Kamholz, J., and Rudroff, T. (2020). No Immediate Effects of Transcranial Direct Current Stimulation at Various Intensities on Cerebral Blood Flow in People with Multiple Sclerosis. Brain Sci., 10.","DOI":"10.3390\/brainsci10020082"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Workman, C.D., Fietsam, A.C., Ponto, L.L.B., Kamholz, J., and Rudroff, T. (2020). Individual Cerebral Blood Flow Responses to Transcranial Direct Current Stimulation at Various Intensities. Brain Sci., 10.","DOI":"10.3390\/brainsci10110855"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"779","DOI":"10.3758\/s13415-019-00720-4","article-title":"The neural correlates of well-being: A systematic review of the human neuroimaging and neuropsychological literature","volume":"19","author":"King","year":"2019","journal-title":"Cogn. Affect. Behav. Neurosci."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.neuroimage.2018.10.069","article-title":"Cognitive enhancement with Salience Network electrical stimulation is influenced by network structural connectivity","volume":"185","author":"Li","year":"2019","journal-title":"Neuroimage"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Koizumi, K., Ueda, K., Li, Z., and Nakao, M. (2020). Effects of Transcranial Direct Current Stimulation on Brain Networks Related to Creative Thinking. Front. Hum. Neurosci., 14.","DOI":"10.3389\/fnhum.2020.541052"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s13311-014-0313-y","article-title":"\u03b2-Amyloid peptides and amyloid plaques in Alzheimer\u2019s disease","volume":"12","author":"Gouras","year":"2015","journal-title":"Neurotherapeutics"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Stampanoni Bassi, M., Garofalo, S., Marfia, G.A., Gilio, L., Simonelli, I., Finardi, A., Furlan, R., Sancesario, G.M., Di Giandomenico, J., and Storto, M. (2017). Amyloid-\u03b2 Homeostasis Bridges Inflammation, Synaptic Plasticity Deficits and Cognitive Dysfunction in Multiple Sclerosis. Front. Mol. Neurosci., 10.","DOI":"10.3389\/fnmol.2017.00390"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/S1474-4422(08)70259-X","article-title":"Cognitive impairment in multiple sclerosis","volume":"7","author":"Chiaravalloti","year":"2008","journal-title":"Lancet Neurol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1017\/S1355617706060723","article-title":"Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS)","volume":"12","author":"Benedict","year":"2006","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Luo, Y., Yang, W., Li, N., Yang, X., Zhu, B., Wang, C., Hou, W., Wang, X., Wen, H., and Tian, X. (2020). Anodal Transcranial Direct Current Stimulation Can Improve Spatial Learning and Memory and Attenuate A\u03b242 Burden at the Early Stage of Alzheimer\u2019s Disease in APP\/PS1 Transgenic Mice. Front. Aging Neurosci., 12.","DOI":"10.3389\/fnagi.2020.00134"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Ko\u0142tuniuk, A., Pawlak, B., Kr\u00f3wczy\u0144ska, D., and Chojdak-\u0141ukasiewicz, J. (2023). The quality of life in patients with multiple sclerosis\u2014Association with depressive symptoms and physical disability: A prospective and observational study. Front. Psychol., 13.","DOI":"10.3389\/fpsyg.2022.1068421"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.msard.2019.01.049","article-title":"Determinants of quality of life in relapsing-remitting and progressive multiple sclerosis","volume":"30","author":"Yalachkov","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.msard.2019.07.029","article-title":"Depression, fatigue and disability are independently associated with quality of life in patients with multiple sclerosis: Results of a cross-sectional study","volume":"35","author":"Schmidt","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"101386","DOI":"10.1016\/j.msard.2019.101386","article-title":"Quality of life in patients with multiple sclerosis and its association with depressive symptoms and physical disability","volume":"36","author":"Flores","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.msard.2018.06.001","article-title":"Coping strategies and quality of life in Mexican multiple sclerosis patients: Physical, psychological and social factors relationship","volume":"25","year":"2018","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_107","first-page":"29","article-title":"Psychosocial and medical determinants of health-related quality of life in patients with relapsing-remitting multiple sclerosis","volume":"55","author":"Boogar","year":"2017","journal-title":"Noro Psikiyatr. Ars."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.msard.2018.04.009","article-title":"Comparative study of quality of life, anxiety, depression, and fatigue among patients with neuromyelitis optica spectrum disorder and multiple sclerosis: The first report from Iran","volume":"22","author":"Barzegar","year":"2018","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_109","first-page":"269","article-title":"Comparison of psychological symptoms of patients with multiple sclerosis and healthy people","volume":"20","author":"Shamsaei","year":"2015","journal-title":"Neurol. Asia"},{"key":"ref_110","first-page":"4","article-title":"The symptoms of depression and the sociodemographic factors in patients with multiple sclerosis","volume":"5","author":"Winiecka","year":"2016","journal-title":"J. Neurol. Neurosurg. Nurs."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"102261","DOI":"10.1016\/j.msard.2020.102261","article-title":"Anxiety and depression in multiple sclerosis (MS): Antecedents, consequences, and differential impact on well-being and quality of life","volume":"44","author":"Hanna","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1080\/16506073.2017.1304445","article-title":"Effect of treatments for depression on quality of life: A meta-analysis","volume":"46","author":"Hofmann","year":"2017","journal-title":"Cogn. Behav. Ther."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s11136-004-1364-z","article-title":"Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients","volume":"14","author":"Hart","year":"2005","journal-title":"Qual. Life Res."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1136\/bmjspcare-2021-002936","article-title":"Global, regional and national quality of life in patients with multiple sclerosis: A global systematic review and meta-analysis","volume":"12","author":"Hoseinipalangi","year":"2022","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1159\/000508949","article-title":"Factors Influencing Health-Related Quality of Life of Patients with Multiple Sclerosis and Their Caregivers","volume":"83","year":"2020","journal-title":"Eur. Neurol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.clineuro.2011.11.012","article-title":"Factors predicting quality of life in a group of polish subjects with multiple sclerosis: Accounting for functional state, socio-demographic and clinical factors","volume":"114","author":"Stelmasiak","year":"2012","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1111\/ene.12046","article-title":"Predictors of quality of life among multiple sclerosis patients: A comprehensive analysis","volume":"20","author":"Yamout","year":"2013","journal-title":"Eur. J. Neurol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1111\/j.1748-0361.2008.00165.x","article-title":"Rural-urban analyses of health-related quality of life among people with multiple sclerosis","volume":"24","author":"Buchanan","year":"2008","journal-title":"J. Rural Health"},{"key":"ref_119","first-page":"215","article-title":"Validation of selected aspects of psychometry of the polish version of the multiple sclerosis impact scale 29 (MSIS-29)","volume":"41","author":"Stelmasiak","year":"2007","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"e318","DOI":"10.5001\/omj.2021.109","article-title":"Health-related quality of life of people with multiple sclerosis in Oman","volume":"36","author":"Natarajan","year":"2021","journal-title":"Oman Med. J."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s11136-005-0891-6","article-title":"Health-related quality of life in multiple sclerosis: The impact of disability, gender and employment status","volume":"15","author":"Miller","year":"2006","journal-title":"Qual. Life Res."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1080\/13548506.2017.1366660","article-title":"Assessing the quality of life in patients with multiple sclerosis in Kuwait: A cross sectional study","volume":"23","author":"Abdullah","year":"2018","journal-title":"Psychol. Health Med."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"e041249","DOI":"10.1136\/bmjopen-2020-041249","article-title":"Quality of life in adults with multiple sclerosis: A systematic review","volume":"10","author":"Conrad","year":"2020","journal-title":"BMJ Open"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"191","DOI":"10.5114\/ms.2017.70345","article-title":"Multiple sclerosis: Patient-reported quality of life in the \u015awi\u0119tokrzyskie region","volume":"33","author":"Brola","year":"2017","journal-title":"Med. Stud. Med."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jns.2014.07.050","article-title":"Individual factors enhance poor health-related quality of life outcome in multiple sclerosis patients. significance of predictive determinants","volume":"345","author":"Cioncoloni","year":"2014","journal-title":"J. Neurol. Sci."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1111\/ane.12854","article-title":"Self-assessments and determinants of HRQoL in a German MS population","volume":"137","author":"Nickel","year":"2018","journal-title":"Acta Neurol. Scand."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"757","DOI":"10.3233\/WOR-152203","article-title":"Quality of life among people with multiple sclerosis: Replication of a three-factor prediction model","volume":"52","author":"Bishop","year":"2015","journal-title":"Work"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"749","DOI":"10.3233\/WOR-152202","article-title":"Employment as a health promotion intervention for persons with multiple sclerosis","volume":"52","author":"Chiu","year":"2015","journal-title":"Work"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/S0028-3843(14)60076-1","article-title":"Validation analysis of the polish version of the multiple sclerosis international quality of life questionnaire (MusiQoL)","volume":"45","author":"Stelmasiak","year":"2011","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1007\/s00415-012-6705-1","article-title":"Cognitive impairment, health-related quality of life and vocational status at early stages of multiple sclerosis: A 7-year longitudinal study","volume":"260","author":"Ruet","year":"2013","journal-title":"J. Neurol."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7224\/1537-2073.2014-046","article-title":"Fatigue, sleep quality, and disability in relation to quality of life in multiple sclerosis","volume":"17","author":"Tabrizi","year":"2015","journal-title":"Int. J. MS Care"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1080\/13548506.2014.979209","article-title":"The relationship of age, function, and psychological distress in multiple sclerosis","volume":"20","author":"Jones","year":"2015","journal-title":"Psychol. Health Med."},{"key":"ref_133","doi-asserted-by":"crossref","unstructured":"Goto, S., Kataoka, K., Isa, M., Nakamori, K., Yoshida, M., Murayama, S., Arasaki, A., Ishida, H., and Kimura, R. (2023). Factors associated with bone thickness: Comparison of the cranium and humerus. PLoS ONE., 18.","DOI":"10.1371\/journal.pone.0283636"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1002\/jbmr.2613","article-title":"Evaluation of Skull Cortical Thickness Changes with Age and Sex from Computed Tomography Scans","volume":"31","author":"Lillie","year":"2016","journal-title":"J. Bone Miner. Res."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1159\/000330168","article-title":"A geographic cline of skull and brain morphology among individuals of European Ancestry","volume":"72","author":"Bakken","year":"2011","journal-title":"Hum. Hered."},{"key":"ref_136","doi-asserted-by":"crossref","unstructured":"Vergallito, A., Feroldi, S., Pisoni, A., and Romero Lauro, L.J. (2022). Inter-Individual Variability in tDCS Effects: A Narrative Review on the Contribution of Stable, Variable, and Contextual Factors. Brain Sci., 12.","DOI":"10.3390\/brainsci12050522"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1177\/1352458512453362","article-title":"Bone health and multiple sclerosis","volume":"18","author":"Dobson","year":"2012","journal-title":"Mult. Scler."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"2935","DOI":"10.1007\/s00198-011-1644-8","article-title":"Bone health in multiple sclerosis","volume":"22","author":"Gibson","year":"2011","journal-title":"Osteoporos. Int."},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Rudroff, T., Rainio, O., and Kl\u00e9n, R. (2024). Leveraging Artificial Intelligence to Optimize Transcranial Direct Current Stimulation for Long COVID Management: A Forward-Looking Perspective. Brain Sci., 14.","DOI":"10.3390\/brainsci14080831"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/373\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:25:34Z","timestamp":1759919134000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,9]]},"references-count":139,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020373"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020373","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,9]]}}}