S S Ayache1,2,3, R Ahdab4,5,6, M A Chalah4,5, W H Farhat4,5, V Mylius4,5,7, C Goujon4,8, M Sorel4,9, J-P Lefaucheur4,5. 1. EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France. samarayache@gmail.com. 2. Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France. samarayache@gmail.com. 3. Division of neurology, UMCRH, Beirut, Lebanon. samarayache@gmail.com. 4. EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France. 5. Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France. 6. Division of neurology, UMCRH, Beirut, Lebanon. 7. Department of Neurology, Philipps University Marburg, Germany. 8. Service de Neurochirurgie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France. 9. Centre d'Evaluation et de Traitement de la Douleur, Centre Hospitalier de Nemours, France.
Abstract
BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can relieve neuropathic pain when applied at high frequency (HF: 5-20 Hz) over the primary motor cortex (M1), contralateral to pain side. In most studies, rTMS is delivered over the hand motor hot spot (hMHS), whatever pain location. Navigation systems have been developed to guide rTMS targeting, but their value to improve rTMS efficacy remains to be demonstrated. OBJECTIVE: To compare the analgesic efficacy of HF-rTMS targeting the hMHS (non-navigated procedure) or the M1 representation of the pain region (navigated procedure). METHODS: The analgesic effect of a single session of 10 Hz-rTMS of M1 was assessed in 66 patients with neuropathic pain of various causes and locations, according to three conditions: sham or active non-navigated rTMS of the hMHS and active navigated rTMS of the pain region. RESULTS: Pain was relieved by both active rTMS conditions, and not by sham. Pain location influenced the results: upper or lower limb pain was significantly relieved, but not facial or hemibody pain. Pain relief lasted 1 week only after navigated rTMS, compared to sham. CONCLUSION: Navigation may improve HF-rTMS efficacy in patients with limb pain, whereas targeting remains to be optimized for more diffuse or facial pain. WHAT DOES THIS STUDY ADD?: To produce analgesic effects, HF-rTMS should be applied over the precentral cortex contralaterally to the painful side. Although the hMHS is the target normally chosen for stimulation, the optimal target has not been defined yet. Neuronavigational methods have been recently developed; they allow the integration of MRI data and are thought to improve rTMS efficacy.
BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can relieve neuropathic pain when applied at high frequency (HF: 5-20 Hz) over the primary motor cortex (M1), contralateral to pain side. In most studies, rTMS is delivered over the hand motor hot spot (hMHS), whatever pain location. Navigation systems have been developed to guide rTMS targeting, but their value to improve rTMS efficacy remains to be demonstrated. OBJECTIVE: To compare the analgesic efficacy of HF-rTMS targeting the hMHS (non-navigated procedure) or the M1 representation of the pain region (navigated procedure). METHODS: The analgesic effect of a single session of 10 Hz-rTMS of M1 was assessed in 66 patients with neuropathic pain of various causes and locations, according to three conditions: sham or active non-navigated rTMS of the hMHS and active navigated rTMS of the pain region. RESULTS:Pain was relieved by both active rTMS conditions, and not by sham. Pain location influenced the results: upper or lower limb pain was significantly relieved, but not facial or hemibody pain. Pain relief lasted 1 week only after navigated rTMS, compared to sham. CONCLUSION: Navigation may improve HF-rTMS efficacy in patients with limb pain, whereas targeting remains to be optimized for more diffuse or facial pain. WHAT DOES THIS STUDY ADD?: To produce analgesic effects, HF-rTMS should be applied over the precentral cortex contralaterally to the painful side. Although the hMHS is the target normally chosen for stimulation, the optimal target has not been defined yet. Neuronavigational methods have been recently developed; they allow the integration of MRI data and are thought to improve rTMS efficacy.
Authors: Alberto Herrero Babiloni; Samuel Guay; Donald R Nixdorf; Louis de Beaumont; Gilles Lavigne Journal: J Pain Res Date: 2018-08-01 Impact factor: 3.133
Authors: Hanna Sahlsten; Anu Holm; Esa Rauhala; Mari Takala; Eliisa Löyttyniemi; Max Karukivi; Johanna Nikkilä; Kirsi Ylitalo; Janika Paavola; Reijo Johansson; Tero Taiminen; Satu K Jääskeläinen Journal: Trends Hear Date: 2019 Jan-Dec Impact factor: 3.293
Authors: Simone Rossi; Andrea Antal; Sven Bestmann; Marom Bikson; Carmen Brewer; Jürgen Brockmöller; Linda L Carpenter; Massimo Cincotta; Robert Chen; Jeff D Daskalakis; Vincenzo Di Lazzaro; Michael D Fox; Mark S George; Donald Gilbert; Vasilios K Kimiskidis; Giacomo Koch; Risto J Ilmoniemi; Jean Pascal Lefaucheur; Letizia Leocani; Sarah H Lisanby; Carlo Miniussi; Frank Padberg; Alvaro Pascual-Leone; Walter Paulus; Angel V Peterchev; Angelo Quartarone; Alexander Rotenberg; John Rothwell; Paolo M Rossini; Emiliano Santarnecchi; Mouhsin M Shafi; Hartwig R Siebner; Yoshikatzu Ugawa; Eric M Wassermann; Abraham Zangen; Ulf Ziemann; Mark Hallett Journal: Clin Neurophysiol Date: 2020-10-24 Impact factor: 4.861