Abstract 125: Repetitive Transcranial Magnetic Stimulation Once A Week Induces Sustainable Long-term Relief Of Post-stroke Pain

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Masahito Kobayashi ◽  
Takamitsu Fujimaki ◽  
Ban Mihara
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Pain Relief ◽  
Motor Cortex ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Cortex Stimulation ◽  
Post Stroke ◽  
Active Motor ◽  
One Year

Introduction: Post-stroke thalamic pain is a serious problem for some patients after stroke, deteriorating their activities of daily life, and is often resistant to medical treatments. Surgical intervention, such as electrical motor cortex stimulation, has been reported to be effective, but only for 40-60% of the patients despite of invasive procedures and costly devices. For some patients with electrical motor cortex stimulation, continuous stimulation is not always essential while occasional stimulation, such as a few hours every several days, is enough for their pain control. Recently, repetitive transcranial magnetic stimulation (rTMS) is reported to relieve post-stroke pain transiently but effectively. Hypothesis: We assessed the hypothesis that rTMS of motor cortex, maintained once a week, could induce sustainable long-term pain relief in patients with medication-resistant post-stroke pain. Methods: Fifteen patients suffering from medication-resistant post-stroke pain after thalamic hemorrhagic stroke were included. rTMS (10 trains of 10-second 5Hz TMS pulses at 50-second intervals, 90% of active motor threshold) was delivered on the motor cortex of the affected side. The rTMS session was repeated once a week for more than 12 weeks. The effect of rTMS on pain was rated by patients using a visual analog scale (VAS). Result: Mean VAS (±SEM) before rTMS (baseline) was 6.4±0.4 and reduced gradually and significantly in accordance with rTMS sessions. The VAS 12 weeks later was 3.4±0.5. Nine of 15 patients (60%) reported reduction of three or more VAS points. Five patients suffering from paresthesia rather than pain showed less reduction of VAS compared to the others. In five patients, rTMS was continued for one year and the effect of pain relief was also sustained. Conclusion: rTMS of the motor cortex, when maintained once a week, can provide long-term pain relief in patients with medication-resistant post-stroke pain.

scholarly journals Added value of multiple versus single sessions of repetitive transcranial magnetic stimulation in predicting motor cortex stimulation efficacy for refractory neuropathic pain

2019 ◽  
Vol 130 (5) ◽  
pp. 1750-1761 ◽  
Author(s):  
Benjamin Pommier ◽  
Charles Quesada ◽  
Camille Fauchon ◽  
Christophe Nuti ◽  
François Vassal ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Transcranial Magnetic Stimulation ◽  
Pain Relief ◽  
Motor Cortex ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Cortex Stimulation ◽  
Single Session ◽  
Analgesic Effects

OBJECTIVESelection criteria for offering patients motor cortex stimulation (MCS) for refractory neuropathic pain are a critical topic of research. A single session of repetitive transcranial magnetic stimulation (rTMS) has been advocated for selecting MCS candidates, but it has a low negative predictive value. Here the authors investigated whether multiple rTMS sessions would more accurately predict MCS efficacy.METHODSPatients included in this longitudinal study could access MCS after at least four rTMS sessions performed 3–4 weeks apart. The positive (PPV) and negative (NPV) predictive values of the four rTMS sessions and the correlation between the analgesic effects of the two treatments were assessed.RESULTSTwelve MCS patients underwent an average of 15.9 rTMS sessions prior to surgery; nine of the patients were rTMS responders. Postoperative follow-up was 57.8 ± 15.6 months (mean ± standard deviation). Mean percentage of pain relief (%R) was 21% and 40% after the first and fourth rTMS sessions, respectively. The corresponding mean durations of pain relief were respectively 2.4 and 12.9 days. A cumulative effect of the rTMS sessions was observed on both %R and duration of pain relief (p < 0.01). The %R value obtained with MCS was 35% after 6 months and 43% at the last follow-up. Both the PPV and NPV of rTMS were 100% after the fourth rTMS session (p = 0.0045). A significant correlation was found between %R or duration of pain relief after the fourth rTMS session and %R at the last MCS follow-up (R2 = 0.83, p = 0.0003).CONCLUSIONSFour rTMS sessions predicted MCS efficacy better than a single session in neuropathic pain patients. Taking into account the cumulative effects of rTMS, the authors found a high-level correlation between the analgesic effects of rTMS and MCS.

scholarly journals Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Calogero Malfitano ◽  
Angela Rossetti ◽  
Stefano Scarano ◽  
Chiara Malloggi ◽  
Luigi Tesio
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Motor Cortex ◽  
Magnetic Stimulation ◽  
Primary Motor Cortex ◽  
Thermal Sensation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
The Body ◽  
Post Stroke ◽  
Thalamic Stroke ◽  
Motor Cortex Excitability

Although rare, central post-stroke pain remains one of the most refractory forms of neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) has been reported to be effective in chronic cases. However, there are no data on the effects in the acute and subacute phases after stroke. In this study, we present a case of a patient with thalamic stroke with acute onset of pain and paresthesia who was responsive to rTMS. After a right thalamic stroke, a 32-year-old woman presented with drug-resistant pain and paresthesia on the left side of the body. There were no motor or sensory deficits, except for blunted thermal sensation and allodynia on light touch. Ten daily sessions were performed, where 10 Hz rTMS was applied to the hand area of the right primary motor cortex, 40 days after stroke. Before rTMS treatment (T0), immediately after treatment conclusion (T1), and 1 month after treatment (T2), three pain questionnaires were administered, and cortical responses to single and paired-pulse TMS were assessed. Eight healthy participants served as controls. At T0, when the patient was experiencing the worst pain, the excitability of the ipsilesional motor cortex was reduced. At T1 and T2, the pain scores and paresthesia' spread decreased. The clinical improvement was paralleled by the recovery in motor cortex excitability of the affected hemisphere, in terms of both intra- and inter-hemispheric connections. In this subacute central post-stroke pain case, rTMS treatment was associated with decreased pain and motor cortex excitability changes.

Mechanisms of human motor cortex facilitation induced by subthreshold 5-Hz repetitive transcranial magnetic stimulation

2013 ◽  
Vol 109 (12) ◽  
pp. 3060-3066 ◽  
Author(s):  
Martin Sommer ◽  
Milena Rummel ◽  
Christoph Norden ◽  
Holger Rothkegel ◽  
Nicolas Lang ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Motor Cortex ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Long Term Potentiation ◽  
Human Motor Cortex ◽  
Term Potentiation ◽  
Human Motor ◽  
Extensor Carpi Radialis

Our knowledge about the mechanisms of human motor cortex facilitation induced by repetitive transcranial magnetic stimulation (rTMS) is still incomplete. Here we used pharmacological conditioning with carbamazepine, dextrometorphan, lorazepam, and placebo to elucidate the type of plasticity underlying this facilitation, and to probe if mechanisms reminiscent of long-term potentiation are involved. Over the primary motor cortex of 10 healthy subjects, we applied biphasic rTMS pulses of effective posterior current direction in the brain. We used six blocks of 200 pulses at 5-Hz frequency and 90% active motor threshold intensity and controlled for corticospinal excitability changes using motor-evoked potential (MEP) amplitudes and latencies elicited by suprathreshold pulses before, in between, and after rTMS. Target muscle was the dominant abductor digiti minimi muscle; we coregistered the dominant extensor carpi radialis muscle. We found a lasting facilitation induced by this type of rTMS. The GABAergic medication lorazepam and to a lesser extent the ion channel blocker carbamazepine reduced the MEP facilitation after biphasic effective posteriorly oriented rTMS, whereas the N-methyl-d-aspartate receptor-antagonist dextrometorphan had no effect. Our main conclusion is that the mechanism of the facilitation induced by biphasic effective posterior rTMS is more likely posttetanic potentiation than long-term potentiation. Additional findings were prolonged MEP latency under carbamazepine, consistent with sodium channel blockade, and larger MEP amplitudes from extensor carpi radialis under lorazepam, suggesting GABAergic involvement in the center-surround balance of excitability.

Effects of Repetitive Transcranial Magnetic Stimulation on Upper Extremity Spasticity Post-Stroke: A Systematic Review

2021 ◽  
Author(s):  
Anas R. Alashram ◽  
Elvira Padua ◽  
Cristian Romagnoli ◽  
Manikandan Raju ◽  
Giuseppe Annino
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Randomized Controlled Trials ◽  
Upper Extremity ◽  
Magnetic Stimulation ◽  
Randomized Clinical Trials ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trials ◽  
Post Stroke ◽  
Randomized Controlled

AbstractUpper extremity spasticity is one of the most popular impairments following stroke. It can reduce patients' functional level. Recently, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising tool in stroke rehabilitation. This review was conducted to investigate the immediate and long-term effects of rTMS on the upper extremity spasticity post-stroke and determine the optimal treatment protocols. PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, AMED, and Web of Science databases were searched for randomized controlled trials investigating the effect of rTMS on the upper extremity spasticity in patients with stroke. The methodological quality was assessed using the Cochrane Collaboration’s tool. Ten randomized clinical trials were met the inclusion criteria. A total of 225 patients were included in this analysis, 35.30% of whom were females. The mean age for all patients was 60.14 years. The findings showed heterogeneous evidence on the benefits of rTMS intervention in the upper extremity spasticity post-stroke. The evidence for the effect of rTMS on the upper extremity spasticity post-stroke is promising. Combining rTMS with other rehabilitation interventions may show a superior effect in reducing the upper extremity spasticity compared with rTMS intervention alone. Further randomized controlled trials with long-term follow-ups are warranted.

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