Pain Psychiatry of Trigeminal Neuralgia

2018 ◽  
pp. 243-264
Author(s):  
Lily H. Kim ◽  
Michael Bret Schneider
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Depression And Anxiety ◽  
Surgical Interventions ◽  
Holistic Treatment ◽  
Carbamazepine Therapy ◽  
High Incidence

In addition to the repeated episodes of paroxysmal, electrical facial pain classically associated with the disease, many patients with trigeminal neuralgia (TN) suffer from severe emotional distress. At present, there is no universally agreed pathophysiological explanation for the high incidence of depression and anxiety within this patient population. Despite the unclear understanding, the psychiatric comorbidities should be addressed as a part of comprehensive, multi-modal approach. Anticonvulsants or serotonin and norepineprhine reuptake inhibitors are viable pharmacological options that can supplement the currently used carbamazepine therapy. For medically refractory cases, surgical interventions are being suggested as effective alternatives in managing both the pain and the psychiatric complaints of TN. Examples include microvascular decompression, stereotactic radiosurgery, and repetitive transcranial magnetic stimulation. Continued research to understand TN should take into account the psychiatric burden in this population in order to promote a holistic treatment approach.

scholarly journals Antiepileptic Efficacy and Network Connectivity Modulation of Repetitive Transcranial Magnetic Stimulation by Vertex Suppression

2021 ◽  
Vol 15 ◽  
Author(s):  
Cong Fu ◽  
Aikedan Aisikaer ◽  
Zhijuan Chen ◽  
Qing Yu ◽  
Jianzhong Yin ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Seizure Frequency ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Reduction Rate ◽  
Network Connectivity ◽  
Hamilton Depression Scale ◽  
Depression And Anxiety ◽  
Epileptiform Discharges ◽  
The Impact

A core feature of drug-resistant epilepsy is hyperexcitability in the motor cortex, and low-frequency repetitive transcranial magnetic stimulation (rTMS) is a suitable treatment for seizures. However, the antiepileptic effect causing network reorganization has rarely been studied. Here, we assessed the impact of rTMS on functional network connectivity (FNC) in resting functional networks (RSNs) and their relation to treatment response. Fourteen patients with medically intractable epilepsy received inhibitive rTMS with a figure-of-eight coil over the vertex for 10 days spread across two weeks. We designed a 6-week follow-up phase divided into four time points to investigate FNC and rTMS-induced timing-dependent plasticity, such as seizure frequency and abnormal interictal discharges on electroencephalography (EEG). For psychiatric comorbidities, the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A) were applied to measure depression and anxiety before and after rTMS. FNC was also compared to that of a cohort of 17 healthy control subjects. The after-effects of rTMS included all subjects that achieved the significant decrease rate of more than 50% in interictal epileptiform discharges and seizure frequency, 12 (14) patients with the reduction rate above 50% compared to the baseline, as well as emotional improvements in depression and anxiety (p < 0.05). In the analysis of RSNs, we found a higher synchronization between the sensorimotor network (SMN) and posterior default-mode network (pDMN) in epileptic patients than in healthy controls. In contrast to pre-rTMS, the results demonstrated a weaker FNC between the anterior DMN (aDMN) and SMN after rTMS, while the FNC between the aDMN and dorsal attention network (DAN) was greater (p < 0.05, FDR corrected). Importantly, the depressive score was anticorrelated with the FNC of the aDMN-SMN (r = −0.67, p = 0.0022), which was markedly different in the good and bad response groups treated with rTMS (p = 0.0115). Based on the vertex suppression by rTMS, it is possible to achieve temporary clinical efficacy by modulating network reorganization in the DMN and SMN for patients with refractory epilepsy.

scholarly journals Structural and functional biomarkers of efficacy of navigated repetitive transcranial magnetic stimulation in therapy for trigeminal neuralgia

2021 ◽  
Author(s):  
AG Poydasheva ◽  
DO Sinitsyn ◽  
IS Bakulin ◽  
NA Suponeva ◽  
MA Piradov
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Trigeminal Neuralgia ◽  
Pain Intensity ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Cerebellar Hemisphere ◽  
Average Pain Intensity ◽  
Postcentral Gyrus ◽  
Average Pain ◽  
Positive Correlations

Repetitive transcranial magnetic stimulation (rTMS) is an alternative treatment option for patients with drug-resistant trigeminal neuralgia (TN). However, the effect of rTMS is variable. The aim of this study was to find neuroimaging biomarkers of clinical efficacy of navigated rTMS. Seventeen patients with TN (14 women and 3 men, median age 56 years) received 10 sessions of high-frequency rTMS of the motor cortex contralateral to pain side. The data were analyzed for correlations between functional connectivity (FC), the grey matter (GM) volume and the reduction in pain intensity. Positive correlations were established between the reduction in average pain intensity and GM volume in caudate nuclei in both hemispheres (p(unc) = 0.03), both cerebellar hemispheres (p(unc) = 0.002) and the postcentral gyrus contralateral to pain side (p(unc) = 0.005); between the reduction in peak pain intensity and GM volume in the caudate nucleus contralateral to pain side (p(unc) = 0.04) and the cerebellar hemisphere ipsilateral to pain (p(unc) = 0.03). Significant positive correlations were discovered between the reduction in average pain intensity and FC between the thalamus contralateral to pain side, the postcentral gyrus and the insular operculum (both ipsilateral to pain side; (p(FWE) = 0.018), as well as between the cingulate cortex and the anterior cingulate cortex ipsilateral to pain (p(FWE) = 0.017), between the contralateral subcallosal gyrus and the cerebellar hemisphere ipsilateral to pain (p(FWE) = 0.018). A negative correlation was established for FC between the contralateral putamen and the occipital lobes in both hemispheres (p(FWE) = 0.001). Our findings may spur the development of individual predictors of rTMS efficacy in patients with chronic pain.

scholarly journals Repetitive Transcranial Magnetic Stimulation as an Add-On Treatment for Cognitive Impairment in Alzheimer’s Disease and Its Impact on Self-Rated Quality of Life and Caregiver’s Burden

2021 ◽  
Vol 11 (6) ◽  
pp. 740
Author(s):  
Juliana Teti Mayer ◽  
Caroline Masse ◽  
Gilles Chopard ◽  
Magali Nicolier ◽  
Matthieu Bereau ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Rating Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Depression And Anxiety ◽  
The Impact

Alzheimer’s disease (AD) is associated with progressive memory loss and decline in executive functions, as well as neuropsychiatric symptoms. Patients usually consider quality of life (QoL) and mood as more important for their health status than disease-specific physical and mental symptoms. In this open-label uncontrolled trial, 12 subjects diagnosed with AD underwent 10 sessions of repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (10 Hz, 20 min, 2000 pulses/day, 110% MT). Outcomes were measured before and 30 days after treatment. Our primary objective was to test the efficacy of rTMS as an add-on treatment for AD on the global cognitive function, assessed through the Mini-Mental State Examination (MMSE) and the Mattis Dementia Rating Scale (MDRS). As secondary objectives, the detailed effect on cognitive functions, depression and anxiety symptoms, QoL, and functionality in daily life activities were evaluated, as well as correlations between QoL and cognition, depression and anxiety scores. The treatment significantly enhanced semantic memory and reduced anxiety. Improvement of these features in AD could become an important target for treatment strategies. Although limited by its design, this trial may contribute with another perspective on the analysis and the impact of rTMS on AD.

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