A randomized, controlled investigation of motor cortex transcranial magnetic stimulation (TMS) effects on quantitative sensory measures in healthy adults: evaluation of TMS device parameters.
A randomized, controlled investigation of motor cortex transcranial magnetic stimulation (TMS) effects on quantitative sensory measures in healthy adults: evaluation of TMS device parameters.
复制标题
DOI：
10.1097/ajp.0b013e31820d2733
复制
发表时间：
2011-07
期刊：
影响因子：
--
通讯作者：
George MS
中科院分区：
文献类型：
--
作者：
Borckardt JJ;Reeves ST;Beam W;Jensen MP;Gracely RH;Katz S;Smith AR;Madan A;Patterson D;George MS
越来越多的证据表明，经颅磁刺激（TMS）可以在临床样本和经历实验性疼痛的健康成人中产生镇痛作用，微创脑刺激治疗疼痛的领域正在迅速扩大。虽然运动皮层是经颅磁刺激治疗神经性疼痛最广泛使用的皮质靶点，但很少有研究系统地研究了全范围装置参数的镇痛效果，以提供对患者最有帮助（甚至潜在有害）的刺激强度和频率的初步提示。此外，在实验室疼痛测量程序、经颅磁刺激治疗参数、假方法的复杂程度和样本量方面，研究之间存在相当大的不一致。本研究采用假对照、受试者内交叉设计，在健康成年志愿者样本中检验五种不同的经颅磁刺激治疗参数对若干定量感官测量的影响。65名参与者在真实和虚假运动皮层经颅磁刺激前后分别进行了40分钟的定量感觉测试。经颅磁刺激以1Hz的80%静息运动阈值（rMT）、1Hz的100%rMT、10Hz的80%rMT、10Hz的100%rMT或50Hz的三次运动阈值（间歇性θ -burst）进行。真实TMS刺激本身的平均疼痛评分为3.0 (SE= 0.36)，且显著大于零（t(64)=8.17, p< 0.0001）。使用的假性经颅磁刺激方法允许在真实和虚假经颅磁刺激诱导的头皮感觉之间进行匹配，并且参与者成功地对条件（真实与虚假）进行盲化。研究结果表明，运动皮层经颅磁刺激对健康成人定量感觉测试的影响因治疗参数的不同而不同，间歇性θ -burst刺激的效果最小（Cohen’s d=0.03），而10Hz 100%rMT的效果最大（d= 0.34）。总的来说，经颅磁刺激对冷热感觉阈值、冷痛阈值、超阈值刺激不愉快评分和上弦疼痛有统计学上显著的影响。关于装置参数效应，高频刺激似乎与大多数镇痛和抗敏感效应有关，但间歇性的θ -burst刺激除外。目前的研究结果支持了一些临床研究结果，表明较高的经颅磁刺激频率往往与慢性疼痛患者的最大临床益处相关。
There is emerging evidence that transcranial magnetic stimulation (TMS) can produce analgesic effects in clinical samples and in healthy adults undergoing experimentally induced pain, and the field of minimally invasive brain stimulation for the management of pain is expanding rapidly. While, motor cortex is the most widely used cortical target for TMS in the management of neuropathic pain, few studies have systematically investigated the analgesic effects of a full range of device parameters to provide initial hints about what stimulation intensities and frequencies are most helpful (or even potentially harmful) to patients. Further, there is considerable inconsistency between studies with respect to laboratory pain measurement procedures, TMS treatment parameters, sophistication of the sham methods, and sample-sizes. The present study employed a sham-controlled, within-subject, cross-over design to examine the effects of five different TMS treatment parameters across several quantitative sensory measures in a sample of healthy adult volunteers. 65 participants underwent quantitative sensory testing procedures pre- and post- 40-minutes of real and sham motor cortex TMS. TMS was delivered at 1Hz 80% resting motor threshold (rMT), 1Hz 100%rMT, 10Hz 80%rMT, 10Hz 100%rMT, or 50Hz triplets at 90% of active motor threshold (intermittent theta-burst). The mean painfulness rating of real TMS stimulation itself was 3.0 (SE=.36) out of 10 and was significantly greater than zero (t(64)=8.17, p<.0001). The sham TMS methods used permitted matching between real and sham TMS-induced scalp sensations and participants were successfully blinded to condition (real versus sham). Findings suggest that the effects of motor cortex TMS on quantitative sensory tests in healthy adults vary across different treatment parameters with the smallest observed effect for intermittent theta-burst stimulation (Cohen's d=0.03) and the largest for 10Hz 100%rMT (d=.34). Overall, TMS was associated with statistically significant effects on warm and cool sensory thresholds, cold pain thresholds, suprathreshold stimulus unpleasantness ratings and wind-up pain. With respect to device parameter effects, higher frequency stimulation appears to be associated with the most analgesic and anti-sensitivity effects with the exception of intermittent theta-burst stimulation. The present findings support several clinical research findings suggesting that higher TMS frequencies tend to be associated with the most clinical benefit in patients with chronic pain.