Repetitive Transcranial Magnetic Stimulation Once a Week Induces Sustainable Long-Term Relief of Central Poststroke Pain
Repetitive Transcranial Magnetic Stimulation Once a Week Induces Sustainable Long-Term Relief of Central Poststroke Pain
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DOI：
10.1111/ner.12301
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发表时间：
2015-06-01
期刊：
影响因子：
2.8
通讯作者：
Ohira, Takayuki
中科院分区：
文献类型：
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作者：
Kobayashi, Masahito;Fujimaki, Takamitsu;Ohira, Takayuki
目的中枢性卒中后疼痛是一些卒中后患者的严重问题。重复经颅磁刺激(RTMS)已被报道可缓解中风后疼痛，但其疗效仍存在争议。我们测试了每周应用一次rTMS的可能性，以诱导卒中后疼痛的持续缓解。材料和方法18名中枢性卒中后疼痛的患者参加了这项研究。RTMS(10串10秒5 Hz-rTMS)在患侧初级运动皮质上进行。RTMS治疗每周重复一次，持续12周，对6名患者进行为期一年的干预。在每周一次的rTMS治疗前评估疼痛程度，以评估持续的效果。结果rTMS的效果在第八周达到平台期。12周时，rTMS有效率为61.1%；18例患者中，5例视觉模拟评分下降70%以上，6例下降40~69%，7例疼痛下降低于40%。当患者被分成有或没有严重感觉障碍的两组时，发现8名有严重感觉障碍的患者的疼痛缓解程度低于没有严重感觉障碍的患者。结论虽然这是一项开放式研究，没有设对照组，但我们的研究结果表明，如果每周维持一次初级运动皮质的rTMS，可以帮助缓解中风后的疼痛。
ObjectiveCentral poststroke pain is a serious problem for some patients after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been reported to relieve poststroke pain but its efficacy is still controversial. We tested the possibility that rTMS, when applied once a week, would induce sustainable relief of poststroke pain.Materials and MethodsEighteen patients with central poststroke pain were included in this study. rTMS (10 trains of 10-sec 5Hz-rTMS) was delivered over the primary motor cortex on the affected side. The rTMS session was repeated once a week for 12 weeks, and for six patients the intervention was continued for one year. The degree of the pain was assessed before each weekly rTMS session to evaluate sustainable effects.ResultsThe effects of the rTMS reached a plateau at the eighth week. At the 12th week, the rTMS was effective in 61.1% of the patients; 5 of the 18 patients showed more than 70% reduction based on a visual analog scale, 6 patients showed 40-69% reduction, and 7 remained at a pain reduction level of less than 40%. When patients were divided into two groups with or without severe dysesthesia, it was found that eight patients with severe dysesthesia showed less pain relief than those without. In the six patients who continued rTMS for one year, the pain relief effects also were sustained.ConclusionAlthough this was an open-label study without a control group, our findings suggest that rTMS of the primary motor cortex, when maintained once a week, could help to relieve poststroke pain.