Analgesic effects of navigated motor cortex rTMS in patients with chronic neuropathic pain
Analgesic effects of navigated motor cortex rTMS in patients with chronic neuropathic pain
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DOI：
10.1002/ejp.864
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发表时间：
2016-10-01
影响因子：
3.6
通讯作者：
Lefaucheur, J. -P.
中科院分区：
文献类型：
--
作者：
Ayache, S. S.;Ahdab, R.;Lefaucheur, J. -P.
研究背景重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）在痛侧对侧初级运动皮层（primary motor cortex，M1）高频（HF：5- 20 Hz）作用下可缓解神经病理性疼痛。在大多数研究中，rTMS是在手部运动热点（hMHS）上传递的，无论疼痛位置如何。已经开发了导航系统来引导rTMS瞄准，目的比较HF-rTMS对hMHS的镇痛效果（非导航程序）或疼痛区域的M1表示方法采用10 Hz-100 Hz的单次治疗，根据以下三种情况，在66例不同原因和部位的神经性疼痛患者中评估了M1的rTMS：hMHS的假手术或主动非导航rTMS和疼痛区域的主动导航rTMS。而不是通过伪装疼痛部位影响结果：上肢或下肢疼痛明显缓解，但面部或半身疼痛没有缓解。疼痛缓解持续1周后，导航rTMS，相比sham.ConclusionNavigation可能会提高HF-rTMS疗效的患者肢体疼痛，而目标仍然是优化更弥漫性或面部pain.What这项研究增加？为了产生镇痛效果，HF-rTMS应应用于中央前皮质对侧的疼痛侧。虽然hMHS是通常选择用于刺激的靶点，但尚未确定最佳靶点。最近开发了神经导航方法;它们允许整合MRI数据，并被认为可以提高rTMS的疗效。
BackgroundRepetitive transcranial magnetic stimulation (rTMS) can relieve neuropathic pain when applied at high frequency (HF: 5-20Hz) 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.ObjectiveTo compare the analgesic efficacy of HF-rTMS targeting the hMHS (non-navigated procedure) or the M1 representation of the pain region (navigated procedure).MethodsThe analgesic effect of a single session of 10Hz-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.ResultsPain 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 1week only after navigated rTMS, compared to sham.ConclusionNavigation 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.