Motor cortex rTMS in chronic neuropathic pain:: pain relief is associated with thermal sensory perception improvement
Motor cortex rTMS in chronic neuropathic pain:: pain relief is associated with thermal sensory perception improvement
复制标题
DOI：
10.1136/jnnp.2007.135327
复制
发表时间：
2008-09-01
影响因子：
11
通讯作者：
Nguyen, J-P
中科院分区：
文献类型：
--
作者：
Lefaucheur, J-P;Drouot, X.;Nguyen, J-P
背景资料：感觉检测阈值的改善与硬膜外运动皮层刺激手术植入电极产生的神经病理性疼痛缓解有关。目的：确定运动皮层重复经颅磁刺激（rTMS）产生类似感觉变化的能力。在46例不同起源的慢性神经性疼痛患者中，热刺激的第一感觉阈值在对应于疼痛侧的运动皮层的rTMS之前和之后，在疼痛区和无痛同源对侧区域中量化（冷、热）和机械（振动、压力）感觉。在rTMS之前和之后还对持续的疼痛水平进行评分。比较了三种类型的rTMS会话，使用有源线圈在1 Hz或10 Hz下进行，或使用假线圈在10 Hz下进行。rTMS诱导的感觉阈值和疼痛scores.Results的变化之间的关系进行了研究：阈下rTMS应用于10 Hz显着降低疼痛评分和热感觉阈值的疼痛区，但不降低机械感觉阈值。疼痛缓解与后rTMS改善的温暖的感觉阈值在pain zone.Conclusions：热感觉继电器是潜在的慢性神经性疼痛继发于敏化或deafferentation诱导的去抑制功能障碍。通过作用于这些结构，运动皮层刺激可以缓解疼痛，同时改善无害的热感觉辨别。
Background: Improvement in sensory detection thresholds was found to be associated with neuropathic pain relief produced by epidural motor cortex stimulation with surgically implanted electrodes.Objective: To determine the ability of repetitive transcranial magnetic stimulation (rTMS) of the motor cortex to produce similar sensory changes.Methods: In 46 patients with chronic neuropathic pain of various origins, first-perception thresholds for thermal (cold, warm) and mechanical (vibration, pressure) sensations were quantified in the painful zone and in the painless homologue contralateral territory, before and after rTMS of the motor cortex corresponding to the painful side. Ongoing pain level was also scored before and after rTMS. Three types of rTMS session, performed at 1 Hz or 10 Hz using an active coil, or at 10 Hz using a sham coil, were compared. The relationships between rTMS-induced changes in sensory thresholds and in pain scores were studied.Results: Subthreshold rTMS applied at 10 Hz significantly lowered pain scores and thermal sensory thresholds in the painful zone but did not lower mechanical sensory thresholds. Pain relief correlated with post-rTMS improvement of warm sensory thresholds in the painful zone.Conclusions: Thermal sensory relays are potentially dysfunctioning in chronic neuropathic pain secondary to sensitisation or deafferentation-induced disinhibition. By acting on these structures, motor cortex stimulation could relieve pain and concomitantly improve innocuous thermal sensory discrimination.