Reduction of intractable deafferentation pain due to spinal cord or peripheral lesion by high-frequency repetitive transcranial magnetic stimulation of the primary motor cortex.
OBJECTIVE
The authors previously reported that navigation-guided repetitive transcranial magnetic stimulation (rTMS) of the precentral gyrus relieves deafferentation pain. Stimulation parameters were 10 trains of 10-second 5-Hz TMS pulses at 50-second intervals. In the present study, they used various stimulation frequencies and compared efficacies between two types of lesions.


METHODS
Patients were divided into two groups: those with a cerebral lesion and those with a noncerebral lesion. The rTMS was applied to all the patients at frequencies of 1, 5, and 10 Hz and as a sham procedure in random order. The effect of rTMS on pain was rated by patients using a visual analog scale.


RESULTS
The rTMS at frequencies of 5 and 10 Hz, compared with sham stimulation, significantly reduced pain, and the pain reduction continued for 180 minutes. A stimulation frequency of 10 Hz may be more effective than 5 Hz, and at 1 Hz was ineffective. The effect of rTMS at frequencies of 5 and 10 Hz was greater in patients with a noncerebral lesion than those with a cerebral lesion.


CONCLUSIONS
High-frequency (5- or 10-Hz) rTMS of the precentral gyrus can reduce intractable deafferentation pain, but low-frequency stimulation (at 1 Hz) cannot. Patients with a noncerebral lesion are more suitable candidates for high-frequency rTMS of the precentral gyrus.
Saitoh
Youichi
Y
Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita-shi, Japan. neurosaitoh@mbk.nifty.com
Hirayama
Azuma
A
Kishima
Haruhiko
H
Shimokawa
Toshio
T
Oshino
Satoru
S
Hirata
Masayuki
M
Tani
Naoki
N
Kato
Amami
A
Yoshimine
Toshiki
T
D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000150:complications*; D002422:Causalgia / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex; D038361:Neuronavigation; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000150:complications*; D013118:Spinal Cord Diseases / Q000150:complications*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome