title: H-coil repetitive transcranial magnetic stimulation for pain relief in patients with diabetic neuropathy.
abstract: BACKGROUND
  Painful neuropathy is associated with plasticity changes in the nervous system. Standard repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique used to study changes in cortical excitability and to inhibit pain perception. Deep rTMS is a newer development that allows direct activation of deeper neuronal populations, by a unique coil design termed the H-coil. This study was designed to assess whether deep rTMS applied over the motor cortical lower-limb representation relieves pain in patients with diabetic neuropathy.
  
  
  METHODS
  Patients were randomly assigned to receive daily real or sham H-coil rTMS for 5 consecutive days. After a 5-week washout period, they crossed over to the alternative treatment for additional 5 days (according to a crossover study design). Outcome measures were changes in the visual analogue scale (VAS) for pain and in area and threshold of RIII nociceptive flexion reflex (RIII reflex).
  
  
  RESULTS
  Of the 25 patients randomized, 23 completed the study. After real rTMS, the VAS scores decreased significantly (p=0.01), and so did RIII reflex area (p<0.01), while no significant effects in these variables were induced by the sham rTMS treatment. The rTMS-induced changes in the outcome measures disappeared about 3 weeks after stimulation. All patients tolerated stimulation well.
  
  
  CONCLUSIONS
  Deep H-coil rTMS provides pain relief in patients with diabetic neuropathy. This innovative technique can induce a therapeutic effect on brain areas that otherwise remain difficult to target. rTMS may produce its analgesic effects, inducing motor cortex plasticity and activating descending inhibitory pain control systems.
authors: Department of Neurology and Psychiatry, University of Rome 'La Sapienza', Italy.
authors: E
authors: E
authors: Onesti
authors: M
authors: M
authors: Gabriele
authors: C
authors: C
authors: Cambieri
authors: M
authors: M
authors: Ceccanti
authors: R
authors: R
authors: Raccah
authors: G
authors: G
authors: Di Stefano
authors: A
authors: A
authors: Biasiotta
authors: A
authors: A
authors: Truini
authors: A
authors: A
authors: Zangen
authors: M
authors: M
authors: Inghilleri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D003929:Diabetic Neuropathies / Q000503:physiopathology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D059408:Pain Management; D010147:Pain Measurement; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome