title: Repetitive transcranial magnetic stimulation once a week induces sustainable long-term relief of central poststroke pain.
abstract: OBJECTIVE
  Central 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.
  
  
  METHODS
  Eighteen patients with central poststroke pain were included in this study. rTMS (10 trains of 10-sec 5 Hz-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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Although 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.
authors.affiliation: Department of Neurosurgery, Saitama Medical University, Saitama, Japan.|Department of Neurology, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Saitama, Japan.
authors.forename: Masahito
authors.identifier: http://orcid.org/0000-0003-2602-8629
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Neurosurgery, Saitama Medical University, Saitama, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Fujimaki
authors.affiliation: Department of Neurology, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Saitama, Japan.
authors.forename: Ban
authors.initials: B
authors.lastname: Mihara
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, Saitama, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ohira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D010146:Pain / Q000209:etiology* / Q000473:pathology; D059408:Pain Management; D020521:Stroke / Q000150:complications*; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D064232:Visual Analog Scale
keywords: Central poststroke pain; thalamic pain; transcranial magnetic stimulation