title: Analgesic effects of navigated motor cortex rTMS in patients with chronic neuropathic pain.
abstract: Repetitive transcranial magnetic stimulation (rTMS) can relieve neuropathic pain when applied at high frequency (HF: 5-20 Hz) 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.
  
  
  
  To compare the analgesic efficacy of HF-rTMS targeting the hMHS (non-navigated procedure) or the M1 representation of the pain region (navigated procedure).
  
  
  
  The analgesic effect of a single session of 10 Hz-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.
  
  
  
  Pain 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 1 week only after navigated rTMS, compared to sham.
  
  
  
  Navigation 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.
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France. samarayache@gmail.com.|Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France. samarayache@gmail.com.|Division of neurology, UMCRH, Beirut, Lebanon. samarayache@gmail.com.
authors.forename: S S
authors.initials: SS
authors.lastname: Ayache
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France.|Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.|Division of neurology, UMCRH, Beirut, Lebanon.
authors.forename: R
authors.initials: R
authors.lastname: Ahdab
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France.|Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.
authors.forename: M A
authors.initials: MA
authors.lastname: Chalah
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France.|Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.
authors.forename: W H
authors.initials: WH
authors.lastname: Farhat
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France.|Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.|Department of Neurology, Philipps University Marburg, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Mylius
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France.|Service de Neurochirurgie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Goujon
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France.|Centre d'Evaluation et de Traitement de la Douleur, Centre Hospitalier de Nemours, France.
authors.forename: M
authors.initials: M
authors.lastname: Sorel
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, France.|Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Lefaucheur
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009437:Neuralgia / Q000503:physiopathology / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult