André-Obadia Nathalie, Peyron Roland, Mertens Patrick, Mauguière François, Laurent Bernard, Garcia-Larrea Luis
University Hospital Lyon Sud, Lyon, France.
Clin Neurophysiol. 2006 Jul;117(7):1536-44. doi: 10.1016/j.clinph.2006.03.025. Epub 2006 Jun 5.
To assess, using a double-blind procedure, the pain-relieving effects of rTMS against placebo, and their predictive value regarding the efficacy of implanted motor cortex stimulation (MCS).
Three randomised, double-blinded, 25 min sessions of focal rTMS (1 Hz, 20 Hz and sham) were performed in 12 patients, at 2 weeks intervals. Effects on pain were estimated from daily scores across 5 days before, and 6 days after each session. Analgesic effects were correlated with those of subsequent implanted motor cortex stimulation (MCS).
Immediately after the stimulating session, pain scores were similarly decreased by all rTMS modalities. Conversely, during the following week, 1 Hz stimulation provided significantly less analgesia than 20 Hz and placebo, and was pro-algesic in some patients. Placebo and 20 Hz rTMS were effective on different patients, and only 20 Hz rTMS predicted the efficacy of subsequent MCS, with no false positives.
While 1Hz rTMS should not be used with analgesic purposes, high-frequency rTMS may become useful to select candidates for MCS. Placebo effects are powerful and should be controlled for. Immediate results after a single rTMS session are misleading.
Defining rTMS parameters is a crucial step before proposing rTMS as predictive test of SCM efficacy in clinical practice.
采用双盲程序评估重复经颅磁刺激（rTMS）相对于安慰剂的止痛效果，以及它们对植入式运动皮层刺激（MCS）疗效的预测价值。
对12例患者进行了3次随机、双盲、持续25分钟的局灶性rTMS治疗（1赫兹、20赫兹和假刺激），间隔2周进行一次。根据每次治疗前5天和治疗后6天的每日评分评估对疼痛的影响。将镇痛效果与随后的植入式运动皮层刺激（MCS）的效果进行关联分析。
刺激治疗后即刻，所有rTMS模式均使疼痛评分同样降低。相反，在接下来的一周内，1赫兹刺激提供的镇痛效果明显低于20赫兹刺激和安慰剂，并且在一些患者中具有促痛作用。安慰剂和20赫兹rTMS对不同患者有效，只有20赫兹rTMS能够预测随后MCS的疗效，且无假阳性结果。
虽然1赫兹rTMS不应用于止痛目的，但高频rTMS可能有助于筛选MCS的候选患者。安慰剂效应很强，应加以控制。单次rTMS治疗后的即时结果具有误导性。
在将rTMS作为临床实践中脊髓刺激器（SCM）疗效的预测性测试提出之前，确定rTMS参数是关键步骤。
