Lawson McLean Aaron, Frank Susanne, Zafar Noman, Waschke Albrecht, Kalff Rolf, Reichart Rupert
a Division of Functional and Restorative Neurosurgery, Department of Neurosurgery , Jena University Hospital - Friedrich Schiller University Jena , Jena , Germany.
b Department of Neurosurgery , Krankenhaus Dresden-Friedrichstadt , Dresden , Germany.
Neurol Res. 2018 Jul;40(7):564-572. doi: 10.1080/01616412.2018.1453636. Epub 2018 Mar 27.
Objective This prospective study evaluated the time to response and outcomes of navigated repetitive transcranial magnetic stimulation (TMS) at a frequency of 10 Hz in patients with chronic neuropathic pain. Methods This prospective study included patients with unilateral chronic neuropathic pain. All patients received motor cortex stimulation at 10 Hz over nine consecutive days using repetitive TMS. Outcome was evaluated over a six-week follow-up period using the visual analogue scale, the German Pain Questionnaire and time to pain reduction. Results Fifty patients (23 female, 27 male) were recruited. Two patients were excluded from analysis owing to premature discontinuation of treatment and follow-up. 31/48 patients in the cohort suffered from atypical facial pain. The pain duration ranged approximately from six months to 27 years. After six weeks, 28/46 patients reported a significant level of pain relief (P < 0.001). Conclusion Navigated repetitive TMS for chronic pain is a non-invasive modality with demonstrable clinical benefit. In particular, patients with atypical facial pain with a clear clinicoanatomical correlate responded well to high-frequency stimulation. Patients with a mean pain history of less than five years benefited significantly from this treatment, so early treatment with repetitive TMS should be encouraged.
目的 本前瞻性研究评估了慢性神经性疼痛患者接受频率为10赫兹的导航重复经颅磁刺激（TMS）后的反应时间和疗效。方法 本前瞻性研究纳入单侧慢性神经性疼痛患者。所有患者连续九天接受频率为10赫兹的运动皮层重复TMS刺激。在为期六周的随访期内，使用视觉模拟量表、德国疼痛问卷和疼痛减轻时间来评估疗效。结果 招募了50名患者（23名女性，27名男性）。两名患者因过早停止治疗和随访而被排除在分析之外。队列中的48名患者中有31名患有非典型面部疼痛。疼痛持续时间约为六个月至27年。六周后，46名患者中有28名报告疼痛明显减轻（P < 0.001）。结论 导航重复TMS治疗慢性疼痛是一种具有明显临床益处的非侵入性方法。特别是，具有明确临床解剖学关联的非典型面部疼痛患者对高频刺激反应良好。平均疼痛病史少于五年的患者从该治疗中获益显著，因此应鼓励对慢性疼痛患者尽早使用重复TMS进行治疗。
