Kang Dong-Ha, Kim Gi-Wook
Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea.
Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea.
Brain Sci. 2020 Dec 2;10(12):929. doi: 10.3390/brainsci10120929.
Post-trauma chronic pain characterized by central pain is a symptom following traumatic brain injury (TBI). Studies on the effect of repetitive transcranial magnetic stimulation (rTMS) on central pain and the association between central pain and spinothalamic tract (STT) have been reported, but few studies have examined the effect of rTMS in patients with mild TBI with central pain through changes in diffusion tensor imaging (DTI)-based metrics of STT before and after rTMS. This case series aimed to investigate the therapeutic effect of rTMS in TBI with central pain and the changes in diffusion tensor imaging (DTI)-based metrics of the spinothalamic tract (STT) before and after rTMS. This study included four patients who complained of severe pain in the left or right side of the body below the neck area after a car accident. We performed numeric rating scale (NRS), bedside sensory examination, electrodiagnostic study, and DTI-based metrics of the STT before and after rTMS. According to the guidelines of the diagnosis and grading for neuropathic pain, all patients had neuropathic pain corresponding to "probable grade." In all patients, rTMS was applied to the contralateral M1 cortex on the more painful side. There were no medication changes and other interventions during the rTMS. After rTMS, NRS decreased, bed sensory testing improved, and DTI-based STT metrics increased in all patients compared to before rTMS.
以中枢性疼痛为特征的创伤后慢性疼痛是创伤性脑损伤（TBI）后的一种症状。关于重复经颅磁刺激（rTMS）对中枢性疼痛的影响以及中枢性疼痛与脊髓丘脑束（STT）之间关联的研究已有报道，但很少有研究通过rTMS前后基于扩散张量成像（DTI）的STT指标变化来考察rTMS对伴有中枢性疼痛的轻度TBI患者的影响。本病例系列旨在研究rTMS对伴有中枢性疼痛的TBI患者的治疗效果以及rTMS前后基于扩散张量成像（DTI）的脊髓丘脑束（STT）指标变化。本研究纳入了4例在车祸后抱怨颈部以下身体左侧或右侧严重疼痛的患者。我们在rTMS前后进行了数字评定量表（NRS）、床边感觉检查、电诊断研究以及基于DTI的STT指标检测。根据神经性疼痛的诊断和分级指南，所有患者均患有对应“可能分级”的神经性疼痛。在所有患者中，rTMS均应用于疼痛更严重一侧的对侧M1皮质。在rTMS期间未改变用药及进行其他干预。与rTMS前相比，rTMS后所有患者的NRS降低、床边感觉测试改善且基于DTI的STT指标升高。
