Department of Applied Physics, Faculty of Forestry and Natural Sciences, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland.
Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
Neurophysiol Clin. 2022 Apr;52(2):95-108. doi: 10.1016/j.neucli.2022.03.001. Epub 2022 Mar 24.
We conducted an open-label cross-over study assessing the global effect of two high-frequency protocols of electric-field navigated repetitive transcranial magnetic stimulation (rTMS) targeted to functional facial motor cortex and comparing their efficacy and tolerability in patients with chronic facial pain. Outcome predictors were also assessed.
We randomized twenty consecutive patients with chronic facial pain (post-traumatic trigeminal neuropathic pain, n=14; persistent idiopathic facial pain, n=4; secondary trigeminal neuralgia, n=2) to receive two distinct 5-day rTMS interventions (10Hz, 2400 pulses and 20Hz, 3600 pulses) separated by six weeks. The target area was assessed by mapping of lower face representation. The primary endpoint was the change in weekly mean of pain intensity (numeric rating scale, NRS) between the baseline and therapy week (1 week), and follow-up weeks (2 and 3 weeks) for each rTMS intervention. Response was defined using a combination scale including the patient's global impression of change and continuance with maintenance treatment.
Overall, pain intensity NRS decreased from 7.4 at baseline to 5.9 ten weeks later, after the second rTMS intervention (p=0.009). The repetition of the treatment had a significant effect (F=4.983, p=0.043) indicating that the NRS scores are lower during the second four weeks period. Eight (40%) patients were responders, 4 (20%) exhibited a modest effect, 4 (20%) displayed no effect, and 4 (20%) experienced worsening of pain. High disability and high pain intensity (>7) predicted a better outcome (p=0.043 and p=0.045). Female gender, shorter duration of pain and low Beck Anxiety Inventory scores showed a trend towards a better outcome (p=0.052, 0.060 and 0.055, respectively).
High-frequency rTMS targeted to face M1 alleviates treatment resistant chronic facial pain. Repeated treatment improves the analgesic effect. A protocol with higher frequency (above 10Hz), longer session duration (more than 20 minutes) and higher number of pulses (above 2400 pulses/session) did not improve the outcome. The results support early consideration of rTMS.
我们进行了一项开放性、交叉研究，评估了两种高频电场导航重复经颅磁刺激（rTMS）方案对面部运动皮质的整体影响，并比较了它们在慢性面痛患者中的疗效和耐受性。还评估了预后预测因素。
我们随机选择了 20 名连续的慢性面痛患者（创伤性三叉神经病理性疼痛 14 例；持续性特发性面痛 4 例；继发性三叉神经痛 2 例），分别接受两种不同的 5 天 rTMS 干预（10Hz，2400 脉冲；20Hz，3600 脉冲），间隔 6 周。通过对面下部代表区的映射来评估目标区域。主要终点是两种 rTMS 干预（基线和治疗周 1 周）之间以及治疗后每周（2 周和 3 周）每周平均疼痛强度（数字评分量表，NRS）的变化。使用包括患者对变化的总体印象和维持治疗的持续时间的综合量表来定义反应。
总体而言，疼痛强度 NRS 从基线时的 7.4 下降到 10 周后的 5.9，在第二次 rTMS 干预后（p=0.009）。治疗的重复有显著的效果（F=4.983，p=0.043），表明在第二个四周期间 NRS 评分较低。8 名（40%）患者为反应者，4 名（20%）表现出适度效果，4 名（20%）无效果，4 名（20%）疼痛恶化。高残疾和高疼痛强度（>7）预测了更好的结果（p=0.043 和 p=0.045）。女性、疼痛持续时间较短和贝克焦虑量表评分较低显示出更好结果的趋势（p=0.052、0.060 和 0.055）。
针对面部 M1 的高频 rTMS 缓解了治疗抵抗性慢性面痛。重复治疗可改善镇痛效果。更高的频率（10Hz 以上）、更长的疗程（20 分钟以上）和更高的脉冲数（2400 脉冲/疗程以上）并没有改善结果。结果支持早期考虑 rTMS。
