Säisänen, L., Huttunen, J., Hyppönen, J., Nissen, M., Kotiranta, U., Mervaala, E., & Fraunberg, M. von und zu. (2022). Efficacy and tolerability in patients with chronic facial pain of two consecutive treatment periods of rTMS applied over the facial motor cortex, using protocols differing in stimulation frequency, duration, and train pattern. Neurophysiologie Clinique, 52(2), 95–108. https://doi.org/10.1016/j.neucli.2022.03.001
Efficacy and tolerability in patients with chronic facial pain of two consecutive treatment periods of rTMS applied over the facial motor cortex, using protocols differing in stimulation frequency, duration, and train pattern
|Author:||Säisänen, Laura1,2,3; Huttunen, Jukka4; Hyppönen, Jelena3;|
1Department of Applied Physics, Faculty of Forestry and Natural Sciences, University of Eastern Finland, Kuopio, Finland
2Department of Clinical Neurophysiology, Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
3Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
4Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
5School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
6University of Oulu, Oulu, Finland
7Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
|Online Access:||PDF Full Text (PDF, 1.6 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2022101061468
|Publish Date:|| 2022-10-11
Objective: 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.
Methods: 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 (1st week), and follow-up weeks (2nd and 3rd 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.
Results: 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).
Conclusions: 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.
|Pages:||95 - 108|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
This work was funded by grants from following foundations: Alfred Kordelin, Maud Kuistilan muistosäätiö and Minerva säätiö. L.S. is supported by Academy of Finland (project 322423) and Business Finland grant no 2956/31/2018.
Supplementary material associated with this article can be found in the online version at doi:10.1016/j.neucli.2022.03.001.
© 2022 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).