Reduction of intractable deafferentation pain due to spinal cord or peripheral lesion by high-frequency repetitive transcranial magnetic stimulation of the primary motor cortex

Youichi SaitohDepartment of Neurosurgery, Osaka University Graduate School of Medicine; and

Search for other papers by Youichi Saitoh in
Current site
Google Scholar
PubMed
Close
 M.D., Ph.D.
,
Azuma HirayamaDepartment of Neurosurgery, Osaka University Graduate School of Medicine; and

Search for other papers by Azuma Hirayama in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Haruhiko KishimaDepartment of Neurosurgery, Osaka University Graduate School of Medicine; and

Search for other papers by Haruhiko Kishima in
Current site
Google Scholar
PubMed
Close
 M.D., Ph.D.
,
Toshio ShimokawaGraduate School of Medicine and Engineering, University of Yamanashi, and Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan

Search for other papers by Toshio Shimokawa in
Current site
Google Scholar
PubMed
Close
 Ph.D.
,
Satoru OshinoDepartment of Neurosurgery, Osaka University Graduate School of Medicine; and

Search for other papers by Satoru Oshino in
Current site
Google Scholar
PubMed
Close
 M.D., Ph.D.
,
Masayuki HirataDepartment of Neurosurgery, Osaka University Graduate School of Medicine; and

Search for other papers by Masayuki Hirata in
Current site
Google Scholar
PubMed
Close
 M.D., Ph.D.
,
Naoki TaniDepartment of Neurosurgery, Osaka University Graduate School of Medicine; and

Search for other papers by Naoki Tani in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Amami KatoDepartment of Neurosurgery, Osaka University Graduate School of Medicine; and

Search for other papers by Amami Kato in
Current site
Google Scholar
PubMed
Close
 M.D., Ph.D.
, and
Toshiki YoshimineDepartment of Neurosurgery, Osaka University Graduate School of Medicine; and

Search for other papers by Toshiki Yoshimine in
Current site
Google Scholar
PubMed
Close
 M.D., Ph.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

Object

The authors previously reported that navigation-guided repetitive transcranial magnetic stimulation (rTMS) of the precentral gyrus relieves deafferentation pain. Stimulation parameters were 10 trains of 10-second 5-Hz TMS pulses at 50-second intervals. In the present study, they used various stimulation frequencies and compared efficacies between two types of lesions.

Methods

Patients were divided into two groups: those with a cerebral lesion and those with a noncerebral lesion. The rTMS was applied to all the patients at frequencies of 1, 5, and 10 Hz and as a sham procedure in random order. The effect of rTMS on pain was rated by patients using a visual analog scale.

Results

The rTMS at frequencies of 5 and 10 Hz, compared with sham stimulation, significantly reduced pain, and the pain reduction continued for 180 minutes. A stimulation frequency of 10 Hz may be more effective than 5 Hz, and at 1 Hz was ineffective. The effect of rTMS at frequencies of 5 and 10 Hz was greater in patients with a noncerebral lesion than those with a cerebral lesion.

Conclusions

High-frequency (5- or 10-Hz) rTMS of the precentral gyrus can reduce intractable deafferentation pain, but low-frequency stimulation (at 1 Hz) cannot. Patients with a noncerebral lesion are more suitable candidates for high-frequency rTMS of the precentral gyrus.

Abbreviations used in this paper:

ANOVA = analysis of variance; MCS = motor cortex stimulation; rTMS = repetitive transcranial magnetic stimulation; SF-MPQ = short-form McGill Pain Questionnaire; VAS = visual analog scale.
  • Collapse
  • Expand
  • 1

    Garcia-Larrea L, , Peyron R, , Mertens P, , Gregoire MC, , Lavenne F, & Le Bars D, et al.: Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 83:259273, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Hirayama A, , Saitoh Y, , Kishima H, , Shimokawa T, , Oshino S, & Hirata M, et al.: Reduction of intractable deafferentation pain by navigation-guided repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex. Pain 122:2227, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Kanda M, , Mima T, , Oga T, , Matsuhashi M, , Toma K, & Hara H, et al.: Transcranial magnetic stimulation (TMS) of the sensorimotor cortex and medial frontal cortex modifies human pain perception. Clin Neurophysiol 114:860866, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Katayama Y, , Fukaya C, & Yamamoto T: Poststroke pain control by chronic motor cortex stimulation. Neurological characteristics predicting a favorable response. J Neurosurg 89:585591, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Kimbrell TA, , Dunn RT, , George MS, , Danielson AL, , Willis MW, & Repella JD, et al.: Left frontal-repetitive transcranial magnetic stimulation (rTMS) and regional cerebral glucose metabolism in normal volunteers. Psychiatry Res 115:101113, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Kimbrell TA, , Little JT, , Dunn RT, , Frye MA, , Greenberg BD, & Wassermann EM, et al.: Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry 46:16031613, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Lefaucheur JP, , Drouot X, , Keravel Y, & Nguyen JP: Pain relief induced by repetitive transcranial magnetic stimulation of precentral cortex. Neuroreport 12:29632965, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Lefaucheur JP, , Drouot X, , Menard-Lefaucheur I, , Zerah F, , Bendib B, & Cesaro P, et al.: Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain. J Neurol Neurosurg Psychiatry 75:612616, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Meyerson BA, , Lindblom U, , Linderoth B, , Lind G, & Herregodts P: Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir Suppl (Wien) 58:150153, 1993

    • Search Google Scholar
    • Export Citation
  • 10

    Migita K, , Uozumi T, , Arita K, & Monden S: Transcranial magnetic coil stimulation of motor cortex in patients with central pain. Neurosurgery 36:10391040, 1995

    • Search Google Scholar
    • Export Citation
  • 11

    Nguyen JP, , Keravel Y, , Feve A, , Uchiyama T, , Cesaro P, & Le Guerinel C, et al.: Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases. Acta Neurochir Suppl 68:5460, 1997

    • Search Google Scholar
    • Export Citation
  • 12

    Peyron R, , Garcia-Larrea L, , Deiber MP, , Cinotti L, , Convers P, & Sindou M, et al.: Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain 62:275286, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Pleger B, , Janssen F, , Schwenkreis P, , Volker B, , Maier C, & Tegent-hoff M: Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I. Neurosci Lett 356:8790, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Rainov NG, & Heidecke V: Motor cortex stimulation for neuropathic facial pain. Neurol Res 25:157161, 2003

  • 15

    Saitoh Y, , Hirayama A, , Kishima H, , Oshino S, , Hirata M, & Kato A, et al.: Stimulation of primary motor cortex for intractable deafferentation pain. Acta Neurochir Suppl 99:5759, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Saitoh Y, , Kato A, , Ninomiya H, , Baba T, , Shibata M, & Mashimo T, et al.: Primary motor cortex stimulation within the central sulcus for treating deafferentation pain. Acta Neurochir Suppl 87:149152, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Saitoh Y, , Osaki Y, , Nishimura H, , Hirano S, , Kato A, & Hashikawa K, et al.: Increased regional cerebral blood flow in the contralateral thalamus after successful motor cortex stimulation in a patient with poststroke pain. J Neurosurg 100:935939, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Saitoh Y, , Shibata M, , Hirano S, , Hirata M, , Mashimo T, & Yoshimine T: Motor cortex stimulation for central and peripheral deafferentation pain. J Neurosurg 92:150155, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Sekino M, & Ueno S: FEM-based determination of optimum current distribution in transcranial magnetic stimulation as an alternative to electroconvulsive therapy. IEEE Trans Magn 40:21672169, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Speer AM, , Kimbrell TA, , Wassermann EM, , Repella JD, , Willis MW, & Herscovitch P, et al.: Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biol Psychiatry 48:11331141, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Tamura Y, , Okabe S, , Ohnishi T, , Saito DN, , Arai N, & Mochio S, et al.: Effects of 1-hz repetitive transcranial magnetic stimulation on acute pain induced by capsaicin. Pain 107:107115, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Topper R, , Foltys H, , Meister IG, , Sparing R, & Boroojerdi B: Repetitive transcranial magnetic stimulation of the parietal cortex transiently ameliorates phantom limb pain-like syndrome. Clin Neurophysiol 114:15211530, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Wassermann EM: Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996. Electroencephalogr Clin Neurophysiol 108:116, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1316 460 23
Full Text Views 252 13 1
PDF Downloads 174 23 0
EPUB Downloads 0 0 0