Enrico De Martino, Bruno Andry Nascimento Couto, Anne Jakobsen, Adenauer Girardi Casali, Poul Dane Bonde-Heriksen, Thomas Graven-Nielsen, Daniel Ciampi de Andrade
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引用次数: 0
Abstract
Objective: Around half of chronic pain patients report pain intensity reduction to high-frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) delivered to the primary motor cortex (M1). However, the other half do not respond, making it essential to identify which patients are likely to benefit before starting treatment. Combining TMS with electroencephalogram (TMS-EEG) allows for exploring cortical connectivity, and evaluating this connectivity before administering rTMS may provide insights into which patients are likely to respond favorably to the treatment.
Methods: Seven chronic pain patients underwent TMS-EEG assessment of M1 before ten daily sessions of 10 Hz rTMS. Pain intensity was measured at baseline and post-treatment, with responders defined as those showing a 30 % reduction on an 11-point numerical rating scale. TMS-evoked potentials were analyzed using the debiased weighted phase lag index to assess connectivity, quantified by phase (connections exceeding the 95 % confidence interval) and space (Euclidean distance between significantly connected EEG channels). Normative connectivity values were also collected from 82 healthy volunteers.
Results: Four patients responded to M1 rTMS, while three did not, with an average pain intensity reduction of 1.4±1.5. TMS-EEG showed low connectivity indices in all responders to rTMS, whereas two non-responders had higher indices, above the 75th percentile of healthy volunteers.
Conclusions: This pilot feasibility study showed that the use of TMS-EEG informed rTMS is feasible, and proceeding to larger randomized clinical trials will allow to test this approach.
期刊介绍：
As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology.
Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.
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