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Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain.
Neurology. 2006 Nov 14; 67(9):1568-74.Neur

Abstract

OBJECTIVE

To assess cortical excitability changes in patients with chronic neuropathic pain at baseline and after repetitive transcranial magnetic stimulation (rTMS) of the motor cortex.

METHODS

In 22 patients with unilateral hand pain of various neurologic origins and 22 age-matched healthy controls, we studied the following parameters of cortical excitability: motor threshold at rest, motor evoked potential amplitude ratio at two intensities, cortical silent period (CSP), and intracortical inhibition (ICI) and intracortical facilitation. We compared these parameters between healthy subjects and patients at baseline. We also studied excitability changes in the motor cortex corresponding to the painful hand of patients after active or sham rTMS of this cortical region at 1 or 10 Hz.

RESULTS

At baseline, CSP was shortened for the both hemispheres of patients vs healthy subjects, in correlation with pain score, while ICI was reduced only for the motor cortex corresponding to the painful hand. Regarding rTMS effects, the single significant change was ICI increase in the motor cortex corresponding to the painful hand, after active 10-Hz rTMS, in correlation with pain relief.

CONCLUSION

Chronic neuropathic pain was associated with motor cortex disinhibition, suggesting impaired GABAergic neurotransmission related to some aspects of pain or to underlying sensory or motor disturbances. The analgesic effects produced by motor cortex stimulation could result, at least partly, from the restoration of defective intracortical inhibitory processes.

Authors+Show Affiliations

Department of Physiology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, INSERM U 421, IM3-Faculté de Médecine de Créteil, Créteil, France. jean-pascal.lefaucheur@hmn.ap-hop-paris.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17101886

Citation

Lefaucheur, J P., et al. "Motor Cortex rTMS Restores Defective Intracortical Inhibition in Chronic Neuropathic Pain." Neurology, vol. 67, no. 9, 2006, pp. 1568-74.
Lefaucheur JP, Drouot X, Ménard-Lefaucheur I, et al. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology. 2006;67(9):1568-74.
Lefaucheur, J. P., Drouot, X., Ménard-Lefaucheur, I., Keravel, Y., & Nguyen, J. P. (2006). Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology, 67(9), 1568-74.
Lefaucheur JP, et al. Motor Cortex rTMS Restores Defective Intracortical Inhibition in Chronic Neuropathic Pain. Neurology. 2006 Nov 14;67(9):1568-74. PubMed PMID: 17101886.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. AU - Lefaucheur,J P, AU - Drouot,X, AU - Ménard-Lefaucheur,I, AU - Keravel,Y, AU - Nguyen,J P, PY - 2006/11/15/pubmed PY - 2006/12/27/medline PY - 2006/11/15/entrez SP - 1568 EP - 74 JF - Neurology JO - Neurology VL - 67 IS - 9 N2 - OBJECTIVE: To assess cortical excitability changes in patients with chronic neuropathic pain at baseline and after repetitive transcranial magnetic stimulation (rTMS) of the motor cortex. METHODS: In 22 patients with unilateral hand pain of various neurologic origins and 22 age-matched healthy controls, we studied the following parameters of cortical excitability: motor threshold at rest, motor evoked potential amplitude ratio at two intensities, cortical silent period (CSP), and intracortical inhibition (ICI) and intracortical facilitation. We compared these parameters between healthy subjects and patients at baseline. We also studied excitability changes in the motor cortex corresponding to the painful hand of patients after active or sham rTMS of this cortical region at 1 or 10 Hz. RESULTS: At baseline, CSP was shortened for the both hemispheres of patients vs healthy subjects, in correlation with pain score, while ICI was reduced only for the motor cortex corresponding to the painful hand. Regarding rTMS effects, the single significant change was ICI increase in the motor cortex corresponding to the painful hand, after active 10-Hz rTMS, in correlation with pain relief. CONCLUSION: Chronic neuropathic pain was associated with motor cortex disinhibition, suggesting impaired GABAergic neurotransmission related to some aspects of pain or to underlying sensory or motor disturbances. The analgesic effects produced by motor cortex stimulation could result, at least partly, from the restoration of defective intracortical inhibitory processes. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/17101886/Motor_cortex_rTMS_restores_defective_intracortical_inhibition_in_chronic_neuropathic_pain_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=17101886 DB - PRIME DP - Unbound Medicine ER -