TY - JOUR
T1 - Insular and anterior cingulate cortex deep stimulation for central neuropathic pain
T2 - Disassembling the percept of pain
AU - Galhardoni, Ricardo
AU - Aparecida da Silva, Valquíria
AU - García-Larrea, Luís
AU - Dale, Camila
AU - Baptista, Abrahão F
AU - Barbosa, Luciana Mendonça
AU - Menezes, Luciana Mendes Bahia
AU - de Siqueira, Silvia R D T
AU - Valério, Fernanda
AU - Rosi, Jefferson
AU - de Lima Rodrigues, Antonia Lilian
AU - Reis Mendes Fernandes, Diego Toledo
AU - Lorencini Selingardi, Priscila Mara
AU - Marcolin, Marco Antônio
AU - Duran, Fábio Luís de Souza
AU - Ono, Carla Rachel
AU - Lucato, Leandro Tavares
AU - Fernandes, Ana Mércia B L
AU - da Silva, Fábio E F
AU - Yeng, Lin T
AU - Brunoni, André R
AU - Buchpiguel, Carlos A
AU - Teixeira, Manoel J
AU - Ciampi de Andrade, Daniel
N1 - © 2019 American Academy of Neurology.
PY - 2019/4/30
Y1 - 2019/4/30
N2 - OBJECTIVE: To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study.METHODS: Participants were randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session.RESULTS: Ninety-eight patients (age 55.02 ± 12.13 years) completed the study. NRS score was not significantly different between groups at the end of the study. Active rTMS treatments had no significant effects on pain interference with daily activities, pain dimensions, neuropathic pain symptoms, mood, medication use, cortical excitability measurements, or quality of life. Heat pain threshold was significantly increased after treatment in the PSI-dTMS group from baseline (1.58, 95% confidence interval [CI] 0.09-3.06]) compared to sham-dTMS (-1.02, 95% CI -2.10 to 0.04, p = 0.014), and ACC-dTMS caused a significant decrease in anxiety scores (-2.96, 95% CI -4.1 to -1.7]) compared to sham-dTMS (-0.78, 95% CI -1.9 to 0.3; p = 0.018).CONCLUSIONS: ACC- and PSI-dTMS were not different from sham-dTMS for pain relief in CNP despite a significant antinociceptive effect after insular stimulation and anxiolytic effects of ACC-dTMS. These results showed that the different dimensions of pain can be modulated in humans noninvasively by directly stimulating deeper SNC cortical structures without necessarily affecting clinical pain per se.CLINICALTRIALSGOV IDENTIFIER: NCT01932905.
AB - OBJECTIVE: To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study.METHODS: Participants were randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session.RESULTS: Ninety-eight patients (age 55.02 ± 12.13 years) completed the study. NRS score was not significantly different between groups at the end of the study. Active rTMS treatments had no significant effects on pain interference with daily activities, pain dimensions, neuropathic pain symptoms, mood, medication use, cortical excitability measurements, or quality of life. Heat pain threshold was significantly increased after treatment in the PSI-dTMS group from baseline (1.58, 95% confidence interval [CI] 0.09-3.06]) compared to sham-dTMS (-1.02, 95% CI -2.10 to 0.04, p = 0.014), and ACC-dTMS caused a significant decrease in anxiety scores (-2.96, 95% CI -4.1 to -1.7]) compared to sham-dTMS (-0.78, 95% CI -1.9 to 0.3; p = 0.018).CONCLUSIONS: ACC- and PSI-dTMS were not different from sham-dTMS for pain relief in CNP despite a significant antinociceptive effect after insular stimulation and anxiolytic effects of ACC-dTMS. These results showed that the different dimensions of pain can be modulated in humans noninvasively by directly stimulating deeper SNC cortical structures without necessarily affecting clinical pain per se.CLINICALTRIALSGOV IDENTIFIER: NCT01932905.
KW - Adult
KW - Aged
KW - Cerebral Cortex/physiopathology
KW - Deep Brain Stimulation/methods
KW - Double-Blind Method
KW - Female
KW - Gyrus Cinguli/physiopathology
KW - Humans
KW - Male
KW - Middle Aged
KW - Neuralgia/physiopathology
KW - Pain Management/methods
KW - Pain Measurement
KW - Transcranial Magnetic Stimulation/methods
KW - Treatment Outcome
U2 - 10.1212/WNL.0000000000007396
DO - 10.1212/WNL.0000000000007396
M3 - Journal article
C2 - 30952795
SN - 0028-3878
VL - 92
SP - e2165-e2175
JO - Neurology
JF - Neurology
IS - 18
ER -