TY - JOUR
T1 - Non-invasive insular stimulation for peripheral neuropathic pain
T2 - influence of target or symptom?
AU - da Cunha, Pedro Henrique Martins
AU - Dongyang, Liu
AU - Fernandes, Ana Mércia
AU - Tibes, Raissa
AU - Sato, João
AU - Tanaka, Harki
AU - Dale, Camila
AU - Lapa, Jorge Dornellys da Silva
AU - Morais, Adriano Donizeth Silva de
AU - Soares, Felipe Henriques Carvalho
AU - Da Silva, Valquiria Aparecida
AU - Graven-Nielsen, Thomas
AU - Teixeira, Manoel Jacobsen
AU - de Andrade, Daniel Ciampi
PY - 2022/4
Y1 - 2022/4
N2 - Objectives: The posterior-superior insula (PSI) has been shown to be a safe and potentially effective target for neuromodulation in peripheral neuropathic pain (PNP) in humans and animal models. However, it remains unknown whether there is a measurable responder profile to PSI stimulation. Two factors were hypothesized to influence the response of repetitive transcranial magnetic stimulation (rTMS) of the PSI: differences in rTMS target (discrete subregions of the PSI) or PNP phenotype. Methods: This is a secondary analysis from a randomized, double-blind, sham-controlled, cross-over trial assessing PSI-rTMS in PNP (N = 31, 5 days rTMS) (10.1016/j.neucli.2021.06.003). Active PSI-rTMS true responders (>50% pain reduction from baseline after active but not after sham series of treatment) were compared with not true responders, to determine whether they differed with respect to 1) rTMS neuro-navigational target coordinates, and/or 2) specific neuropathic pain symptom inventory (NPSI) clusters (pinpointed pain, evoked pain, and deep pain) at baseline. Results: Mean rTMS target coordinates did not differ between true (n = 45.1%) and not true responders (p = 0.436 for X, p = 0.120 for Y, and p = 0.116 for Z). The Euclidian distance between true and not true responders was 4.04 mm. When comparing differences in responders between NPSI clusters, no participant within the evoked pain cluster was a true responder (p = 0.024). Conclusion: Response to PSI-rTMS may depend on pain cluster subtype rather than on differences in targeting within the PSI.
AB - Objectives: The posterior-superior insula (PSI) has been shown to be a safe and potentially effective target for neuromodulation in peripheral neuropathic pain (PNP) in humans and animal models. However, it remains unknown whether there is a measurable responder profile to PSI stimulation. Two factors were hypothesized to influence the response of repetitive transcranial magnetic stimulation (rTMS) of the PSI: differences in rTMS target (discrete subregions of the PSI) or PNP phenotype. Methods: This is a secondary analysis from a randomized, double-blind, sham-controlled, cross-over trial assessing PSI-rTMS in PNP (N = 31, 5 days rTMS) (10.1016/j.neucli.2021.06.003). Active PSI-rTMS true responders (>50% pain reduction from baseline after active but not after sham series of treatment) were compared with not true responders, to determine whether they differed with respect to 1) rTMS neuro-navigational target coordinates, and/or 2) specific neuropathic pain symptom inventory (NPSI) clusters (pinpointed pain, evoked pain, and deep pain) at baseline. Results: Mean rTMS target coordinates did not differ between true (n = 45.1%) and not true responders (p = 0.436 for X, p = 0.120 for Y, and p = 0.116 for Z). The Euclidian distance between true and not true responders was 4.04 mm. When comparing differences in responders between NPSI clusters, no participant within the evoked pain cluster was a true responder (p = 0.024). Conclusion: Response to PSI-rTMS may depend on pain cluster subtype rather than on differences in targeting within the PSI.
KW - Transcranial Magnetic Stimulation
KW - insula
KW - neuronavigation
KW - neuropathic pain
KW - neuropathy
KW - peripheral
KW - symptom profile
KW - Transcranial magnetic stimulation
KW - Neuronavigation
KW - Insula
KW - Peripheral neuropathy
KW - Neuropathic pain
KW - Symptom profile
UR - http://www.scopus.com/inward/record.url?scp=85126328585&partnerID=8YFLogxK
U2 - 10.1016/j.neucli.2022.02.001
DO - 10.1016/j.neucli.2022.02.001
M3 - Journal article
SN - 0987-7053
VL - 52
SP - 109
EP - 116
JO - Neurophysiologie Clinique
JF - Neurophysiologie Clinique
IS - 2
ER -