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Continuous Repetitive Transcranial Magnetic Stimulation for intractable Neuropathic Pain

Dec 7, 2012. Continuous Repetitive Transcranial Magnetic Stimulation for intractable Neuropathic Pain. Youichi Saitoh , M.D., Ph.D. Department of Neuromodulation and Neurosurgery Office for Univeristy -Industry Collaboration, Osaka University.

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Continuous Repetitive Transcranial Magnetic Stimulation for intractable Neuropathic Pain

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  1. Dec 7, 2012 Continuous Repetitive Transcranial Magnetic Stimulation for intractable Neuropathic Pain YouichiSaitoh, M.D., Ph.D. Department of Neuromodulation and Neurosurgery Office for Univeristy-Industry Collaboration, Osaka University

  2. Electrical motor cortex stimulation; EMCS EMCS expand to the world from Japan Rasche et al., Pain, 2006 Saitoh et al. J Neurosurg 2000 Department of Neurosurgery, Osaka University Graduate School of Medicine

  3. Efficacy of EMCS on intractable neuropathic pain Approximately half of the patients satisfy No large double-blinded clinical trials Saitoh and Yoshimine, ActaNeurochirSuppl, 2007 Saitoh Y et al, ActaNeurochir, 2007

  4. Repetitive transcranial magnetic stimulation(rTMS) Eddy current curent Figure-8-coil is most popular

  5. Cochrane reviewO’Connell NE et al, 2010Non-invasive brain stimulation techniques for chronic pain • Single doses of high-frequency rTMS of motor cortex may have short-term effects on chronic pain. • Efficacies of cranial electrotherapy stimulation and transcranial direct current stimulation are uncertain. VS

  6. Multi-centered, Randomized, double-blind, sham-controlled, crossover study2009 〜2011 This study was funded by the Japanese Ministry of Health, Labourand Welfare with a Health and Labour Sciences Research Grant.

  7. Randomized, double-blind, sham-controlled, crossover study • Real (5Hz)and sham stimulations are randomized. • Double-blind Randomized Crossover Study • Specialist of biological statistics randomized the patients to two groups. • Validation of efficacy and safety of daily rTMS for 2 weeks. • Previous studies were mostly single session • Primary endpoint is VAS, secondary is SF-MPQ • Realistic shamis applied. • Synchronized cutaneous electrical stimulation is delivered. • Hamada M et al, MovDisord, 23:1524-31, 2008 • 70 patients

  8. Randomized, double-blind, sham-controlled, crossover study • Seven centers • Rehabilitation, Hokaido Univ. • Neurology, Fukushima • Neurosurgery, Nihon Univ. • Neurosurgery, Hamamatsu Univ. • Neurosurgery, Osaka Univ. • Neurology, Kinki Univ. • Neurology, Univ. of Occulational

  9. Protocol of sham-controlled crossover study

  10. Trial profile Sham first Real first

  11. Results of short-term effect of VASPrimary endpoint

  12. Results of short-term effect ofSF-MPQ Secondary endpoint

  13. Patient global impression of change (PGIC) Intervention

  14. Beck depression inventory (BDI) Intervention

  15. Forest Plot of subgroup analyses

  16. Adverse effects

  17. Discussion • This prospective study shows daily high-frequency rTMS is transiently effective for pain relief in intractable neuropathic pain patients (70 cases). • There has been no serious adverse effects. • The real rTMS, compared with the sham, showed significant short-term improvements in VAS and SF-MPQ scores without a carry-over effect. The result of PGIC suggested cumulative effect. • More than once a day or continuous rTMS treatment may improve the effect. • In this study, 81% of enrolled patients were post-stroke pain and 60.7 y.o. (mean) which is older than previous studies. Therefore, the effect was mild but significant.

  18. Cerebral mechanism of pain relief(EMCS, rTMS) rTMS M1 ACC S2 Modulate pain recognition PFC Ins Th Pain relief PAG Modulate a pain threshold Elicit plastic changes

  19. Thank you for attention!!

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