Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study
Although rare, central post-stroke pain remains one of the most refractory forms of neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) has been reported to be effective in chronic cases. However, there are no data on the effects in the acute and subacute phases after stroke. In th...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-11-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.742567/full |
| _version_ | 1818931778971238400 |
|---|---|
| author | Calogero Malfitano Angela Rossetti Stefano Scarano Stefano Scarano Chiara Malloggi Luigi Tesio Luigi Tesio |
| author_facet | Calogero Malfitano Angela Rossetti Stefano Scarano Stefano Scarano Chiara Malloggi Luigi Tesio Luigi Tesio |
| author_sort | Calogero Malfitano |
| collection | DOAJ |
| description | Although rare, central post-stroke pain remains one of the most refractory forms of neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) has been reported to be effective in chronic cases. However, there are no data on the effects in the acute and subacute phases after stroke. In this study, we present a case of a patient with thalamic stroke with acute onset of pain and paresthesia who was responsive to rTMS. After a right thalamic stroke, a 32-year-old woman presented with drug-resistant pain and paresthesia on the left side of the body. There were no motor or sensory deficits, except for blunted thermal sensation and allodynia on light touch. Ten daily sessions were performed, where 10 Hz rTMS was applied to the hand area of the right primary motor cortex, 40 days after stroke. Before rTMS treatment (T0), immediately after treatment conclusion (T1), and 1 month after treatment (T2), three pain questionnaires were administered, and cortical responses to single and paired-pulse TMS were assessed. Eight healthy participants served as controls. At T0, when the patient was experiencing the worst pain, the excitability of the ipsilesional motor cortex was reduced. At T1 and T2, the pain scores and paresthesia' spread decreased. The clinical improvement was paralleled by the recovery in motor cortex excitability of the affected hemisphere, in terms of both intra- and inter-hemispheric connections. In this subacute central post-stroke pain case, rTMS treatment was associated with decreased pain and motor cortex excitability changes. |
| first_indexed | 2024-12-20T04:22:00Z |
| format | Article |
| id | doaj.art-ac7f4668695044ab8ac9cb43c4b18cab |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-20T04:22:00Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-ac7f4668695044ab8ac9cb43c4b18cab2022-12-21T19:53:36ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-11-011210.3389/fneur.2021.742567742567Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case StudyCalogero Malfitano0Angela Rossetti1Stefano Scarano2Stefano Scarano3Chiara Malloggi4Luigi Tesio5Luigi Tesio6Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano, ItalyDepartment of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano, ItalyDepartment of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano, ItalyDepartment of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, ItalyDepartment of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano, ItalyDepartment of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano, ItalyDepartment of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, ItalyAlthough rare, central post-stroke pain remains one of the most refractory forms of neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) has been reported to be effective in chronic cases. However, there are no data on the effects in the acute and subacute phases after stroke. In this study, we present a case of a patient with thalamic stroke with acute onset of pain and paresthesia who was responsive to rTMS. After a right thalamic stroke, a 32-year-old woman presented with drug-resistant pain and paresthesia on the left side of the body. There were no motor or sensory deficits, except for blunted thermal sensation and allodynia on light touch. Ten daily sessions were performed, where 10 Hz rTMS was applied to the hand area of the right primary motor cortex, 40 days after stroke. Before rTMS treatment (T0), immediately after treatment conclusion (T1), and 1 month after treatment (T2), three pain questionnaires were administered, and cortical responses to single and paired-pulse TMS were assessed. Eight healthy participants served as controls. At T0, when the patient was experiencing the worst pain, the excitability of the ipsilesional motor cortex was reduced. At T1 and T2, the pain scores and paresthesia' spread decreased. The clinical improvement was paralleled by the recovery in motor cortex excitability of the affected hemisphere, in terms of both intra- and inter-hemispheric connections. In this subacute central post-stroke pain case, rTMS treatment was associated with decreased pain and motor cortex excitability changes.https://www.frontiersin.org/articles/10.3389/fneur.2021.742567/fullthalamic strokecentral post-stroke painrTMSneuropathic paincortical excitabilityrehabilitation |
| spellingShingle | Calogero Malfitano Angela Rossetti Stefano Scarano Stefano Scarano Chiara Malloggi Luigi Tesio Luigi Tesio Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study Frontiers in Neurology thalamic stroke central post-stroke pain rTMS neuropathic pain cortical excitability rehabilitation |
| title | Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study |
| title_full | Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study |
| title_fullStr | Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study |
| title_full_unstemmed | Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study |
| title_short | Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study |
| title_sort | efficacy of repetitive transcranial magnetic stimulation for acute central post stroke pain a case study |
| topic | thalamic stroke central post-stroke pain rTMS neuropathic pain cortical excitability rehabilitation |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.742567/full |
| work_keys_str_mv | AT calogeromalfitano efficacyofrepetitivetranscranialmagneticstimulationforacutecentralpoststrokepainacasestudy AT angelarossetti efficacyofrepetitivetranscranialmagneticstimulationforacutecentralpoststrokepainacasestudy AT stefanoscarano efficacyofrepetitivetranscranialmagneticstimulationforacutecentralpoststrokepainacasestudy AT stefanoscarano efficacyofrepetitivetranscranialmagneticstimulationforacutecentralpoststrokepainacasestudy AT chiaramalloggi efficacyofrepetitivetranscranialmagneticstimulationforacutecentralpoststrokepainacasestudy AT luigitesio efficacyofrepetitivetranscranialmagneticstimulationforacutecentralpoststrokepainacasestudy AT luigitesio efficacyofrepetitivetranscranialmagneticstimulationforacutecentralpoststrokepainacasestudy |