Resting-state fMR evidence of network reorganization induced by navigated transcranial magnetic repetitive stimulation in phantom limb pain. (3rd April 2018)

• Record Type: Journal Article
• Authors: Scibilia, Antonino; Conti, Alfredo; Raffa, Giovanni; Granata, Francesca; Abbritti, Rosaria Viola; Priola, Stefano Maria; Sindorio, Carmela; Cardali, Salvatore; Germanò, Antonino
• Is Part Of: Neurological research. Volume 40:Number 4(2018)
• Page Start: 241
• Page End: 248
• Publication Date: 2018-04-03
• Subjects: Phantom limb pain -- navigated repetitive transcranial magnetic stimulation -- resting-state functional magnetic resonance -- brain connectivity -- brain plasticity; Neurology -- Periodicals; Neurosciences -- Periodicals; 616.8005
• DOI: 10.1080/01616412.2018.1429203
• Languages: English
• ISSNs: 0161-6412

Abstract

Abstract: Objectives: Repetitive transcranial magnetic stimulation (rTMS) is a promising tool for treatment of chronic pain. We describe the use of navigated rTMS to treat a patient affected by phantom limb pain (PLP) and to modulate brain functional connectivity. We reviewed the literature on the use of rTMS as a tool for relieving central pain by promoting brain plasticity. Methods: A 69-year-old patient came to our observation blaming severe pain (Visual Analog scale, VAS, score 9) to a phantom right lower limb. We mapped left primary motor area (PMA) by navigated TMS and assessed connectivity with resting-state functional MR (rsfMR). The patient underwent 30-days navigated rTMS treatment. We applied low-frequency stimulation (1 Hz) over the primary somatosensory area (PSA) and high-frequency stimulation (10 Hz) over PMA and dorsolateral prefrontal cortex (DLPFC) of the left hemisphere. Results: This strategy allowed a pain relief with a reduction of 5 points of the VAS score after 1 month. Post-treatment rsfMR showed increased connectivity, mainly in the sensory-motor network and the unaffected hemisphere ( P < 0.05). Discussion: This report represents a proof-of-concept that navigated rTMS can be effectively used to stimulate selected brain areas in PLP patients in order to promote brain connectivity, and that rsfMR is a useful tool able to analyze functional results. In the literature, we found data supporting the assumption that, in patients affected by PLP, a reduced connectivity in interhemispherical and sensory-motor network plays a role in generating pain and that rTMS has the potential to restore impaired connectivity.