What is the efficacy of transcranial magnetic stimulation (TMS) for treating thalamic post-stroke central pain syndrome?

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From the Research

Transcranial magnetic stimulation (TMS) shows modest promise for treating thalamic post-stroke central pain syndrome, with the most recent and highest quality study suggesting that repetitive TMS (rTMS) may provide temporary pain relief for some patients. According to the study published in 2021 1, rTMS treatment was associated with decreased pain and motor cortex excitability changes in a patient with thalamic stroke. The study found that 10 daily sessions of rTMS at 10 Hz, applied to the hand area of the right primary motor cortex, resulted in decreased pain scores and paresthesia spread.

Key Findings

  • The study suggests that rTMS may be effective in reducing pain in patients with thalamic post-stroke central pain syndrome, with a significant reduction in pain scores and paresthesia spread observed after treatment 1.
  • The mechanism of action is thought to involve modulation of thalamic and cortical hyperexcitability and restoration of inhibitory circuits disrupted by stroke.
  • Deep TMS with H-coils may offer better penetration to deeper brain structures than conventional figure-8 coils, potentially leading to improved pain relief.

Treatment Protocol

  • A typical treatment protocol might involve 10-20 daily sessions of rTMS at 10 Hz, with 1500-3000 pulses per session at 80-90% of motor threshold.
  • Maintenance sessions may be necessary to sustain benefit, as pain reduction is often temporary, lasting from hours to weeks after treatment completion.

Considerations

  • Patients should be aware that response rates vary significantly, with some experiencing minimal benefit.
  • TMS should be considered as part of a comprehensive pain management approach rather than a standalone treatment, and patients may need to try different stimulation parameters to find an effective protocol for their specific condition.
  • The study published in 2015 2 also supports the use of rTMS for central post-stroke pain, with 61.1% of patients experiencing pain relief after 12 weeks of treatment. However, the most recent study 1 provides the strongest evidence for the efficacy of rTMS in treating thalamic post-stroke central pain syndrome.

References

2
Research

Repetitive transcranial magnetic stimulation once a week induces sustainable long-term relief of central poststroke pain.

Neuromodulation : journal of the International Neuromodulation Society, 2015

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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