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P013 rTMS therapy on M1 modifies the motor map in chronic neuropathic facial pain – A pilot study
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Abstracts / Clinical Neurophysiology 128 (2017) e1–e163
Introduction: Auditory verbal hallucinations (AVHs) are perception-like experiences that occur without an external stimulus. AVHs can occur following a stroke. Repetitive Transcranial Magnetic Stimulation (rTMS) is a tool used to induce brain plasticity in local and remote areas of the brain that may be used for AVHs treatment. Here, we report the case of a patient experiencing AVHs following a stroke treated with rTMS applied to the left temporoparietal junction. Objective: To treat AVHs in a post-stroke incomplete locked-in patient with rTMS. Patient and methods: Following a stroke event, an MRI revealed bilateral lesions in a 55-year-old male brain (large lesion from the bulbo-pontine junction to the cerebral peduncles, and small lesions in the right cerebellar and the left capsulo-thalamic regions). The patient developed an incomplete locked-in syndrome and he experienced AVHs and delusional melancholia six years after the insult. An antipsychotic treatment was not tolerated well and, consequently, an experimental treatment by rTMS was applied to this patient to ameliorate these symptoms. To this purpose, an inhibitory 1-Hz rTMS protocol was delivered twice per day, with an interval of 1 h and an intensity of 100% of his resting Motor Threshold of the left hemisphere. Each session lasted 20 min and delivered 1200 pulses. In total, 56 rTMS sessions were administered. AVHs and mood were assessed using the Auditory Hallucinations Rating Scale (AHRS), the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression scale (HAD) before and during the treatment. Results: After 26 sessions of the 1-Hz rTMS, the AHRS score was reduced from 29 to 0, indicating the absence of AVHs. A reduction of BDI and HAD scores showed an improvement in mood. In addition, there was an unexpected improvement of motor function in the contralateral hand to the stimulated region. Conclusion: Repetitive TMS should be considered as a therapeutic option for AVHs following a stroke. Potential associated motor improvement that stimulation could unfold provides additional value to the use of rTMS such clinical scenario. Further investigations are underway to understand the brain plasticity mechanisms underlying such unexpected motor improvement.
chronic neuropathic pain. However, the mechanisms of action of rTMS are so far unknown. Better efficacy has been shown when rTMS is targeted to adjacent cortical area (Lefaucheur et al., 2006), though somatotopic targeting is also commonly used. Previously, smaller hand motor representation area of the painful side has been shown in chronic pain (Krause et al., 2006). Objectives: We hypothesized that the motor map plasticity would be changed after two 5-days rTMS treatment sessions separated by 6 weeks. Therapy was targeted to the somatotopic facial M1 using neuronavigated TMS. Patients and methods: Three patients with severe unilateral, chronic atypical facial pain were enrolled in the study. Highfrequency rTMS (10 Hz or 20 Hz, 2400 or 3600 pulses per session, 90% of the resting motor threshold, rMT) was targeted to functional motor representation area of the mentalis muscle. Hotspots and rMTs were determined for face and hand on both hemispheres. Silent period duration was measured on the hand muscle. Mapping was performed at 105% of the rMT of the mentalis muscle to determine the center-of-gravity (CoG) on the hemisphere contralateral to painful side. A grid with 5 mm spacing was used and two stimuli were applied per square. Results: rTMS sessions did not significantly change the hand or face rMTs on either hemisphere. In all three patients, the representation area of the mentalis muscle has expanded in anterior-posterior direction. Correspondingly, the CoG of the mentalis muscle moved posteriorly (Fig. 1). Silent period duration was increased in the third patient showing the largest shift of the CoG. Patients 2 and 3 benefitted from the treatment. Conclusion: These preliminary results suggest that rTMS induces changes in the motor map plasticity measurable 4–11 days after last rTMS session. Plastic changes may be related to normalized corticospinal inhibition.
doi:10.1016/j.clinph.2016.10.142
doi:10.1016/j.clinph.2016.10.143
P013
P015 The effects of cathodal transcranial direct current stimulation in patienst with focal epilepsy (a pilot study)‘—M. Zoghi *, M. Cook, T. O’Brien, P. Kwan, S. Jaberzadeh, M. Galea (The University of Melbourne, Medicine, Melbourne, Australia)
rTMS therapy on M1 modifies the motor map in chronic neuropathic facial pain – A pilot study—L. Säisänen *, J. Hyppönen, E. Hallikainen-Pirskanen, E. Kallioniemi, J. Huttunen, E. Mervaala, M. Fraunberg (University of Eastern Finland, Clinical medicine, Kuopio, Finland) ⇑
Corresponding author.
Introduction: Repetitive TMS (rTMS) targeted to primary motor cortex (M1) has been proven effective in treating pharmacoresistant
References Lefaucheur JP et al. Neurology 2006;67:1998–2004. Krause et al. Clin Neurophysiol ause et al.,;117:169–76.
⇑
Corresponding author.
Introduction: Over 65 million people live with epilepsy worldwide. Unfortunately, seizures can not be adequately controlled in a third of the affected individuals. Therefore, there is a definite need for adjunctive or alternative therapeutic approaches in this group of
Figure 1: The CoG of the mentalis muscle before (yellow dot) and after (red dot) rTMS treatment.
Abstracts / Clinical Neurophysiology 128 (2017) e1–e163
Introduction: Auditory verbal hallucinations (AVHs) are perception-like experiences that occur without an external stimulus. AVHs can occur following a stroke. Repetitive Transcranial Magnetic Stimulation (rTMS) is a tool used to induce brain plasticity in local and remote areas of the brain that may be used for AVHs treatment. Here, we report the case of a patient experiencing AVHs following a stroke treated with rTMS applied to the left temporoparietal junction. Objective: To treat AVHs in a post-stroke incomplete locked-in patient with rTMS. Patient and methods: Following a stroke event, an MRI revealed bilateral lesions in a 55-year-old male brain (large lesion from the bulbo-pontine junction to the cerebral peduncles, and small lesions in the right cerebellar and the left capsulo-thalamic regions). The patient developed an incomplete locked-in syndrome and he experienced AVHs and delusional melancholia six years after the insult. An antipsychotic treatment was not tolerated well and, consequently, an experimental treatment by rTMS was applied to this patient to ameliorate these symptoms. To this purpose, an inhibitory 1-Hz rTMS protocol was delivered twice per day, with an interval of 1 h and an intensity of 100% of his resting Motor Threshold of the left hemisphere. Each session lasted 20 min and delivered 1200 pulses. In total, 56 rTMS sessions were administered. AVHs and mood were assessed using the Auditory Hallucinations Rating Scale (AHRS), the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression scale (HAD) before and during the treatment. Results: After 26 sessions of the 1-Hz rTMS, the AHRS score was reduced from 29 to 0, indicating the absence of AVHs. A reduction of BDI and HAD scores showed an improvement in mood. In addition, there was an unexpected improvement of motor function in the contralateral hand to the stimulated region. Conclusion: Repetitive TMS should be considered as a therapeutic option for AVHs following a stroke. Potential associated motor improvement that stimulation could unfold provides additional value to the use of rTMS such clinical scenario. Further investigations are underway to understand the brain plasticity mechanisms underlying such unexpected motor improvement.
chronic neuropathic pain. However, the mechanisms of action of rTMS are so far unknown. Better efficacy has been shown when rTMS is targeted to adjacent cortical area (Lefaucheur et al., 2006), though somatotopic targeting is also commonly used. Previously, smaller hand motor representation area of the painful side has been shown in chronic pain (Krause et al., 2006). Objectives: We hypothesized that the motor map plasticity would be changed after two 5-days rTMS treatment sessions separated by 6 weeks. Therapy was targeted to the somatotopic facial M1 using neuronavigated TMS. Patients and methods: Three patients with severe unilateral, chronic atypical facial pain were enrolled in the study. Highfrequency rTMS (10 Hz or 20 Hz, 2400 or 3600 pulses per session, 90% of the resting motor threshold, rMT) was targeted to functional motor representation area of the mentalis muscle. Hotspots and rMTs were determined for face and hand on both hemispheres. Silent period duration was measured on the hand muscle. Mapping was performed at 105% of the rMT of the mentalis muscle to determine the center-of-gravity (CoG) on the hemisphere contralateral to painful side. A grid with 5 mm spacing was used and two stimuli were applied per square. Results: rTMS sessions did not significantly change the hand or face rMTs on either hemisphere. In all three patients, the representation area of the mentalis muscle has expanded in anterior-posterior direction. Correspondingly, the CoG of the mentalis muscle moved posteriorly (Fig. 1). Silent period duration was increased in the third patient showing the largest shift of the CoG. Patients 2 and 3 benefitted from the treatment. Conclusion: These preliminary results suggest that rTMS induces changes in the motor map plasticity measurable 4–11 days after last rTMS session. Plastic changes may be related to normalized corticospinal inhibition.
doi:10.1016/j.clinph.2016.10.142
doi:10.1016/j.clinph.2016.10.143
P013
P015 The effects of cathodal transcranial direct current stimulation in patienst with focal epilepsy (a pilot study)‘—M. Zoghi *, M. Cook, T. O’Brien, P. Kwan, S. Jaberzadeh, M. Galea (The University of Melbourne, Medicine, Melbourne, Australia)
rTMS therapy on M1 modifies the motor map in chronic neuropathic facial pain – A pilot study—L. Säisänen *, J. Hyppönen, E. Hallikainen-Pirskanen, E. Kallioniemi, J. Huttunen, E. Mervaala, M. Fraunberg (University of Eastern Finland, Clinical medicine, Kuopio, Finland) ⇑
Corresponding author.
Introduction: Repetitive TMS (rTMS) targeted to primary motor cortex (M1) has been proven effective in treating pharmacoresistant
References Lefaucheur JP et al. Neurology 2006;67:1998–2004. Krause et al. Clin Neurophysiol ause et al.,;117:169–76.
⇑
Corresponding author.
Introduction: Over 65 million people live with epilepsy worldwide. Unfortunately, seizures can not be adequately controlled in a third of the affected individuals. Therefore, there is a definite need for adjunctive or alternative therapeutic approaches in this group of
Figure 1: The CoG of the mentalis muscle before (yellow dot) and after (red dot) rTMS treatment.