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P695: rTMS in treatment of neuropathic facial pain – a prospective study of 20 patients
S242
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
P694 Task dependency of long latency facilitatory effect on soleus H-reflex by cerebellar transcranial magnetic stimulation A. Matsugi 1 , S. Uehara 2,3 , N. Kamata 4 , N. Mori 5 , K. Oku 6 , K. Mukai 1 , K. Nagano 1 1 Shijonawate gakuen university, Faculty of Rehabilitation, Osaka, Japan; 2 Center for Information and Neural Networks (CiNet), National Institute of Information and Communications Technology, Osaka, Japan; 3 Japan Society for the Promotion of Science, Osaka, Japan; 4 Osaka University Hospital, Rehabilitation Unit, Osaka, Japan; 5 Yamamoto Hospital, Rehabilitation, Wakayama, Japan; 6 Hannachuo Hospital, Rehabilitation, Nara, Japan Question: This study’s questions were whether cerebellar transcranial magnetic stimulation (C-TMS) modulates excitability of motoneuron pool and whether the effect by C-TMS is regulated during task that cerebellar activity associated with. Methods: In the first experiment, 11 healthy humans were recruited. The subjects were prone and their bilateral ankle joints were fixed with braces. The center of the junction region of the coil was placed at the site 1 cm below and 3 cm to the right of the inion to stimulate the right cerebellum. Intensity of conditioning TMS was set at 90% of the active motor threshold of a right soleus muscle. The tibial nerve stimulus (NS) evoking the H-reflex from right soleus muscle was delivered after or before TMS. Conditioningtest interstimulus interval (ISI) was every 10 ms in section from 0 to 130 ms or every 1 ms in section from −6 to 0 ms. No-TMS condition test and sham TMS (S-TMS) condition test only ISI 0 or 110 ms were inserted at random. In the second experiment, 9 healthy humans were recruited. The subject was set same as first experiment. NS after C-TMS 110 ms later was delivered during right finger tapping with 1 Hz auditory external cues (tapping task) or during staying the finger at 0-degree position for flexion/extension (stay task), and no-TMS condition test during each task was inserted at random. Results: Amplitude of H-reflex was significantly inhibited at ISI −1, 0, 10 ms and facilitated at ISI 110, 120, 130 ms (Fig. 1). There was no significant difference between the amplitude in S-TMS condition and no-TMS condition at ISI 0 and 110 ms, and the amplitude in C-TMS condition was significantly higher than that in S-TMS condition (Fig. 2A). There was no significant difference of amplitude of H-reflex between tapping task and stay task (Fig. 2B), although the quantity of facilitation induced by C-TMS was significantly decreased during tapping task (Fig. 2C).
Conclusions: Cause of short latency inhibitory effect by C-TMS may be auditory effect. On the other hand, long latency facilitatory effect by C-TMS can not be auditory startle response. The long latency facilitatory effect by C-TMS is modulated by finger tapping task that needs temporal control of movement due to cerebellum. So, the modulation of long latency facilitation by C-TMS can reflect the alteration of cerebellar activity with motor control.
P695 rTMS in treatment of neuropathic facial pain – a prospective study of 20 patients S. Frank, A. Waschke, R. Reichart University Jena, Neurosurgery, Jena, Germany Introduction: Atypical facial pain as a kind of neuropathic disorders could occur after traumatic lesions and remains difficult to treat. One option for management of intractable pain is stimulation of the motor cortex by implantation of an epidural electrode. This effect of invasive stimulation could be replaced by transcranial magnetic stimulation. Objectives: The objective of the study was to observe the pain reducing effect of non-invasive transcranial magnetic stimulation (rTMS) in patients suffering from facial pain, and furthermore to detect whether there is a predictable value for invasive motor cortex stimulation (MCS). Materials and methods: The study was prospective but not randomized. We included patients suffering from chronical neuropathic facial pain. The primary motor cortex has been stimulated with high-frequent, repetitive transcranial magnetic stimulation (rTMS). Stimulation was daily repeated for a period of 9 days. The individual pain level was assessed by the visual analogue scale (VAS) and documented daily for three weeks. The first follow up was done after 6 weeks. Results: We included 20 patients (14 female/6 male) between 32 and 75 years of age. The follow up was done at least after six weeks, further intervals were determined individually with a maximum follow up time of 2.5 years. 8 patients suffered from posttraumatic pain, 12 patients suffered from idiopathic atypical facial pain. A pain reduction in terms of a decrease in the VAS scale was obtained in 14 patients, ranging from 2 to 8 points with a mean value of 5.0. The pain reduction occurred with a delay between 3 and 28 days (mean 16 days), and showed a long term effect up to 6 weeks. Two patients successfully underwent invasive motor cortex stimulation. Conclusion: Non-invasive transcranial magnetic stimulation seems to be applicable for some kind of neuropathic pain, i.e. atypical facial pain. Pain reduction has a long term effect. Furthermore, it may be used as a positive predictor for invasive motor cortex stimulation.
P696 Differential effect of muscle fatigue on short-interval intracortical inhibition and short-interval intracortical facilitation in motor cortex A. Maruyama 1 , A. Higashihara 1 , K. Yamashiro 1 , D. Sato 1 , H. Onishi 2 , A. Nuruki 3 , J. Rothwell 4 1 Niigata University of Health and Welfare, Health and Sports, Niigata, Japan; 2 Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan; 3 Kagoshima University, Information Science and Biomedical Engineering, Kagoshima, Japan; 4 UCL Institute of Neurology, Human Neurophysiology, London, United Kingdom Figure 1
Figure 2
Questions: Muscle fatigue can reduce the excitability of short-interval intracortical inhibition (SICI) in the hand area of motor cortex. However, particularly at an interstimulus interval of 3ms, SICI can be contaminated by concurrent short-interval intracortical facilitation (SICF). Here we examine whether the change in SICI after fatigue is related to changes in SICF. Method: Eight male subjects participated in two separate experiments. In each of them SICI and SICF was evaluated before and after three 2 min periods during which they contracted the right FDI isometrically at 50% of MVC. SICI was evaluated with a conditioning stimulus of 80% active motor threshold whereas SICF was evaluated with S2 equal to 100% resting motor threshold. In experiment 1 (8 subjects), SICI and SICF were both evaluated with an ISI =3ms; in addition ICF was tested at ISI=10ms. In experiment 2 (7 subjects) SICI and SICF were tested at ISI=2ms; in addition SICF was also tested at ISI=3ms. Test stimulus were adjusted to produce an MEP about 1-1.2 mV throughout the two experiments. The amplitudes of the test MEP as well as SICI, ICF and SICF were assessed before, after each of the individual contractions and then at 5, 10, 15, 20, 30 min after the last contraction.
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
P694 Task dependency of long latency facilitatory effect on soleus H-reflex by cerebellar transcranial magnetic stimulation A. Matsugi 1 , S. Uehara 2,3 , N. Kamata 4 , N. Mori 5 , K. Oku 6 , K. Mukai 1 , K. Nagano 1 1 Shijonawate gakuen university, Faculty of Rehabilitation, Osaka, Japan; 2 Center for Information and Neural Networks (CiNet), National Institute of Information and Communications Technology, Osaka, Japan; 3 Japan Society for the Promotion of Science, Osaka, Japan; 4 Osaka University Hospital, Rehabilitation Unit, Osaka, Japan; 5 Yamamoto Hospital, Rehabilitation, Wakayama, Japan; 6 Hannachuo Hospital, Rehabilitation, Nara, Japan Question: This study’s questions were whether cerebellar transcranial magnetic stimulation (C-TMS) modulates excitability of motoneuron pool and whether the effect by C-TMS is regulated during task that cerebellar activity associated with. Methods: In the first experiment, 11 healthy humans were recruited. The subjects were prone and their bilateral ankle joints were fixed with braces. The center of the junction region of the coil was placed at the site 1 cm below and 3 cm to the right of the inion to stimulate the right cerebellum. Intensity of conditioning TMS was set at 90% of the active motor threshold of a right soleus muscle. The tibial nerve stimulus (NS) evoking the H-reflex from right soleus muscle was delivered after or before TMS. Conditioningtest interstimulus interval (ISI) was every 10 ms in section from 0 to 130 ms or every 1 ms in section from −6 to 0 ms. No-TMS condition test and sham TMS (S-TMS) condition test only ISI 0 or 110 ms were inserted at random. In the second experiment, 9 healthy humans were recruited. The subject was set same as first experiment. NS after C-TMS 110 ms later was delivered during right finger tapping with 1 Hz auditory external cues (tapping task) or during staying the finger at 0-degree position for flexion/extension (stay task), and no-TMS condition test during each task was inserted at random. Results: Amplitude of H-reflex was significantly inhibited at ISI −1, 0, 10 ms and facilitated at ISI 110, 120, 130 ms (Fig. 1). There was no significant difference between the amplitude in S-TMS condition and no-TMS condition at ISI 0 and 110 ms, and the amplitude in C-TMS condition was significantly higher than that in S-TMS condition (Fig. 2A). There was no significant difference of amplitude of H-reflex between tapping task and stay task (Fig. 2B), although the quantity of facilitation induced by C-TMS was significantly decreased during tapping task (Fig. 2C).
Conclusions: Cause of short latency inhibitory effect by C-TMS may be auditory effect. On the other hand, long latency facilitatory effect by C-TMS can not be auditory startle response. The long latency facilitatory effect by C-TMS is modulated by finger tapping task that needs temporal control of movement due to cerebellum. So, the modulation of long latency facilitation by C-TMS can reflect the alteration of cerebellar activity with motor control.
P695 rTMS in treatment of neuropathic facial pain – a prospective study of 20 patients S. Frank, A. Waschke, R. Reichart University Jena, Neurosurgery, Jena, Germany Introduction: Atypical facial pain as a kind of neuropathic disorders could occur after traumatic lesions and remains difficult to treat. One option for management of intractable pain is stimulation of the motor cortex by implantation of an epidural electrode. This effect of invasive stimulation could be replaced by transcranial magnetic stimulation. Objectives: The objective of the study was to observe the pain reducing effect of non-invasive transcranial magnetic stimulation (rTMS) in patients suffering from facial pain, and furthermore to detect whether there is a predictable value for invasive motor cortex stimulation (MCS). Materials and methods: The study was prospective but not randomized. We included patients suffering from chronical neuropathic facial pain. The primary motor cortex has been stimulated with high-frequent, repetitive transcranial magnetic stimulation (rTMS). Stimulation was daily repeated for a period of 9 days. The individual pain level was assessed by the visual analogue scale (VAS) and documented daily for three weeks. The first follow up was done after 6 weeks. Results: We included 20 patients (14 female/6 male) between 32 and 75 years of age. The follow up was done at least after six weeks, further intervals were determined individually with a maximum follow up time of 2.5 years. 8 patients suffered from posttraumatic pain, 12 patients suffered from idiopathic atypical facial pain. A pain reduction in terms of a decrease in the VAS scale was obtained in 14 patients, ranging from 2 to 8 points with a mean value of 5.0. The pain reduction occurred with a delay between 3 and 28 days (mean 16 days), and showed a long term effect up to 6 weeks. Two patients successfully underwent invasive motor cortex stimulation. Conclusion: Non-invasive transcranial magnetic stimulation seems to be applicable for some kind of neuropathic pain, i.e. atypical facial pain. Pain reduction has a long term effect. Furthermore, it may be used as a positive predictor for invasive motor cortex stimulation.
P696 Differential effect of muscle fatigue on short-interval intracortical inhibition and short-interval intracortical facilitation in motor cortex A. Maruyama 1 , A. Higashihara 1 , K. Yamashiro 1 , D. Sato 1 , H. Onishi 2 , A. Nuruki 3 , J. Rothwell 4 1 Niigata University of Health and Welfare, Health and Sports, Niigata, Japan; 2 Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan; 3 Kagoshima University, Information Science and Biomedical Engineering, Kagoshima, Japan; 4 UCL Institute of Neurology, Human Neurophysiology, London, United Kingdom Figure 1
Figure 2
Questions: Muscle fatigue can reduce the excitability of short-interval intracortical inhibition (SICI) in the hand area of motor cortex. However, particularly at an interstimulus interval of 3ms, SICI can be contaminated by concurrent short-interval intracortical facilitation (SICF). Here we examine whether the change in SICI after fatigue is related to changes in SICF. Method: Eight male subjects participated in two separate experiments. In each of them SICI and SICF was evaluated before and after three 2 min periods during which they contracted the right FDI isometrically at 50% of MVC. SICI was evaluated with a conditioning stimulus of 80% active motor threshold whereas SICF was evaluated with S2 equal to 100% resting motor threshold. In experiment 1 (8 subjects), SICI and SICF were both evaluated with an ISI =3ms; in addition ICF was tested at ISI=10ms. In experiment 2 (7 subjects) SICI and SICF were tested at ISI=2ms; in addition SICF was also tested at ISI=3ms. Test stimulus were adjusted to produce an MEP about 1-1.2 mV throughout the two experiments. The amplitudes of the test MEP as well as SICI, ICF and SICF were assessed before, after each of the individual contractions and then at 5, 10, 15, 20, 30 min after the last contraction.