Effects and safety of high-frequency repetitive transcranial magnetic stimulation in trigeminal neuralgia

Abstract

Background. Trigeminal neuralgia is the most common cause of facial pain. Insufficient effectiveness and frequent side effects of pharmacological therapy, as well as the risk of complications of invasive neurosurgical manipulations, determine the relevance of the development of new treatment approaches, one of which is repetitive transcranial magnetic stimulation (rTMS).The aim of the study is to determine the effectiveness of high‑frequency rTMS of the primary motor cortex in terms of pain intensity and quality of life in patients with trigeminal neuralgia, as well as to assess the safety of the stimulation course.Materials and methods. This open‑label non‑randomized single arm study included 20 patients with classic trigeminal neuralgia according to the ICHD‑3 classification. All patients received 10 sessions of navigated high‑frequency rTMS of the primary motor cortex (hand area) of the hemisphere, contralateral to pain syndrome localization. The maximum and average pain intensity was assessed before and after 10 rTMS sessions according to a Numeric Pain Rating Scale (NPRS), as well as quality of life was measured according to the SF‑36 questionnaire, and the severity of affective disorders according was measured to the Beck Depression Inventory (BDI). Safety and tolerability of rTMS were assessed using self‑developed questionnaires for adverse events that occurred during stimulation and within 24 hours after the previous session.Results. A significant decrease in the maximum (p = 0.01) and average (p <0.01) pain intensity was shown after 10 sessions of rTMS. In 50 % of patients, the maximum pain intensity decreased by more than 30 % vs baseline. Significant changes were detected in the physical health measure of SF‑36 quality of life questionnaire, particularly, in the “bodily pain” domain, as well as in such aspects of the mental health measure as “vitality” and “social functioning”. The severity of affective disorders did not change significantly. A favorable profile of rTMS tolerability has been demonstrated.Conclusion. An open‑label study showed the possible effectiveness of 10 sessions of high‑frequency rTMS to reduceт the pain intensity in patients with trigeminal neuralgia. For the first time, the spectrum of adverse events both during stimulation and within a day after its completion was systematically analyzed.