Long-Term Relief of Painful Bladder Syndrome by High-Intensity, Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Right and Left Dorsolateral Prefrontal Cortices.

Julien Nizard,Jean-Pascal Lefaucheur,Alcira Suarez Moreno,Julien Esnault,Bénédicte Bouche,Jean-Paul Nguyen

doi:10.3389/fnins.2018.00925

Abstract

Aim: To show the value of low-frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) to treat bladder pain syndrome (BPS), characterized by suprapubic pain, urgency and increased micturition frequency.Methods: A 68-year-old woman with BPS underwent 16 sessions of high-intensity, low-frequency (1 Hz) rTMS of the DLPFC, first on the right hemisphere (one daily session for 5 days, followed by one weekly session for 5 weeks), and then on the left hemisphere (one monthly session for 6 months).Results: At the end of the rTMS protocol, suprapubic pain completely vanished, micturition frequency dramatically decreased (by 60–80%), while fatigue and sleep quality improved (by 57–60%). The patient reported an overall satisfaction rate of 80% and her activities of daily living tending to normalize.Conclusion: This is the first report showing that high-intensity, low-frequency rTMS delivered on the DLPFC region of both hemispheres can relieve most symptoms of BPS (pain, urinary symptoms, and interference with physical functioning) in clinical practice.

Highlights

Bladder pain syndrome (BPS), known as “interstitial cystitis,” is pain a relatively common disease, with a prevalence of about 2.5%, affecting women about four times more than men (van de Merwe et al, 2008; Offiah et al, 2013; Hanno et al, 2015)
The etiology of BPS is unknown, but symptoms repetitive transcranial magnetic stimulation (rTMS) in Bladder Pain Syndrome are thought to arise from chronic inflammation of the bladder wall in the absence of infection
Chronic inflammation is mostly associated with the release of various factors and cytokines that may contribute to induce a hyperexcitation of nerve fiber endings in the bladder wall, and a central sensitization of ascending pathways and brain structures involved in sensory information integration (Yoshimura et al, 2014a,b)

Summary

Methods

A 68-year-old woman with BPS underwent 16 sessions of high-intensity, lowfrequency (1 Hz) rTMS of the DLPFC, first on the right hemisphere (one daily session for 5 days, followed by one weekly session for 5 weeks), and on the left hemisphere (one monthly session for 6 months)

Results

Conclusion

INTRODUCTION

DISCUSSION