Abstract
BackgroundTranscranial direct current stimulation (tDCS) of the primary motor cortex has been shown to modulate pain and trigeminal nociceptive processing.MethodsTen patients with classical trigeminal neuralgia (TN) were stimulated daily for 20 minutes over two weeks using anodal (1 mA) or sham tDCS over the primary motor cortex (M1) in a randomized double-blind cross-over design. Primary outcome variable was pain intensity on a verbal rating scale (VRS 0–10). VRS and attack frequency were assessed for one month before, during and after tDCS. The impact on trigeminal pain processing was assessed with pain-related evoked potentials (PREP) and the nociceptive blink reflex (nBR) following electrical stimulation on both sides of the forehead before and after tDCS.ResultsAnodal tDCS reduced pain intensity significantly after two weeks of treatment. The attack frequency reduction was not significant. PREP showed an increased N2 latency and decreased peak-to-peak amplitude after anodal tDCS. No severe adverse events were reported.ConclusionAnodal tDCS over two weeks ameliorates intensity of pain in TN. It may become a valuable treatment option for patients unresponsive to conventional treatment.
Highlights
Transcranial direct current stimulation of the primary motor cortex has been shown to modulate pain and trigeminal nociceptive processing
Several studies showed that transcranial direct current stimulation modulates the cortical excitability of the motor cortex depending on the direction of the electric current and that its neuroplastic effects sustain after stimulation [1]
This study aims to investigate the efficacy of anodal Transcranial direct current stimulation (tDCS) of the motor cortex in the treatment of trigeminal neuralgia (TN) with and without concomitant permanent pain using a randomized, crossover design
Summary
Transcranial direct current stimulation (tDCS) of the primary motor cortex has been shown to modulate pain and trigeminal nociceptive processing. The effects of tDCS on cortical excitability can spread to distant cortical areas possibly along interconnections between the stimulated area and adjacent regions [5]. It was suggested, that anodal tDCS modulates pain perception by shifts of the resting membrane potential and consequent alteration of the corticospinal. Carbamazepine is currently the drug of first choice in the treatment of TN It is effective in 70-80% of patients but often associated with severe adverse effects such as drowsiness, confusion, nausea and ataxia, which may require discontinuation of medication [15]. Pain evoked potentials and the nociceptive blink reflex were used as objective measure of the tDCS effect on human trigeminal pain processing
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