TDCS neuromodulation to enhance cognitive and proprioceptive treatment of Burning Mouth Syndrome

Abstract

Abstract Background: Burning Mouth Syndrome is an idiopathic and multifactorial condition characterized by a severely painful burning sensation of the tongue and mucosal tissue of the mouth. Its pathophysiology may be associated with both psychogenic and neuropathic pathways, but the diagnosis is made clinically, after excluding other causes of oral pain. We present a pilot study with a 74-years-old female with a 2-year history of a painful sensation in the gums and palate accompanied with alternating sialorrhea and xerostomia, pain does not increase with palpation or movement. Treatment with NSAID's and opioids, topical clonazepam, alpha-lipoic acid, botulinum toxin and neuroleptics had not been successful. A protocol of non-invasive neuromodulation, cognitive therapy and oral proprioception exercises is proposed. Method: 10 sessions of 20 min 2mA anodal TDCS stimulation at the right dorsolateral frontal cortex with two concomitant treatments: 1) 20 min sessions of attention focused neurorehabilitation protocol. 2) Training for proprioceptive rehabilitation that was performed daily at home. Pain, cognitive and psychological measurements were performed. Results: Although no changes were observed in pain threshold and conditioned pain regulation objective assessment was not evidenced, significant improvements were observed in Brief pain inventory, Inventory of disability and craniofacial pain, Oral health Impact profile scale, Pain Catastrofism scale and Lans neuropathic assessment. Improvement in scores of Trail making test A and B measuring attention and processing speed was also evidenced. (Table 1). Conclusion: TDCS may be of great relevance in burning mouth syndrome treatment when combined with different approaches as cognitive and proprioception rehabilitation. The improvement in quality of life and pain perception may be independent of objective pain assessment improvement Keywords: BMS, Therapeutic Exercise, tDCS, Cognitive Rehabilitation