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Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain

Galhardoni, Ricardo ; Aparecida da Silva, Valquíria ; García-Larrea, Luís ; Dale, Camila ; Baptista, Abrahão F ; Barbosa, Luciana Mendonça ; Menezes, Luciana Mendes Bahia ; de Siqueira, Silvia R.D.T ; Valério, Fernanda ; Rosi, Jefferson ; de Lima Rodrigues, Antonia Lilian ; Reis Mendes Fernandes, Diego Toledo ; Lorencini Selingardi, Priscila Mara ; Marcolin, Marco Antônio ; Duran, Fábio Luís de Souza ; Ono, Carla Rachel ; Lucato, Leandro Tavares ; Fernandes, Ana Mércia B L ; da Silva, Fábio E F ; Yeng, Lin T ; Brunoni, André R ; Buchpiguel, Carlos A ; Teixeira, Manoel J ; Ciampi de Andrade, Daniel

Neurology, 2019-04, Vol.92 (18), p.e2165-e2175 [Periódico revisado por pares]

United States: American Academy of Neurology

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Título:
Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain
Autor: Galhardoni, Ricardo ; Aparecida da Silva, Valquíria ; García-Larrea, Luís ; Dale, Camila ; Baptista, Abrahão F ; Barbosa, Luciana Mendonça ; Menezes, Luciana Mendes Bahia ; de Siqueira, Silvia R.D.T ; Valério, Fernanda ; Rosi, Jefferson ; de Lima Rodrigues, Antonia Lilian ; Reis Mendes Fernandes, Diego Toledo ; Lorencini Selingardi, Priscila Mara ; Marcolin, Marco Antônio ; Duran, Fábio Luís de Souza ; Ono, Carla Rachel ; Lucato, Leandro Tavares ; Fernandes, Ana Mércia B L ; da Silva, Fábio E F ; Yeng, Lin T ; Brunoni, André R ; Buchpiguel, Carlos A ; Teixeira, Manoel J ; Ciampi de Andrade, Daniel
Assuntos: Adult ; Aged ; Cerebral Cortex - physiopathology ; Deep Brain Stimulation - methods ; Double-Blind Method ; Female ; Gyrus Cinguli - physiopathology ; Humans ; Male ; Middle Aged ; Neuralgia - physiopathology ; Neuralgia - therapy ; Pain Management - methods ; Pain Measurement ; Transcranial Magnetic Stimulation - methods ; Treatment Outcome
É parte de: Neurology, 2019-04, Vol.92 (18), p.e2165-e2175
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-News-1
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Descrição: OBJECTIVETo compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study. METHODSParticipants were randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session. RESULTSNinety-eight patients (age 55.02 ± 12.13 years) completed the study. NRS score was not significantly different between groups at the end of the study. Active rTMS treatments had no significant effects on pain interference with daily activities, pain dimensions, neuropathic pain symptoms, mood, medication use, cortical excitability measurements, or quality of life. Heat pain threshold was significantly increased after treatment in the PSI-dTMS group from baseline (1.58, 95% confidence interval [CI] 0.09–3.06]) compared to sham-dTMS (−1.02, 95% CI −2.10 to 0.04, p = 0.014), and ACC-dTMS caused a significant decrease in anxiety scores (−2.96, 95% CI −4.1 to −1.7]) compared to sham-dTMS (−0.78, 95% CI −1.9 to 0.3; p = 0.018). CONCLUSIONSACC- and PSI-dTMS were not different from sham-dTMS for pain relief in CNP despite a significant antinociceptive effect after insular stimulation and anxiolytic effects of ACC-dTMS. These results showed that the different dimensions of pain can be modulated in humans noninvasively by directly stimulating deeper SNC cortical structures without necessarily affecting clinical pain per se. CLINICALTRIALS.GOV IDENTIFIER:NCT01932905.
Editor: United States: American Academy of Neurology
Idioma: Inglês

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Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain

United States: American Academy of Neurology

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