Panduan Diskusi Workshop Tms

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PANDUAN DISKUSI WORKSHOP TMS

AGUS SOLICHIEN, MD

Therapeutic Use of High-FrequencyRepetitive Transcranial Magnetic

Stimulation in Stroke

1. Christophe Hotermans, MD+ Author Affiliations

1. Neurology Department, University of Lige, Lige, Belgium1. Philippe Peigneux, PhD

+ Author Affiliations

1. Cyclotron Research Centre, University of Lige, Lige, Belgium1. Gustave Moonen, MD, PhD;2. Alain Maertens de Noordhout, MD, PhD;3.

Pierre Maquet, MD, PhD


1. Neurology Department, University of Lige, Lige, BelgiumTo the Editor:

We read with great interest the article published by Kim et al on repetitive transcranial

magnetic stimulation (rTMS)induced corticomotor excitability and associated motor skill

acquisition in chronic stroke.1The authors used high-frequency (10 Hz) rTMS over the

primary motor cortex contralateral to the paretic hand in patients with chronic subcorticalstroke and reported an immediate enhancement of excitability associated with an

improvement in motor skill of the paretic hand.

The induced enhancement of corticomotor excitability and the related improvement in

performance open new and fascinating possibilities for future rehabilitation strategies.

Despite our genuine enthusiasm for this kind of initiative, we feel that the effects of high-

frequency rTMS still have to be firmly established and better understood, before it is

proposed for widespread clinical use.

First, the effect of rTMS is dependent on the frequency, intensity, intervals and duration ofstimulation. At high frequency (>1 Hz), the effects on corticomotor excitability are highly
http://stroke.ahajournals.org/search?author1=Christophe+Hotermans&sortspec=date&submit=Submithttp://stroke.ahajournals.org/content/38/2/253.fullhttp://stroke.ahajournals.org/search?author1=Philippe+Peigneux&sortspec=date&submit=Submithttp://stroke.ahajournals.org/content/38/2/253.fullhttp://stroke.ahajournals.org/search?author1=Gustave+Moonen&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Alain+Maertens+de+Noordhout&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Pierre+Maquet&sortspec=date&submit=Submithttp://stroke.ahajournals.org/content/38/2/253.fullhttp://stroke.ahajournals.org/content/38/2/253.full#ref-1http://stroke.ahajournals.org/content/38/2/253.full#ref-1http://stroke.ahajournals.org/content/38/2/253.full#ref-1http://stroke.ahajournals.org/content/38/2/253.full#ref-1http://stroke.ahajournals.org/content/38/2/253.fullhttp://stroke.ahajournals.org/search?author1=Pierre+Maquet&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Alain+Maertens+de+Noordhout&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Gustave+Moonen&sortspec=date&submit=Submithttp://stroke.ahajournals.org/content/38/2/253.fullhttp://stroke.ahajournals.org/search?author1=Philippe+Peigneux&sortspec=date&submit=Submithttp://stroke.ahajournals.org/content/38/2/253.fullhttp://stroke.ahajournals.org/search?author1=Christophe+Hotermans&sortspec=date&submit=Submit


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variable across subjects.2Some healthy subjects even do not show any significant

enhancement of corticospinal excitability after 10 Hz stimulation (although admittedly with

other parameters of stimulation than those used by Kim et al).3An even greater variability is

to be expected in disease. This implies that in the context of the rehabilitation of stroke

patients, the stimulation protocol will probably have to be tailored to each individual case.

Second, high-frequency rTMS may worsen motor skill in healthy volunteers.4We used in

healthy volunteers high-frequency (20 Hz) rTMS with an intensity of 90% of resting motor

threshold, during 20 minutes with trains of stimulation of 2 seconds and intertrain intervals of

28 seconds. Immediately after rTMS, subjects had a significantly lower performance on a

finger-tapping task than controls (without rTMS).

Third, rTMS effects may be temporary and unrelated to the motor performance eventually

achieved in the long term. In our case, the detrimental effect of high-frequency rTMS was

transient and the performance was similar 2 days later whether or not subjects had previously

received rTMS. In patients, multiple sessions of rTMS5,6

would probably have to be

performed to promote cortical plasticity and to induce a long-lasting functional recovery afterstroke.

Fourth, there are so far no safety guidelines for the use of rTMS in pathological conditions.

For safety and methodological reasons, the authors restricted their study to subcortical stroke

patients. Nevertheless, because of a higher motor threshold,1,7

these patients required a higher

intensity of stimulation to enhance corticomotor excitability. This increases the risk of

seizures and rTMS can become painful.

Finally, low-frequency rTMS, which is typically better tolerated and safer, has also been

shown to improve motor performance of the paretic hand when applied on the unaffected

hemisphere.6,8,9The respective risks and benefits of low- and high-frequency rTMS should be

further specified.

Repetitive Transcranial Magnetic

Stimulation of Contralesional Primary

Motor Cortex Improves Hand FunctionAfter Stroke

1. Naoyuki Takeuchi, MD;2. Takayo Chuma, MD;3. Yuichiro Matsuo, MD;4. Ichiro Watanabe, MD, PhD;5. Katsunori Ikoma, MD, PhD

http://stroke.ahajournals.org/content/38/2/253.full#ref-2http://stroke.ahajournals.org/content/38/2/253.full#ref-2http://stroke.ahajournals.org/content/38/2/253.full#ref-2http://stroke.ahajournals.org/content/38/2/253.full#ref-3http://stroke.ahajournals.org/content/38/2/253.full#ref-3http://stroke.ahajournals.org/content/38/2/253.full#ref-3http://stroke.ahajournals.org/content/38/2/253.full#ref-4http://stroke.ahajournals.org/content/38/2/253.full#ref-4http://stroke.ahajournals.org/content/38/2/253.full#ref-4http://stroke.ahajournals.org/content/38/2/253.full#ref-5http://stroke.ahajournals.org/content/38/2/253.full#ref-5http://stroke.ahajournals.org/content/38/2/253.full#ref-1http://stroke.ahajournals.org/content/38/2/253.full#ref-1http://stroke.ahajournals.org/content/38/2/253.full#ref-1http://stroke.ahajournals.org/content/38/2/253.full#ref-6http://stroke.ahajournals.org/content/38/2/253.full#ref-6http://stroke.ahajournals.org/content/38/2/253.full#ref-6http://stroke.ahajournals.org/search?author1=Naoyuki+Takeuchi&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Takayo+Chuma&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Yuichiro+Matsuo&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Ichiro+Watanabe&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Katsunori+Ikoma&sortspec=date&submit=Submithttp://stroke.ahajournals.org/content/36/12/2681.fullhttp://stroke.ahajournals.org/content/36/12/2681.fullhttp://stroke.ahajournals.org/search?author1=Katsunori+Ikoma&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Ichiro+Watanabe&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Yuichiro+Matsuo&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Takayo+Chuma&sortspec=date&submit=Submithttp://stroke.ahajournals.org/search?author1=Naoyuki+Takeuchi&sortspec=date&submit=Submithttp://stroke.ahajournals.org/content/38/2/253.full#ref-6http://stroke.ahajournals.org/content/38/2/253.full#ref-1http://stroke.ahajournals.org/content/38/2/253.full#ref-5http://stroke.ahajournals.org/content/38/2/253.full#ref-4http://stroke.ahajournals.org/content/38/2/253.full#ref-3http://stroke.ahajournals.org/content/38/2/253.full#ref-2


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1. From the Department of Rehabilitation Medicine, Hokkaido University GraduateSchool of Medicine, Sapporo 060-0814, Japan.

1. Correspondence to Naoyuki Takeuchi, MD, Department of Rehabilitation Medicine,Hokkaido University Graduate School of Medicine, North 14 West 5, Sapporo 060-

0814, Japan. E-mail [email protected]

Next Section

Abstract

Background and PurposeA recent report has demonstrated that the contralesional primary

motor cortex (M1) inhibited the ipsilesional M1 via an abnormal transcallosal inhibition

(TCI) in stroke patients. We studied whether a decreased excitability of the contralesional M1

induced by 1 Hz repetitive transcranial magnetic stimulation (rTMS) caused an improvedmotor performance of the affected hand in stroke patients by releasing the TCI.

MethodsWe conducted a double-blind study of real versus sham rTMS in stroke patients.

After patients had well- performed motor training to minimize the possibility of motor

training during the motor measurement, they were randomly assigned to receive a

subthreshold rTMS at the contralesional M1 (1 Hz, 25 minutes) or sham stimulation.

ResultsWhen compared with sham stimulation, rTMS reduced the amplitude of motor-

evoked potentials in contralesional M1 and the TCI duration, and rTMS immediately induced

an improvement in pinch acceleration of the affected hand, although a plateau in motor

performance had been reached by the previous motor training. This improvement in motorfunction after rTMS was significantly correlated with a reduced TCI duration.

ConclusionsWe have demonstrated that a disruption of the TCI by the contralesional M1

virtual lesion caused a paradoxical functional facilitation of the affected hand in stroke

patients; this suggests a new neurorehabilitative strategy for stroke patients.

Therapeutic and dose-dependent effect of

repetitive microelectroshock induced by

transcranial magnetic stimulation in

Parkinson's disease

1. Judit Mally1,*,2. T. W. Stone2

Article first published online: 30 AUG 1999
mailto:[email protected]://stroke.ahajournals.org/content/36/12/2681.full#intro-headerhttp://stroke.ahajournals.org/content/36/12/2681.full#intro-headermailto:[email protected]


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Abstract

Transcranial magnetic stimulation (TMS) has been used in the diagnosis of neurological

lesions and has been introduced into the therapy of central nervous diseases. Lately it has

been claimed that TMS would be useful not only in the treatment of depression, but also in

relieving symptoms of Parkinson's disease. In this study, we sought evidence of the effect ofrepetitive TMS on the symptoms of Parkinson's disease, the dose dependency between the

applied elecromagnetic field and the Parkinsonian symptoms, and the maintenance of the

improvement. Forty-nine patients with Parkinson's disease were divided into four groups,

each given one stimulus, repeated 30 times, once or twice a day (0.34Tesla (T), 0.57T,

0.80T). Patients were followed for 3 months and assessed using two different parkinsonian

scales: the graded clinical rating scale and Unified Parkinson Disability Rating Scale

(UPDRS), and with a short-term memory test (Ziehen-Ranschburg word pair test). No effect

was seen in the group treated with 0.34T\30 stimuli once a day. In all of the groups

receiving TMS twice a day, the parkinsonian scores were significantly decreased compared

with that of baselines after 1 month of treatment. The greatest improvement in the

hypokinesia was detected in the group treated with 0.57T\30 stimuli twice a day (baseline

total UPDRS: 30.62 15.23; 1 month after treatment: 17.08 7.04, P < 0.01; 3 months after

treatment: 16.08 7.06, P < 0.01). A dose-dependent difference was observed between the

two groups after 3 months. The total UPDRS in Group II (0.34T\30 stimuli twice a day)

significantly differed from Group III (0.57T\30 stimuli twice a day; 22.43 8.87, 16.08 7.06, P < 0.05). The long-lasting improvement effect with TMS would seem to suggest it as

an appropriate tool in the therapy of Parkinson's disease. J. Neurosci. Res. 57:935940, 1999.

1999 Wiley-Liss, Inc.

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5/11

Therapeutic effect and mechanism of

repetitive transcranial magnetic stimulation

in Parkinson's diseaseHotetsu Shimamoto, Katsuyuki Takasaki, Minoru Shigemori, Toshihiro Imaizumi,

Mitsuyoshi Ayabe and Hiroshi Shoji

Abstract

The therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on clinical

performance was assessed by a double-blind study in 9 patients with Parkinson's disease(PD). Nine other patients underwent sham stimulation as controls. The modified Hoehn and

Yahr (H&Y) staging scale, the Schwab and England Activities of Daily Living (ADL) scale,

and the Unified Parkinson's disease rating scale (UPDRS) were used to assess changes of

clinical performance. Patients were assessed prior to and following 2 months of rTMS. In

addition, the mechanism of rTMS was investigated by dopamine and homovanillic acid

(HVA) in the lumbar cerebrospinal fluid (CSF) of 17 patients before and after therapeutic

rTMS for three or four months. rTMS was applied manually to the frontal areas 60 times per

session, i. e., 30 times per side using a large circular coil, a pulse intensity of 700 V, and a

frequency of 0.2 Hz. Sessions were continued once a week for 2 months. The 9 control

patients showed no changes of symptoms between the initial evaluation and that after 2

months of sham rTMS. In contrast, all 9 patients receiving rTMS showed a significantdecrease of the modified H&Y and UPDRS scores after 2 months, while the Schwab and

England ADL Scale scores increased significantly. In the second CSF sample from patients

receiving rTMS, HVA showed a significant decrease These results suggest that rTMS is

beneficial for the symptoms of Parkinson's disease and that it may act via inhibition of

dopaminergic systems.

Intermittent theta-burst transcranial

magnetic stimulation for treatment of

Parkinson disease

1. D.H. Benninger, MD,2. B.D. Berman, MD,3. E. Houdayer, PhD,4. N. Pal,5. D.A. Luckenbaugh,6. L. Schneider,7. S. Miranda, MD and8. M. Hallett, MD
http://www.springerlink.com/content/?Author=Hotetsu+Shimamotohttp://www.springerlink.com/content/?Author=Katsuyuki+Takasakihttp://www.springerlink.com/content/?Author=Minoru+Shigemorihttp://www.springerlink.com/content/?Author=Toshihiro+Imaizumihttp://www.springerlink.com/content/?Author=Mitsuyoshi+Ayabehttp://www.springerlink.com/content/?Author=Hiroshi+Shojihttp://www.neurology.org/search?author1=D.H.+Benninger&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=B.D.+Berman&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=E.+Houdayer&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=N.+Pal&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=D.A.+Luckenbaugh&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=L.+Schneider&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=S.+Miranda&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=M.+Hallett&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=M.+Hallett&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=S.+Miranda&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=L.+Schneider&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=D.A.+Luckenbaugh&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=N.+Pal&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=E.+Houdayer&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=B.D.+Berman&sortspec=date&submit=Submithttp://www.neurology.org/search?author1=D.H.+Benninger&sortspec=date&submit=Submithttp://www.springerlink.com/content/?Author=Hiroshi+Shojihttp://www.springerlink.com/content/?Author=Mitsuyoshi+Ayabehttp://www.springerlink.com/content/?Author=Toshihiro+Imaizumihttp://www.springerlink.com/content/?Author=Minoru+Shigemorihttp://www.springerlink.com/content/?Author=Katsuyuki+Takasakihttp://www.springerlink.com/content/?Author=Hotetsu+Shimamoto


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1. From the Medical Neurology Branch (D.H.B., B.D.B., E.H., N.P., L.S., S.M., M.H.),National Institute of Neurological Disorders and Stroke (NINDS), National Institute

of Mental Health (NIMH) (D.A.L.), National Institutes of Health, Bethesda, MD; and

Department of Neurology (D.H.B.), University Hospital of Basel, Basel, Switzerland.

1. Address correspondence and reprint requests to Dr. David H. Benninger, Departmentof Neurology, University Hospital of Basel, Petersgraben 4, 4051 Basel, Switzerland

[email protected]

Abstract

Objective: To investigate the safety and efficacy of intermittent theta-burst stimulation

(iTBS) in the treatment of motor symptoms in Parkinson disease (PD).

Background: Progression of PD is characterized by the emergence of motor deficits, which

eventually respond less to dopaminergic therapy and pose a therapeutic challenge. Repetitive

transcranial magnetic stimulation (rTMS) has shown promising results in improving gait, a

major cause of disability, and may provide a therapeutic alternative. iTBS is a novel type of

rTMS that may be more efficacious than conventional rTMS.

Methods: In this randomized, double-blind, sham-controlled study, we investigated safety

and efficacy of iTBS of the motor and dorsolateral prefrontal cortices in 8 sessions over 2

weeks (evidence Class I). Assessment of safety and clinical efficacy over a 1-month period

included timed tests of gait and bradykinesia, Unified Parkinson's Disease Rating Scale

(UPDRS), and additional clinical, neuropsychological, and neurophysiologic measures.

Results: We investigated 26 patients with mild to moderate PD: 13 received iTBS and 13

sham stimulation. We found beneficial effects of iTBS on mood, but no improvement of gait,

bradykinesia, UPDRS, and other measures. EEG/EMG monitoring recorded no pathologic

increase of cortical excitability or epileptic activity. Few reported discomfort or pain and one

experienced tinnitus during real stimulation.

Conclusion: iTBS of the motor and prefrontal cortices appears safe and improves mood, but

failed to improve motor performance and functional status in PD.

Classification of evidence: This study provides Class I evidence that iTBS was not effectivefor gait, upper extremity bradykinesia, or other motor symptoms in PD.
http://www.neurology.org/content/76/7/601.shortmailto:[email protected]:[email protected]://www.neurology.org/content/76/7/601.short


7/11

The Use of Slow-Frequency Prefrontal Repetitive

Transcranial Magnetic Stimulation in Refractory

Neuropathic Pain

Sampson, Shirlene M. MD, MS; Kung, Simon MD; McAlpine, Donald E. MD;

Sandroni, Paola MD, PhD

Abstract

Objective: A number of antidepressant medications, as well as electroconvulsive therapy,

have been shown to reduce chronic pain. Slow-frequency repetitive transcranial magnetic

stimulation (rTMS) applied to the right dorsolateral prefrontal cortex has also been shown to

have an antidepressant effect. Given the high degree of suffering experienced by subjectswith chronic neuropathic pain and the treatment resistance noted in this population, the use of

slow-frequency rTMS as adjuvant therapy may be of significant clinical benefit.

Methods: Fifteen sessions of 1-Hz rTMS (1600 stimulations/session) were applied to the right

dorsolateral prefrontal cortex as adjuvant treatment in 9 subjects with refractory neuropathic

pain over 3 weeks. Pain and depression ratings were performed at baseline, weekly during

rTMS treatment, and monthly for up to 3 months after treatment.

Results: Five males and 4 females participated, and all had longstanding refractory

neuropathic pain (range, 1-19 years), with an average baseline pain rating of 7.3 and no

depression (Hamilton Rating Scale for Depression average, 3.6; range, 0-8). Three subjectshad a greater than 50% decline in pain ratings by the completion of rTMS treatments, and 1

subject responded more slowly with greater than 50% improvement in pain by the end of the

3-month follow-up. An improvement in pain ratings was noted in responders within the first

week.

Conclusions: Although these are preliminary findings in an open treatment trial, the subjects

in this trial are among the least likely to have a placebo response. Given that rTMS is a well-

tolerated and noninvasive intervention, any sustained improvement in neuropathic pain with

rTMS is encouraging.

BAB 1Neural Correlates of theAntinociceptive Effects of Repetitive
http://showhide%28%27ej-article-box-text1%27%2C%20%27img1%27%29/


8/11

Transcranial Magnetic Stimulation on

Central Pain After Stroke

1. Suk Hoon Ohn1. Won Hyuk Chang1. Chang-hyun Park1. Sung Tae Kim1. Jung Il Lee1. Alvaro Pascual-Leone1. Yun-Hee Kim, M.D., Ph.D. [email protected]

Abstract

Background. Repetitive transcranial magnetic stimulation (rTMS) modulates central

neuropathic pain in some patients after stroke, but the mechanisms of action are uncertain.

Objective. The authors used diffusion tensor imaging (DTI) and functional MRI (fMRI) to

evaluate the integrity of the thalamocortical tract (TCT) and the activation pattern of the pain

network in 22 patients with poststroke central pain.Methods. Each patient underwent daily

10-Hz rTMS sessions for 1000 pulses on 5 consecutive days over the hotspot for the firstdorsal interosseus muscle. Pain severity was monitored using the Visual Analogue Scale

(VAS). Mood was assessed by the Hamilton Depression Rating Scale.Results. Clinical data

from all participants along with the DTI and fMRI findings from 10 patients were analyzed.

VAS scores decreased significantly, if modestly, following administration of rTMS in 14

responders, which lasted for 2 weeks after the intervention. Regression analysis showed a

significant correlation between less initial depression and higher antalgic effect of rTMS.

Integrity of the superior TCT in the ipsilesional hemisphere showed significant correlation

with change of VAS score after rTMS. fMRI showed significantly decreased activity in the

secondary somatosensory cortex, insula, prefrontal cortex, and putamen in rTMS responders,

whereas no change was noted in nonresponders. Conclusion. Mood may affect the modest

antinociceptive effects of rTMS that we found, which may be mediated by the superior TCTthrough modulation of a distributed pain network.
http://nnr.sagepub.com/search?author1=Suk+Hoon+Ohn&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Won+Hyuk+Chang&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Chang-hyun+Park&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Sung+Tae+Kim&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Jung+Il+Lee&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Alvaro+Pascual-Leone&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Yun-Hee+Kim&sortspec=date&submit=Submitmailto:[email protected]:[email protected]://nnr.sagepub.com/search?author1=Yun-Hee+Kim&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Alvaro+Pascual-Leone&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Jung+Il+Lee&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Sung+Tae+Kim&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Chang-hyun+Park&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Won+Hyuk+Chang&sortspec=date&submit=Submithttp://nnr.sagepub.com/search?author1=Suk+Hoon+Ohn&sortspec=date&submit=Submit


9/11

A Randomized, Placebo-Controlled Trial of

Repetitive Spinal Magnetic Stimulation in

Lumbosacral Spondylotic Pain1. Yew L. Lo MD1,*,2. Stephanie Fook-Chong MSc2,3. Antonio P. Huerto MD3,4. Jane M. George MD3

Article first published online: 13 JUN 2011

Abstract

Objective. Lumbar spondylosis is a degenerative disorder of the spine, whereby pain is a

prominent feature that poses therapeutic challenges even after surgical intervention. There are

no randomized, placebo-controlled studies utilizing repetitive spinal magnetic stimulation

(SMS) in pain associated with lumbar spondylosis. In this study, we utilize SMS technique

for patients with this condition in a pilot clinical trial.

Methods. We randomized 20 patients into SMS treatment or placebo arms. All patients

must have clinical and radiological evidence of lumbar spondylosis. Patients should present

with pain in the lumbar region, localized or radiating down the lower limbs in a radicular

distribution.

SMS was delivered with a Medtronic R30 repetitive magnetic stimulator (Medtronic

Corporation, Skovlunde, Denmark) connected to a C-B60 figure of eight coil capable of

delivering a maximum output of 2 Tesla per pulse. The coil measured 90 mm in each wing

and was centered over the surface landmark corresponding to the cauda equina region. The

coil was placed flat over the back with the handle pointing cranially. Each patient on active

treatment received 200 trains of five pulses delivered at 10 Hz, at an interval of 5 seconds

between each train. Sham SMS was delivered with the coil angled vertically and one of the

wing edges in contact with the stimulation point.

Results. All patients tolerated the procedure well and no side effects of SMS were reported.

In the treatment arm, SMS had resulted in significant pain reduction immediately and at Day

4 after treatment (P < 0.05). In the placebo arm, however, no significant pain reduction was

seen immediately and at Day 4 after SMS.

SMS in the treatment arm had resulted in mean pain reduction of 62.3% postprocedure and

17.4% at Day 4. The placebo arm only achieved pain reduction of 6.1% postprocedure and

4.5% at Day 4.

Discussion. This is the first study to show that a single session of SMS resulted in

significant improvement of pain associated with lumbar spondylosis in a randomized, double-

blind, placebo-controlled setting. The novel findings support the potential of this techniquefor future studies pertaining to neuropathic pain.


10/11


11/11

TANDA TERIMA SURAT

Telah diterima surat Undangan Simposium Pendekatan Diagnostik Penyakit Jantung dan Otak untuk

Mewujudkan Sumber Daya Manusia yang Berkualitas.

Palembang, 06 Januari 2012

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