Article

Neuropathic pain often follows spinal cord injury (SCI). OBJECTIVE:
To compare the effect of repetitive transcranial magnetic stimulation (rTMS)
applied over different motor cortex targets (hand vs leg area) versus sham
stimulation on neuropathic pain and local neurophysiological changes in patients
with SCI. METHODS: A total of 16 patients with complete or incomplete motor SCI
and chronic neuropathic pain participated in a double-blind, cross-over
randomized study. Three single sessions of sham or active rTMS (10 Hz, total of
2000 stimuli) were applied in random order over the hand or leg area with a
minimal 2-week interval. THE MAIN OUTCOME MEASURES: were the numeric rating scale
for pain sensation and parameters derived from motor mapping of the first dorsal
interosseous muscle, including maximal amplitude of evoked response as well as
map area, volume, and location. RESULTS: rTMS applied to either the hand or the
leg area, but not sham stimulation, induced a significant but equivalent
reduction in pain for the first 48 hours postintervention (P < .05). Participants
with an incomplete lesion showed greater analgesia than those with a complete
lesion (21% vs. 3%, respectively; P < .05). The main change observed for motor
map measurements was an increase in corticospinal excitability after stimulation
of the hand area (P = .04) but not for the other conditions. CONCLUSION: rTMS
applied over the hand or leg motor cortex decreased neuropathic pain regardless
of any change in cortical excitability, suggesting that the analgesic effect is
not associated with local changes at the motor cortex level itself.

Langue : ANGLAIS