Modulation der Kalt-Warm-Wahrnehmung durch zerebelläre repetitive transkranielle Magnetstimulation (rTMS) - Ergebnisse einer Pilotstudie

Zusammenfassung

Anliegen Chronische Schmerzzustände resultieren aus einer dysfunktionalen Prozessierung innerhalb kortikaler Netzwerke. Es soll untersucht werden, ob durch eine repetitive transkranielle Magnetstimulation des Zerebellums die Schmerzwahrnehmung moduliert werden kann. Methode Quantitative sensorische Testung vor und nach 1-Hz- bzw. 10-Hz-rTMS des Zerebellums bei 4 Probanden. Ergebnisse Eine zerebelläre Stimulation veränderte die Wahrnehmungsschwellen und senkte die Kälteschmerzschwelle signifikant. Schlussfolgerungen rTMS des Zerebellums kann zu einer Änderung der Schmerzwahrnehmung führen.

Abstract

Objective Chronic pain syndromes often constitute a therapeutic dilemma characterized by drug resistance or abuse of pain relievers. According to recent studies, chronic pain states result from a dysfunctional processing within a complex cortical-subcortical network including frontal cortical regions, the thalamus and the cerebellum. Modulation of this network activity might hold potential of pain attenuation in chronic pain states. Repetitive transcranial magnetic stimulation (rTMS) has been shown to effectively change neuronal activity in distributed cortical circuits. Based on these findings, we investigated whether rTMS of the cerebellum leads to altered pain sensation by modulating this network. Methods Quantitative sensory testing before and after 1 Hz and 10 Hz neuronavigated rTMS of the cerebellum in 4 adult healthy volunteers. Results Cerebellar stimulation led to alteration of sensory thresholds and attenuation of cold pain sensation. Conclusions These results demonstrate that rTMS of the cerebellum is able to modulate pain sensation. Whether this treatment modality is clinically effective in chronic pain states has to be addressed in further studies.

Schlüsselwörter

Kleinhirnstimulation - repetitive transkranielle Magnetstimulation - Schmerzwahrnehmung

Key words

cerebellar stimulation - repetitive transcranial magnetic stimulation - pain perception

Literatur

• 1 Eisenberg E, McNicol E D, Carr D B. Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials.  JAMA. 2005;  293 (24) 3043-3052
• 2 Melzack R. From the gate to the neuromatrix.  Pain. 1999;  Suppl 6 S121-S126
• 3 Bestmann S, Baudewig J, Siebner H R, Rothwell J C, Frahm J. BOLD MRI responses to repetitive TMS over human dorsal premotor cortex.  Neuroimage. 2005;  28 (1) 22-29
• 4 Walpoth M, Hörtnagl C, Hinterhölzl J, Conca A, Hinterhuber H, Hausmann A. Aspekte der transkraniellen Magnetstimulation (TMS) in der Neuropsychiatrie.  Neuropsychiatrie. 2005;  19 (1) 3-14
• 5 Eichhammer P, Langguth B, Müller J, Hajak G. Die neuronale Ebene der Motorik: Bestimmung der kortikalen Exzitabilität durch TMS.  Psychiat Prax. 2005;  32 43-46
• 6 Oliveri M, Koch G, Torriero S, Caltagirone C. Increased facilitation of the primary motor cortex following 1 Hz repetitive transcranial magnetic stimulation of the contralateral cerebellum in normal humans.  Neurosci Lett. 2005;  376 (3) 188-193
• 7 Lefaucheur J P, Drouot X, Nguyen J P. Interventional neurophysiology for pain control: duration of pain relief following repetitive transcranial magnetic stimulation of the motor cortex.  Neurophysiology Clin Neurosci. 2001;  31 (4) 247-252
• 8 Rossini P M, Barker A T, Berardelli A, Caramia M D, Caruso G, Cracco R Q. et al . Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee.  Electroencephal Clin Neurophysiol. 1994;  91 (2) 79-92
• 9 Eichhammer P, Langguth B, Marienhagen J, Kleinjung T, Hajak G. Neuronavigated repetitive transcranial magnetic stimulation in patients with tinnitus: a short case series.  Biol Psychiatry. 2003;  54 (8) 862-865
• 10 Summers J, Johnson S, Pridmore S, Oberoi G. Changes to cold detection and pain thresholds following low and high frequency transcranial magnetic stimulation of the motor cortex.  Neurosci Lett. 2004;  368 (2) 197-200
• 11 Pleger B, Janssen F, Schwenkreis P, Volker B, Maier C, Tegenthoff M. Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I.  Neurosci Lett. 2004;  356 (2) 87-90
• 12 Gerschlager W, Christensen L O, Bestmann S, Rothwell J C. rTMS over the cerebellum can increase corticospinal excitability through a spinal mechanism involving activation of peripheral nerve fibres.  Clin Neurophysiol. 2002;  113 1435-1440