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Randomized Controlled Trial
. 2014 Nov 25;15(1):78.
doi: 10.1186/1129-2377-15-78.

Patient-conducted anodal transcranial direct current stimulation of the motor cortex alleviates pain in trigeminal neuralgia

Tim Hagenacker, Vera Bude, Steffen Naegel, Dagny Holle, Zaza Katsarava, Hans-Christoph Diener, Mark Obermann  1
Affiliations
Randomized Controlled Trial

Patient-conducted anodal transcranial direct current stimulation of the motor cortex alleviates pain in trigeminal neuralgia

Tim Hagenacker et al. J Headache Pain. .

Abstract

Background: Transcranial direct current stimulation (tDCS) of the primary motor cortex has been shown to modulate pain and trigeminal nociceptive processing.

Methods: Ten patients with classical trigeminal neuralgia (TN) were stimulated daily for 20 minutes over two weeks using anodal (1 mA) or sham tDCS over the primary motor cortex (M1) in a randomized double-blind cross-over design. Primary outcome variable was pain intensity on a verbal rating scale (VRS 0-10). VRS and attack frequency were assessed for one month before, during and after tDCS. The impact on trigeminal pain processing was assessed with pain-related evoked potentials (PREP) and the nociceptive blink reflex (nBR) following electrical stimulation on both sides of the forehead before and after tDCS.

Results: Anodal tDCS reduced pain intensity significantly after two weeks of treatment. The attack frequency reduction was not significant. PREP showed an increased N2 latency and decreased peak-to-peak amplitude after anodal tDCS. No severe adverse events were reported.

Conclusion: Anodal tDCS over two weeks ameliorates intensity of pain in TN. It may become a valuable treatment option for patients unresponsive to conventional treatment.

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Figures

Figure 1
Figure 1
Fitting and configuration of the stimulation electrodes during transcranial direct current stimulation using a pair of surface rubber electrodes in a NaCl-solution soaked synthetic sponge over the primary motor cortex (M1) and above the contralateral orbit.
Figure 2
Figure 2
Analgesic efficacy of anodal transcranial direct currents stimulation (tDCS). tDCS significantly decreases mean pain intensity on the verbal rating scale (VRS) (p < 0.05), while attack frequency (AF) is not significantly different compared to control conditions. Changes of values are expressed as Δ compared to mean values under control conditions in box plots.
Figure 3
Figure 3
Effects of anodal transcranial direct current stimulation (tDCS) on (A) pain-related evoked potentials (PREPs) and (B) nociceptive blink reflex (nBR). Anodal tDCS results in decreased trigeminal peak-to-peak amplitudes and increased N2 latencies compared to baseline. Trigeminal N2 latencies and area under the curve are not significantly different between anodal tDCS and sham stimulation. Grey lines mark single patients, red lines mark mean values.
See this image and copyright information in PMC

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