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. 2022 Mar 4:16:848347.
doi: 10.3389/fnhum.2022.848347. eCollection 2022.

A Preliminary Study of the Efficacy of Transcranial Direct Current Stimulation in Trigeminal Neuralgia

Babak Babakhani  1 , Narges Hoseini Tabatabaei  2 , Kost Elisevich  3 , Narges Sadeghbeigi  4 , Mojtaba Barzegar  4   5 , Neda Mohammadi Mobarakeh  6   7 , Fatemeh Eyvazi  7   8 , Zahra Khazaeipour  1 , Arman Taheri  2 , Mohammad-Reza Nazem-Zadeh  6   7
Affiliations

A Preliminary Study of the Efficacy of Transcranial Direct Current Stimulation in Trigeminal Neuralgia

Babak Babakhani et al. Front Hum Neurosci. .

Abstract

The purpose of this study is to assess the efficacy of transcranial direct current stimulation (tDCS) in patients with treatment-refractory trigeminal neuralgia (TN) and examine the utility of neuroimaging methods in identifying markers of such efficacy. Six patients with classical TN refractory to maximal medical treatment, underwent tDCS (three cases inhibitory/cathodic and three cases excitatory/anodic stimulation). All patients underwent pre- and posttreatment functional magnetic resonance imaging (fMRI) during block-design tasks (i.e., Pain, Pain + tDCS, tDCS) as well as single-shell diffusion MRI (dMRI) acquisition. The precise locations of tDCS electrodes were identified by neuronavigation. Five therapeutic tDCS sessions were carried out for each patient with either anodic or cathodic applications. The Numeric Rating Scale of pain (NRS) and the Headache Disability Index (HDI) were used to score the subjective efficacy of treatment. Altered activity of regional sites was identified by fMRI and associated changes in the spinothalamocortical sensory tract (STCT) were measured by the dMRI indices of fractional anisotropy (FA) and mean diffusivity (MD). Fiber counts of the bilateral trigeminal root entry zone (REZ) were performed as an added measure of fiber loss or recovery. All patients experienced a significant reduction in pain scores with a substantial decline in HDI (P value < 0.01). Following a course of anodic tDCS, the ipsilateral caudate, globus pallidus, somatosensory cortex, and the contralateral globus pallidus showed a significantly attenuated activation whereas cathodic tDCS treatment resulted in attenuation of the thalamus and globus pallidus bilaterally, and the somatosensory cortex and anterior cingulate gyrus contralaterally. dMRI analysis identified a substantial increase (>50%) in the number of contralateral sensory fibers in the STCT with either anodic or cathodic tDCS treatment in four of the six patients. A significant reduction in FA (>40%) was observed in the ipsilateral REZ in the posttreatment phase in five of the six patients. Preliminary evidence suggests that navigated tDCS presents a promising method for alleviating the pain of TN. Different patterns of activation manifested by anodic and cathodic stimulation require further elaboration to understand their implication. Activation and attenuation of responses at various sites may provide further avenues for condition treatment.

Keywords: brain stimulation; dMRI (diffusion magnetic resonance imaging); fMRI; neural bases; pain; tDCS—transcranial direct current stimulation; treatment efficacy; trigeminal neuralgia.

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Conflict of interest statement

MB was employed by Intelligent Quantitative Biomedical Imaging L.L.C. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Comparison of HDI and NRS scores in pre- and postsessions by cathodic and anodic stimulation. Note that NRS is used to quantify the severity of pain stipulating “0” as no pain and “10” as the greatest imaginable pain, while HDI provides a score for the level of disability suffered with TN.
FIGURE 2
FIGURE 2
The proposed cathodic tDCS modulation pathway of the contralateral sensory area.
FIGURE 3
FIGURE 3
The proposed anodic tDCS modulation pathway of the contralateral motor area.
See this image and copyright information in PMC

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