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Successful Treatment of Phantom Limb Pain by 1 Hz Repetitive Transcranial Magnetic Stimulation Over Affected Supplementary Motor Complex: A Case Report

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주제분류재활의학

초록

A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere.

Abstract

A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere.

참고문헌 (5)

  1. Bittar RG, "Deep brain stimulation for pain relief:a meta-analysis", J Clin Neurosci, 12, pp.515~519 (2005)
  2. O’Connell NE, "Non-invasive brain stimulation techniques for chronic pain", Cochrane Database Syst Rev, 4, pp.CD008208~ (2014)
  3. Dettmers C, "Increased excitability in the primary motor cortex and supplementary motor area in patients with phantom limb pain after upper limb amputation", Neurosci Lett, 307, pp.109~112 (2001)
  4. Romero-Romo JI, "Abnormal functioning of the thalamocortical system underlies the conscious awareness of the phantom limb phenomenon", Neuroradiol J, 23, pp.671~679 (2010)
  5. Diers M, "Mirrored, imagined and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain", Pain, 149, pp.296~304 (2010)

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