Repetitive TMS in treatment of resistant diabetic neuropathic pain

• Main Authors: Ann A. Abdelkader, Amira M. El Gohary, Husam S. Mourad, Dina A. El Salmawy
• Format: Article
• Language: English
• Published: SpringerOpen 2019-05-01
• Series: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
• Subjects: High-frequency repetitive transcranial magnetic stimulation; Painful diabetic neuropathy; Motor cortex; Nerve conduction
• Online Access: http://link.springer.com/article/10.1186/s41983-019-0075-x

Abstract Background Diabetes mellitus is a clinical syndrome characterized by hyperglycemia caused by respective or absolute deficiency of insulin. Painful neuropathy in diabetic population is popular, impacting numerous chronic diabetic patients. Although antidepressants, anticonvulsants, and opioid agonists are useful in alleviating painful neuropathy, they produce a diversity of side effects and are occasionally ineffective. Hence, there is presently a need to pursue safe, non-invasive, and effective therapeutic opportunities. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive mechanism used in releasing neuropathic pain. TMS pulses—when applied repetitively—can modulate cortical plasticity, consequently causing excitability or inhibition according to the rate of stimulation. Objectives The aim of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving resistant chronic diabetic neuropathic pain. Subjects and methods Twenty patients were recruited and divided equally into two groups: insulin-dependent (group A) and non-insulin-dependent (group B). A high-frequency (10 Hz) rTMS stimulation protocol was applied to both groups for five consecutive days over lower limbs motor cortex. VAS score and nerve conduction studies were compared before and after rTMS sessions. Results Highly significant improvements in VAS and nerve conduction studies (p > 0.01) were detected for both patient cohorts following the administration of the rTMS protocol. Conclusion According to our study, rTMS significantly reduced painful diabetic neuropathy. rTMS may produce its analgesic effects, inducing motor cortex plasticity and activating descending inhibitory pain control systems.