Motor cortical excitability behavior in chronic spinal cord injury neuropathic pain individuals submitted to transcranial direct current stimulation—case reports

Abstract

Introduction

Increased excitability of the motor cortex through transcranial direct current stimulation (tDCS) has been described as a non-pharmacological strategy for the treatment of Spinal Cord Injury neuropathic pain (SCINP). It is also believed that the ability to enhance motor cortex excitability (MCE) could be impaired within chronic SCINP individuals. The following case reports describe the MCE behavior in individuals with chronic SCINP submitted to electrical non-invasive neuromodulation.

Case presentations

This article reports 11 cases with chronic SCINP in which each individual was submitted to a 5-day pre-post MCE analysis in order to evaluate its behavior after the anodal tDCS sessions. All cases maintained ongoing pharmacological treatment. Four individuals have shown negative variation of the MCE, two of which reported pain intensity reduction. Three other individuals had MCE-positive variation along 5 days, from which only one reported a VAS 0.5 pain reduction after the 5th day of observation. The other four individuals did not present significant variation of the MCE.

Discussion

The positive variation of MCE was significantly altered by adjunctive tDCS only in three individuals, though no clinically relevant reduction in pain intensity was reported among these participants. Key factors such as pain and injury duration, age, chronic medication use and underlying maladaptive neuroplasticity may influence responsiveness to brain stimulation within this population. These case reports try to add evidence for cautious recommendation of tDCS in chronic SCINP individuals and to the necessity of identifying groups of individuals that are most susceptible to neuromodulation.

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Fig. 1: Individual MEP-quotient variation D1-D5.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors gratefully acknowledge Mrs. Mariana Vieira da Fonseca Ph.D. for the valuable statistical and methodological consulting, and Dr. Enio Alberto Comerlato and Dr. Denise Lima Medeiros de Melo for gently helping in acquisition of the neurophysiological parameters.

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Contributions

VGC was responsible for designing the study protocol, writing the protocol, enrolling patients, extracting and analyzing data, interpreting results, updating reference lists, and drafting the final report. RLA was responsible for reviewing the study protocol, interpreting results and reviewing critically the final report for important intellectual content. RBB was responsible for reviewing the protocol, providing feedback on the final report and final approval of the version to be submitted.

Corresponding author

Correspondence to Victor Gomide Carvalho.

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The present study was approved by the Associação das Pioneiras Sociais ethics committee (process number 2.357.788). We certify that all applicable institutional and governmental regulations concerning the ethical use of human health data were followed during the course of this research.

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Carvalho, V.G., de Almeida, R.L. & Boechat-Barros, R. Motor cortical excitability behavior in chronic spinal cord injury neuropathic pain individuals submitted to transcranial direct current stimulation—case reports. Spinal Cord Ser Cases 6, 101 (2020). https://doi.org/10.1038/s41394-020-00355-5

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