Therapeutic Efficacy Of Transcranial Direct Current Stimulation In Trigeminal Neuralgia (S32.005)

Objective: To investigate the therapeutic efficacy of transcranial direct current stimulation (tDCS) in medically insufficiently controlled classical trigeminal neuralgia. Background: Previous research suggested impairment of the trigeminal nociceptive system and central facilitation of trigeminal nociceptive processing patients with TN indicating over activation of central sensory transmission. Therefore, tDCS may be useful in the treatment of insufficiently controlled TN. Design/ Methods: Fifteen patients with TN were treated with tDCS over 20 minutes every day for 14 days both with anodal stimulation as well as sham/placebo stimulation to determine the efficacy of anodal tDCS on attack frequency and pain intensity in these highly affected patients with insufficient medical treatment. Additionally, we performed pain-related evoked potentials (PREP) and the nociceptive blink reflex (nBR) following electrical stimulation of the forehead in all three divisions of the trigeminal nerve to investigate the objective neurophysiological effect of this treatment stimulation. Results: Mean attack frequency after 14 days of anodal stimulation decreased by 46% compared to 21% following sham. Mean pain intensity on a verbal rating scale (VRS) decreased by 38% after anodal and 14% after sham stimulation. PREP amplitude increased and latency decreased as expected with anodal tDCS. NBR latency decreased and area under the curve increased following that same pattern. Treatment was generally well tolerated. One patient developed a migraine attack following stimulation. Conclusion/ Relevance: TDCS showed good efficacy and excellent tolerability in patients with medically insufficiently controlled TN. Electrophysiological recording showed an adequate neurophysiological response. TDCS may provide an interesting treatment option in patients that do not response to conventional medical treatment and wait for alternative surgical or interventional treatment or prevent invasive treatment. Disclosure: Dr. Obermann has received personal compensation for activities with Biogen Idec, Novartis, Sanofi-Aventis Pharmaceuticals Inc., Pfizer Inc., and Teva Neuroscience. Dr. Obermann has received research support from the German Federal Ministry of Education and Research, and Allergan Inc. Dr. Bude has nothing to disclose. Dr. Holle received research support from Grunenthal. Dr. Hagenacker has nothing to disclose. Dr. Diener has received personal compensation for activities with Merck & Co., Inc. Allergan, Inc., Electrocore, Amgen Inc., and Novartis. Dr. Diener has received research support from Merck & Co., Inc., Allergan, Inc., Weber & Weber, and Electrocore. Dr. Katsarava has received personal compensation for activities with Allergan Inc., Bayer Pharmaceuticals Corp., Biogen Idec, and Merck & Co. Inc. Dr. Katsarave has received research support from Allergan Inc., Bayer Pharmaceuticals Corp., Biogen Idec, and Merck & Co. Inc.