Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study

Although rare, central post-stroke pain remains one of the most refractory forms of
neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) has been reported
to be effective in chronic cases. However, there are no data on the effects in the acute
and subacute phases after stroke. In this study, we present a case of a patient with
thalamic stroke with acute onset of pain and paresthesia who was responsive to rTMS.
After a right thalamic stroke, a 32-year-old woman presented with drug-resistant pain
and paresthesia on the left side of the body. There were no motor or sensory deficits,
except for blunted thermal sensation and allodynia on light touch. Ten daily sessions were
performed, where 10Hz rTMS was applied to the hand area of the right primary motor
cortex, 40 days after stroke. Before rTMS treatment (T0), immediately after treatment
conclusion (T1), and 1 month after treatment (T2), three pain questionnaires were
administered, and cortical responses to single and paired-pulse TMS were assessed.
Eight healthy participants served as controls. At T0, when the patient was experiencing
the worst pain, the excitability of the ipsilesional motor cortex was reduced. At T1 and
T2, the pain scores and paresthesia’ spread decreased. The clinical improvement was
paralleled by the recovery in motor cortex excitability of the affected hemisphere, in terms
of both intra- and inter-hemispheric connections. In this subacute central post-stroke
pain case, rTMS treatment was associated with decreased pain and motor cortex
excitability changes.