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Higher Pretreatment Evoked Alpha-Band Oscillatory Brain Dynamics Predict Chronic Pain Reduction of Noninvasive Brain
Enrico De Martino1, Margit Midtgaard Bach1, Bruno Nascimento Couto1
1CNAP, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Objectives:
Repetitive transcranial magnetic stimulation (TMS; rTMS) of nonmotor cortical targets, including the left dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), and posterosuperior insula (PSI), has been proposed as a treatment for chronic pain with variable clinical outcomes. Previous work identified pretreatment cortical excitability and oscillatory dynamics, assessed using the combination of TMS and electroencephalography (TMS-EEG), that were associated with treatment response after primary motor cortex stimulation. In this secondary analysis of a large clinical trial, it was evaluated whether responders to rTMS delivered to these nonmotor targets exhibited distinct pretreatment TMS-evoked cortical responses compared with nonresponders.
Materials And Methods:
A total of 45 patients with chronic pain received 12 sessions over 8 weeks of 10 Hz rTMS to DLPFC, ACC or PSI. Pretreatment cortical responses were assessed using TMS-EEG at each of the 3 targets. Cortical reactivity was quantified using global and local mean field power, and oscillatory dynamics were assessed using event-related spectral perturbation (ERSP) and intertrial coherence (ITC) in the alpha-band (8-12 Hz).
Results:
Responders (20 of 45, 44%) compared with nonresponders showed higher pretreatment alpha-band ERSP and ITC over the stimulated cortical targets (both p < 0.05), and higher alpha-band ERSP and ITC values were negatively correlated with the percentage change in pain intensity (both p < 0.05). These results suggest that elevated pretreatment TMS-evoked alpha-band oscillatory activity may indicate a higher probability of pain reduction to nonmotor rTMS in chronic pain.
Conclusions:
This study supports the development of enrichment strategies using cortical neurophysiology-based markers in neuromodulation trials aimed at individualized, precision-oriented treatments.
