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Abstract
Objective: This double-blind, randomized, placebo-controlled study investigated the impact of repetitive transcranial magnetic stimulation (rTMS) on quality of life (QoL) of patients with fibromyalgia, and its possible brain metabolic substrate.
Methods: Thirty-eight patients were randomly assigned to receive high-frequency rTMS (n = 19) or sham stimulation (n = 19), applied to left primary motor cortex in 14 sessions over 10 weeks. Primary clinical outcomes were QoL changes at the end of week 11, measured using the Fibromyalgia Impact Questionnaire (FIQ). Secondary clinical outcomes were mental and physical QoL component measured using the 36-Item Short Form Health Survey (SF-36), but also pain, mood, and anxiety. Resting-state [18F]-fluorodeoxyglucose-PET metabolism was assessed at baseline, week 2, and week 11. Whole-brain voxel-based analysis was performed to study between-group metabolic changes over time.
Results: At week 11, patients of the active rTMS group had greater QoL improvement in the FIQ (p = 0.032) and in the mental component of the SF-36 (p = 0.019) than the sham stimulation group. No significant impact was found for other clinical outcomes. Compared with the sham stimulation group, patients of the active rTMS group presented an increase in right medial temporal metabolism between baseline and week 11 (p < 0.001), which was correlated with FIQ and mental component SF-36 concomitant changes (r = −0.38, p = 0.043; r = 0.51, p = 0.009, respectively). QoL improvement involved mainly affective, emotional, and social dimensions.
Conclusion: Our study shows that rTMS improves QoL of patients with fibromyalgia. This improvement is associated with a concomitant increase in right limbic metabolism, arguing for a neural substrate to the impact of rTMS on emotional dimensions involved in QoL.
Classification of evidence: This study provides Class II evidence that rTMS compared with sham rTMS improves QoL in patients with fibromyalgia.
GLOSSARY
- BDI=
- Beck Depression Inventory;
- DSM-IV-R=
- Diagnostic and Statistical Manual of Mental Disorders, 4th edition, revised;
- FDG=
- [18F]-fluorodeoxyglucose;
- FIQ=
- Fibromyalgia Impact Questionnaire;
- MCS=
- Mental Composite Score;
- PCS=
- Physical Composite Score;
- QoL=
- quality of life;
- rTMS=
- repetitive transcranial magnetic stimulation;
- SF-36=
- 36-Item Short Form Health Survey
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received March 1, 2013.
- Accepted in final form January 6, 2014.
- © 2014 American Academy of Neurology
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- rTMS for fibromyalgia: protocol departures and interpretive issues
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