Long-Term Relief of Painful Bladder Syndrome by High-Intensity, Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Right and Left Dorsolateral Prefrontal Cortices.

Aim: To show the value of low-frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) to treat bladder pain syndrome (BPS), characterized by suprapubic pain, urgency and increased micturition frequency. Methods: A 68-year-old woman with BPS underwent 16 sessions of high-intensity, low-frequency (1 Hz) rTMS of the DLPFC, first on the right hemisphere (one daily session for 5 days, followed by one weekly session for 5 weeks), and then on the left hemisphere (one monthly session for 6 months). Results: At the end of the rTMS protocol, suprapubic pain completely vanished, micturition frequency dramatically decreased (by 60-80%), while fatigue and sleep quality improved (by 57-60%). The patient reported an overall satisfaction rate of 80% and her activities of daily living tending to normalize. Conclusion: This is the first report showing that high-intensity, low-frequency rTMS delivered on the DLPFC region of both hemispheres can relieve most symptoms of BPS (pain, urinary symptoms, and interference with physical functioning) in clinical practice.

Frontiers in neuroscience. 2018 Dec 11*** epublish ***

Julien Nizard, Julien Esnault, Bénédicte Bouche, Alcira Suarez Moreno, Jean-Pascal Lefaucheur, Jean-Paul Nguyen

Multidisciplinary Pain, Palliative and Support Care Center, UIC22, PHU2 and EA3826, University Hospital Nantes, Nantes, France., Multidisciplinary Pain Center, Clinique Brtch, Groupe ELSAN, Nantes, France., Clinical Neurophysiology Department and EA4391, Henri Mondor University Hospital, and UPEC Faculty of Medicine, Crteil, France.