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

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

doi:10.3389/fnins.2018.00925

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

Front Neurosci. 2018 Dec 11:12:925. doi: 10.3389/fnins.2018.00925. eCollection 2018.

Authors

Julien Nizard¹, Julien Esnault², Bénédicte Bouche², Alcira Suarez Moreno², Jean-Pascal Lefaucheur³, Jean-Paul Nguyen^{1

2}

Affiliations

¹ Multidisciplinary Pain, Palliative and Support Care Center, UIC22, PHU2 and EA3826, University Hospital Nantes, Nantes, France.
² Multidisciplinary Pain Center, Clinique Brtch, Groupe ELSAN, Nantes, France.
³ Clinical Neurophysiology Department and EA4391, Henri Mondor University Hospital, and UPEC Faculty of Medicine, Crteil, France.

Abstract

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.

Keywords: bladder pain syndrome; central sensitization; dorsolateral prefrontal cortex; interstitial cystitis; neuromodulation; transcranial magnetic stimulation.