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Douleurs
Volume 18, n° 2
pages 71-77 (avril 2017)
Doi : 10.1016/j.douler.2017.03.007
Received : 25 December 2016 ;  accepted : 20 Mars 2017
La neurostimulation cérébrale non invasive dans les douleurs neuropathiques
Non-invasive brain neurostimulation for neuropathic pain
 

Xavier Moisset a, , Didier Bouhassira b
a UMR-1107, NeuroDol, Inserm, service de neurologie, université Auvergne, CHU de Clermont-Ferrand, 58, rue Montalemenbert, 63000 Clermont-Ferrand, France 
b U-987, Inserm, centre d’évaluation et de traitement de la douleur, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France 

Auteur correspondant.
Résumé

La stimulation épidurale implantée du cortex moteur primaire (motor cortex stimulation [MCS]) a montré son efficacité chez 60 % des patients présentant des douleurs neuropathiques chroniques réfractaires au traitement médicamenteux. Comme toute chirurgie, cette intervention n’est pas dépourvue de risque. L’objectif des techniques de stimulation non invasive est d’essayer d’obtenir le même type d’effet sans nécessiter de chirurgie. La stimulation magnétique transcrânienne répétitive (repetitive transcranial magnetic stimulation [rTMS]) a un mode d’action proche de celui de la MCS. En ciblant le cortex moteur primaire ou le cortex dorsolateral prefrontal, il est possible d’obtenir un effet antalgique qui peut se prolonger pendant plus de deux semaines après chaque séance. En ce qui concerne la stimulation électrique trans-crânienne (transcranial direct current stimulation [tDCS]), le mécanisme d’action est différent puisqu’il existe une modulation du potentiel de membrane d’une large zone cérébrale. L’objectif de ce bref article est d’exposer quelques données d’efficacité concernant ces deux techniques ainsi que les principaux axes d’amélioration de ces méthodes.

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Summary

Epidural motor cortex stimulation (MCS) has proven to be effective for pain relief in around 60% of patients suffering from chronic neuropathic pain refractory to pharmacological analgesics. Common to all surgeries, this procedure is not without risk. The aim of these non-invasive stimulation techniques is to obtain the same efficacy avoiding surgery. Repetitive transcranial magnetic stimulation (rTMS) has an action mode similar to MCS. Targeting either primary motor cortex or dorsolateral prefrontal cortex, it is possible to obtain an analgesic effect that can last for more than 2 weeks after each session. Concerning transcranial direct current stimulation (tDCS), the action mechanism is quite different as it is based on the modulation of axon potential in a large part of the brain. The aim of this short article is to provide some data concerning efficacy and ways toward amelioration of these two techniques.

The full text of this article is available in PDF format.

Mots clés : rTMS, tDCS, Stimulation cérébrale non invasive, Douleur neuropathique

Keywords : rTMS, tDCS, Non invasive stimulation, Neuropathic pain




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