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Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients with Advanced Head and Neck Cancer

View Article: PubMed Central - PubMed

ABSTRACT

Patients with head and neck cancer often experience a significant decrease in their quality of life during chemoradiotherapy (CRT) due to treatment-related pain, which is frequently classified as severe. Transcranial direct current stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. In this pilot study, we investigated the clinical impact and central mechanisms of twenty primary motor cortex (M1) stimulation sessions with tDCS during 7 weeks of CRT for head and neck cancer. From 48 patients screened, seven met the inclusion criteria and were enrolled. Electroencephalography (EEG) data were recorded before and after tDCS stimulation as well as across the trial to monitor short and long-term impact on brain function. The compliance rate during the long trial was extremely high (98.4%), and patients mostly reported mild side effects in line with the literature (e.g., tingling). Compared to a large standard of care study from our institution, our initial results indicate that M1-tDCS stimulation has a pain relief effect during the CRT that resulted in a significant attenuation of weight reduction and dysphagia normally observed in these patients. These results translated to our patient cohort not needing feeding tubes or IV fluids. Power spectra analysis of EEG data indicated significant changes in α, β, and γ bands immediately after tDCS stimulation and, in addition, α, δ, and θ bands over the long term in the seventh stimulation week (p < 0.05). The independent component EEG clustering analysis showed estimated functional brain regions including precuneus and superior frontal gyrus (SFG) in the seventh week of tDCS stimulation. These areas colocalize with our previous positron emission tomography (PET) study where there was activation in the endogenous μ-opioid system during M1-tDCS. This study provides preliminary evidence demonstrating the feasibility and safety of M1-tDCS as a potential adjuvant neuromechanism-driven analgesic therapy for head and neck cancer patients receiving CRT, inducing immediate and long-term changes in the cortical activity and clinical measures, with minimal side-effects.

No MeSH data available.


tDCS Stimulation and EEG recording setup. (A) M1-PFC tDCS set up with concurrent EEG. (B) Electric current pathway from M1 anode in red to PFC cathode in blue. (C) tDCS anode/cathode and EEG channel locations set up.
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Figure 2: tDCS Stimulation and EEG recording setup. (A) M1-PFC tDCS set up with concurrent EEG. (B) Electric current pathway from M1 anode in red to PFC cathode in blue. (C) tDCS anode/cathode and EEG channel locations set up.

Mentions: The 25 cm2 sponge-pad tDCS montage consisted of the anodal electrode placed on the left primary motor cortex (M1) at the location of C5 (according the 10–20 intermediate Modified Combinatorial Nomenclature EEG system) and the cathode electrode placed on the right DLPFC at the location of F4 (Figure 2).


Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients with Advanced Head and Neck Cancer
tDCS Stimulation and EEG recording setup. (A) M1-PFC tDCS set up with concurrent EEG. (B) Electric current pathway from M1 anode in red to PFC cathode in blue. (C) tDCS anode/cathode and EEG channel locations set up.
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Related In: Results  -  Collection

License
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Figure 2: tDCS Stimulation and EEG recording setup. (A) M1-PFC tDCS set up with concurrent EEG. (B) Electric current pathway from M1 anode in red to PFC cathode in blue. (C) tDCS anode/cathode and EEG channel locations set up.
Mentions: The 25 cm2 sponge-pad tDCS montage consisted of the anodal electrode placed on the left primary motor cortex (M1) at the location of C5 (according the 10–20 intermediate Modified Combinatorial Nomenclature EEG system) and the cathode electrode placed on the right DLPFC at the location of F4 (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Patients with head and neck cancer often experience a significant decrease in their quality of life during chemoradiotherapy (CRT) due to treatment-related pain, which is frequently classified as severe. Transcranial direct current stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. In this pilot study, we investigated the clinical impact and central mechanisms of twenty primary motor cortex (M1) stimulation sessions with tDCS during 7 weeks of CRT for head and neck cancer. From 48 patients screened, seven met the inclusion criteria and were enrolled. Electroencephalography (EEG) data were recorded before and after tDCS stimulation as well as across the trial to monitor short and long-term impact on brain function. The compliance rate during the long trial was extremely high (98.4%), and patients mostly reported mild side effects in line with the literature (e.g., tingling). Compared to a large standard of care study from our institution, our initial results indicate that M1-tDCS stimulation has a pain relief effect during the CRT that resulted in a significant attenuation of weight reduction and dysphagia normally observed in these patients. These results translated to our patient cohort not needing feeding tubes or IV fluids. Power spectra analysis of EEG data indicated significant changes in α, β, and γ bands immediately after tDCS stimulation and, in addition, α, δ, and θ bands over the long term in the seventh stimulation week (p < 0.05). The independent component EEG clustering analysis showed estimated functional brain regions including precuneus and superior frontal gyrus (SFG) in the seventh week of tDCS stimulation. These areas colocalize with our previous positron emission tomography (PET) study where there was activation in the endogenous μ-opioid system during M1-tDCS. This study provides preliminary evidence demonstrating the feasibility and safety of M1-tDCS as a potential adjuvant neuromechanism-driven analgesic therapy for head and neck cancer patients receiving CRT, inducing immediate and long-term changes in the cortical activity and clinical measures, with minimal side-effects.

No MeSH data available.