Limits...
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.


EEG power spectra analysis results comparison for all channels in the pre-study visit week and seventh week (1–50 Hz; Fp1, Fp2, Fz, F3, Cz, and P3). The background colors indicate the EEG frequency bands: red, δ wave; orange, θ wave; yellow, α wave; green, β wave; blue, γ wave. The green lines and blue lines, respectively, indicate power spectra in the seventh week and pre-visit week of tDCS stimulation. Generally the power of δ, θ, α, and β waves increased, while the power of γ wave decreased in channels Fp1/Fp2/P3 and increased in channels F3/Fz/Cz, after 7 weeks of tDCS stimulation.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5037215&req=5

Figure 5: EEG power spectra analysis results comparison for all channels in the pre-study visit week and seventh week (1–50 Hz; Fp1, Fp2, Fz, F3, Cz, and P3). The background colors indicate the EEG frequency bands: red, δ wave; orange, θ wave; yellow, α wave; green, β wave; blue, γ wave. The green lines and blue lines, respectively, indicate power spectra in the seventh week and pre-visit week of tDCS stimulation. Generally the power of δ, θ, α, and β waves increased, while the power of γ wave decreased in channels Fp1/Fp2/P3 and increased in channels F3/Fz/Cz, after 7 weeks of tDCS stimulation.

Mentions: Figure 4 indicates EEG data spectrum change right before and after tDCS stimulus (Week 2, 3, and 7 EEG data included, power between 0 and 50 Hz frequency band were compared). Power spectra at γ band significantly decreased immediately after tDCS application at location F3, Fz, Cz, and P3 (p < 0.05). Power spectra at β band significantly decreased immediately after tDCS application at location Fz and P3 (p < 0.05). In α band, the power spectra significantly decreased after tDCS stimulus at location Cz and P3 (p < 0.05). Figure 5 compares EEG data spectrum in pre-study visit week and week 7 in a long term. Power spectra at δ band significantly increased after 7 weeks tDCS stimulation at location Fp1, F3, Fz, Cz, and P3 (p < 0.05). Power spectra at θ band significantly increased in week 7 at locations Fp1, Fz and Cz compared with pre-study visit week (p < 0.05). In α band, the power spectra significantly increased in week 7 at locations Fp1, Fz and Cz (p < 0.05). In γ band, the power spectra significantly increased in week 7 at location P3 (p < 0.05).


Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients with Advanced Head and Neck Cancer
EEG power spectra analysis results comparison for all channels in the pre-study visit week and seventh week (1–50 Hz; Fp1, Fp2, Fz, F3, Cz, and P3). The background colors indicate the EEG frequency bands: red, δ wave; orange, θ wave; yellow, α wave; green, β wave; blue, γ wave. The green lines and blue lines, respectively, indicate power spectra in the seventh week and pre-visit week of tDCS stimulation. Generally the power of δ, θ, α, and β waves increased, while the power of γ wave decreased in channels Fp1/Fp2/P3 and increased in channels F3/Fz/Cz, after 7 weeks of tDCS stimulation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037215&req=5

Figure 5: EEG power spectra analysis results comparison for all channels in the pre-study visit week and seventh week (1–50 Hz; Fp1, Fp2, Fz, F3, Cz, and P3). The background colors indicate the EEG frequency bands: red, δ wave; orange, θ wave; yellow, α wave; green, β wave; blue, γ wave. The green lines and blue lines, respectively, indicate power spectra in the seventh week and pre-visit week of tDCS stimulation. Generally the power of δ, θ, α, and β waves increased, while the power of γ wave decreased in channels Fp1/Fp2/P3 and increased in channels F3/Fz/Cz, after 7 weeks of tDCS stimulation.
Mentions: Figure 4 indicates EEG data spectrum change right before and after tDCS stimulus (Week 2, 3, and 7 EEG data included, power between 0 and 50 Hz frequency band were compared). Power spectra at γ band significantly decreased immediately after tDCS application at location F3, Fz, Cz, and P3 (p < 0.05). Power spectra at β band significantly decreased immediately after tDCS application at location Fz and P3 (p < 0.05). In α band, the power spectra significantly decreased after tDCS stimulus at location Cz and P3 (p < 0.05). Figure 5 compares EEG data spectrum in pre-study visit week and week 7 in a long term. Power spectra at δ band significantly increased after 7 weeks tDCS stimulation at location Fp1, F3, Fz, Cz, and P3 (p < 0.05). Power spectra at θ band significantly increased in week 7 at locations Fp1, Fz and Cz compared with pre-study visit week (p < 0.05). In α band, the power spectra significantly increased in week 7 at locations Fp1, Fz and Cz (p < 0.05). In γ band, the power spectra significantly increased in week 7 at location P3 (p < 0.05).

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 &alpha;, &beta;, and &gamma; bands immediately after tDCS stimulation and, in addition, &alpha;, &delta;, and &theta; bands over the long term in the seventh stimulation week (p &lt; 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 &mu;-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.