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

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.

Figures

FIGURE 1
FIGURE 1
Total daily number of micturitions (Total mict), number of nocturnal micturitions (Noct mict), and suprapubic pain intensity rated on a 0–10 numeric scale (SP Pain), after 16 sessions of 1 Hz repetitive transcranial magnetic stimulation (rTMS) delivered to the right (sessions 1 to 10) or left (sessions 11 to 16) dorsolateral prefrontal cortex (DLPFC).

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