Sangpil Son

Background: Central poststroke pain (CPSP) is neuropathic pain caused by a cerebrovascular lesion. Repetitive transcranial magnetic stimulation has been shown to effectively reduce CPSP. Intermittent theta burst stimulation (iTBS), an alternative stimulation method to conventional repetitive transcranial magnetic stimulation, has been shown to have beneficial effects for neuropathic pain. The objective of this study was to investigate the effects of iTBS on CPSP and demonstrate the effects using clinical assessment scales. Methods: Patients with CPSP who met the neuropathic pain criteria of the PainDetect questionnaire (PD-Q), Leeds assessment of neuropathic symptoms and signs (LANSS), and Douleur neuropathique 4 questions (DN4) were recruited. Twenty patients were randomly assigned to a real or sham iTBS and underwent 5 sessions of iTBS to the motor cortex. Before the initial stimulation and after the completion of 5 sessions, PD-Q, LANSS, DN4, and numeric rating scale were assessed. Results: PD-Q, LANSS, DN4, and numeric rating scale decreased significantly in the real iTBS group but not in the sham iTBS group. There were no adverse effects regarding the iTBS sessions. Conclusion: iTBS was effective in reducing CPSP. Considering the safety and convenience of application, iTBS can be suggested as an effective treatment for patients with CPSP.

The sciatic nerve can be injured through various mechanisms, including direct compression and ischemia related to traumatic events. Reports of iatrogenic sciatic nerve injury caused by misplaced intramuscular injections are rare. We present a case involving a 5-year-old patient who developed motor weakness and hypesthesia in the left lower extremity following an intramuscular injection of diclofenac into the left buttock. An electrodiagnostic study diagnosed the patient with an injury to the left sciatic nerve, primarily affecting its peroneal division. This diagnosis was later confirmed by radiologic evaluation. Following several weeks of rehabilitation, which included gait pattern correction, verbal cueing, and electrical stimulation therapy, the patient showed improvement in sensory deficits and motor impairment. The peroneal portion of the sciatic nerve is more susceptible to injury than the tibial portion due to its structural characteristics. Additionally, the sciatic nerve follows various paths as it passes the piriformis muscle. Certain drugs, such as diclofenac, exhibit greater neurotoxicity than others. When neurologic deficits are observed, an electrodiagnostic study is recommended. This helps not only in identifying the etiology and precise location of the neural insult but also in predicting the prognosis and formulating a comprehensive treatment plan.

Lumbar plexopathy resulting from gunshot wounds is rare and is typically associated with open or penetrating injuries. We report a case of lumbar plexopathy caused by a gunshot wound without direct trauma to the plexus. A 77-year-old woman visited the emergency room with a gunshot wound incurred accidentally by a hunter. The entry wound was located on the right lower back, with the exit wound on the left upper arm. The projectiles remained lodged in the paraspinal muscles and had not traversed the fractured vertebral body. Following an emergent left lower pulmonary lobectomy, the patient reported paresthesia and a tingling sensation on the lateral aspects of both thighs. Electrophysiological studies indicated bilateral upper lumbar plexopathy with direct injury to the paraspinal muscles. A low-velocity shotgun injury can transform into high-energy trauma due to the direct impacts of the projectiles, secondary shock waves, and cavitation effects. When neurologic symptoms manifest along a specific dermatome in the lower extremities after a gunshot wound to the lower back, clinicians should consider the possibility of plexopathy, even in the absence of direct trauma to the plexus.

To compare the effects of intermittent theta burst stimulation (iTBS) and high-frequency repetitive transcranial magnetic stimulation (rTMS) on spinal cord injury-related neuropathic pain with sham controls, using neuropathic pain-specific evaluation tools. A randomized, double-blind, sham-controlled trial. Rehabilitation medicine department of a university hospital. Thirty-three patients with spinal cord injury-related neuropathic pain. Patients were randomly allocated to one of three groups (real iTBS, real rTMS, and sham rTMS). Each patient underwent five sessions of assigned stimulation. Before and after completion of the five sessions, patients were evaluated using the self-completed Leeds Assessment of Neuropathic Symptoms and Signs, Numeric Rating Scale, Neuropathic Pain Symptom Inventory, and Neuropathic Pain Scale. Real iTBS and real rTMS reduced pain levels after stimulation according to all the evaluation tools, and the changes were significant when compared to the values of the sham rTMS group. No significant differences were found between the real iTBS and real rTMS groups. Both iTBS and rTMS were effective in reducing spinal cord injury-related neuropathic pain. When safety, convenience, and compliance are considered, iTBS would have an advantage over rTMS in clinical situations with spinal cord injury-related neuropathic pain.Trial Registration: This trial was registered with the Clinical Research Information Service (registration no. KCT0004976).