Hyun-Wook Nah

Background/Objectives: Central neuropathic pain (CNP) is difficult to manage, and comparative evidence for non-invasive brain stimulation is limited. We explored the short-term efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in CNP. Methods: In this randomized, sham-controlled crossover trial, 26 patients were allocated to active or sham stimulation and received high-frequency rTMS (10 Hz, 2000 pulses/session) and anodal tDCS (2 mA, 30 min) over the primary motor cortex for five days each, separated by a 4-week washout. The primary outcome was change in Numerical Rating Scale (NRS) pain intensity at 1 and 4 weeks, analysed using factorial linear mixed-effects models with and without age adjustment. Results: At 1 week, the difference between active and sham rTMS was 0.76 points (95% CI −0.005 to 1.53; p = 0.051) and 0.42 points after age adjustment (95% CI −0.37 to 1.21; p = 0.30). Active tDCS did not differ from sham tDCS, and active rTMS did not differ from active tDCS. No significant differences were found at 4 weeks or in responder analyses. No serious adverse events occurred. Conclusions: In this small exploratory trial, neither rTMS nor tDCS showed statistically significant superiority over modality-matched sham, and no difference between modalities was demonstrated. Adequately powered trials are needed.

Objectives: Sleep-disordered breathing is a common comorbidity in patients who have experienced ischemic stroke. It is typically diagnosed using polysomnography (PSG); however, no guidelines have been established regarding the appropriate timing for this test. We investigated whether polysomnographic findings obtained during hospitalization for acute ischemic stroke differ from findings obtained after discharge following symptom stabilization. Methods: We retrospectively analyzed the medical records of patients who underwent PSG at the Department of Neurology, Chungnam National University Hospital, between January 1, 2024, and January 31, 2025. Among patients diagnosed with ischemic stroke and admitted to our hospital within one year prior to the date of PSG, we compared the clinical characteristics and polysomnographic findings between those who underwent PSG during hospitalization and those who underwent it after discharge. Results: No significant differences in clinical characteristics or polysomnographic findings were observed between patients who underwent PSG while hospitalized and those who underwent PSG after discharge. Conclusions: Unless the patient is clinically unstable, the timing of PSG—whether during hospitalization or after discharge following an ischemic stroke—does not appear to make a difference.