Repetitive Transcranial Magnetic Stimulation Significantly Improves Cognitive, Psychiatric Function in Fibromyalgia

Patients with fibromyalgia treated with 20 sessions of low frequency repetitive transcranial magnetic stimulation (rTMS) had significantly greater improvements in cognitive and psychiatric function compared with the sham rTMS cohort for both short- and long-term follow-up, according to a study published in Brain Sciences.¹

Findings revealed rTMS therapy over the right dorsolateral prefrontal area (DLPFC) improved Fibromyalgia Impact Questionnaire (FIQ) scores. Further, the changes in Rey Auditory Verbal Learning Test (RAVLT) and Tower of London test (TOL) scores correlated with these FIQ changes.

rTMS is a noninvasive brain stimulation technique that uses electromagnetic fields to alter activity in particular areas of the cerebral cortex. It has previously demonstrated efficacy in treating neuropathic pain and is used for the management of neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, as well as in cases where pharmacological treatment has been unsuccessful. The technique is also beneficial for the management of treatment-resistant depression and obsessive-compulsive disorder (OCD).²

“Many studies have evaluated the efficacy of rTMS for relieving pain in FM; however, few have evaluated the efficacy of rTMS in modulating the associated symptoms of FM, such as fatigue and disorders of sleep, cognition, and mood, nor have they examined the relationship between changes in pain and cognitive symptoms,” wrote a team of investigators led by Marwa Y. Badr, MD, MSc, neurologist and lecturer at Tanta University in Egypt.

In the current study, eligible patients were randomized to receive 20 sessions (5 sessions per week for 4 weeks) of either active or sham rTMS (1 Hz, 120% of resting motor threshold with a total of 1200 pules/session) over the right DLPFC.

Patients were assessed at baseline, directly after sessions, and 3 months after sessions using the FIQ, the Hamilton depression rating scale (HDRS), and the Hamilton anxiety rating scale (HARS). Other measurements of interest were RAVLT, TOL, the Montreal Cognitive Assessment (MoCA), Digit Span Tests, and Trail Making. The primary outcomes were changes in FIQ scores before and after treatment and at 3 months afterwards. Secondary outcomes focused on changes in cognitive scales and Hamilton scales.

A total of 42 patients were included in the trial, with both groups relatively balanced according to age, sex, education, disease severity, and disease duration.

Although both groups reported improvements at the 1- and 3-month follow-up visits, a significantly greater improvement was reported in total FIQ (12.35 and 8.25 points, respectively) among the treatment cohort compared with the sham cohort. Similar results were demonstrated for HDRS scores (3.75 and 4.25 points, respectively), and HARS scores (4.75 and 3.4 points, respectively). Greater improvements in cognitive scales, such as RAVLT, TOL, and MoCA were also reported for those treated with rTMS.

Significant correlations between changes in FIQ and RAVLT and TOL scores were observed. However, these were only observed at 1 month post treatment.

Investigators noted the number of treatment sessions as a strength of the study, as it was greater than previous studies evaluating rTMS in patients with fibromyalgia. Additionally, follow-up visits were performed by 2 neuropsychiatric consultants who were blinded to the type of treatment sessions and the meaning of each score assessed. However, the small number of patients and short follow-up period limited the findings.

“We recommend further studies with a larger sample size and long-term follow-up,” they wrote.

References

1. ^{Badr MY, Ahmed GK, Amer RA, et al. Impact of Repetitive Transcranial Magnetic Stimulation on Cognitive and Psychiatric Dysfunction in Patients with Fibromyalgia: A Double-Blinded, Randomized Clinical Trial. Brain Sci. 2024;14(5):416. Published 2024 Apr 24. doi:10.3390/brainsci14050416}
2. ^{Khedr, E.M.; Kotb, H.; Kamel, N.F.; Ahmed, M.A.; Sadek, R.; Rothwell, J.C. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J. Neurol. Neurosurg. Psychiatry 2005, 76, 833–838.}