No abstract

We assessed for the first time the long-term maintenance of repetitive transcranial magnetic stimulation (rTMS)-induced analgesia in patients with chronic widespread pain due to fibromyalgia. Forty consecutive patients were randomly assigned, in a double-blind fashion, to 2 groups: one receiving active rTMS (n=20) and the other, sham stimulation (n=20), applied to the left primary motor cortex. The stimulation protocol consisted of 14 sessions: an "induction phase" of 5 daily sessions followed by a "maintenance phase" of 3 sessions a week apart, 3 sessions a fortnight apart, and 3 sessions a month apart. The primary outcome was average pain intensity over the last 24 hours, measured before each stimulation from day 1 to week 21 and at week 25 (1 month after the last stimulation). Other outcomes measured included quality of life, mood and anxiety, and several parameters of motor cortical excitability. Thirty patients completed the study (14 in the sham stimulation group and 16 in the active stimulation group). Active rTMS significantly reduced pain intensity from day 5 to week 25. These analgesic effects were associated with a long-term improvement in items related to quality of life (including fatigue, morning tiredness, general activity, walking, and sleep) and were directly correlated with changes in intracortical inhibition. In conclusion, these results suggest that TMS may be a valuable and safe new therapeutic option in patients with fibromyalgia.

Previous research suggests that patients with Alzheimer's disease (AD) are impaired on executive function early in the course of disease, but negative findings were reported. To evaluate the performance on executive tasks in early AD and to determine the involvement of memory on the outcome of executive tasks. Thirty-six AD patients were divided into two subgroups on the basis of the MMSE: very mild and mild. The comparison with 17 normal controls shows that very mild AD patients had deficits on visuospatial short-term memory, episodic memory, flexibility and self-monitoring abilities, concept formation and reasoning. The mild AD patients showed additional deficits on the Similarities test. Episodic memory and executive deficits occur in the very early stage of AD and precede impairment in constructional praxis, language and sustained attention. With the progression of the disease, additional deficit is observed in abstract thinking. In mild AD, memory failure is also related to executive impairment.