Predicción de la respuesta a la estimulación magnética transcraneal  repetitiva de la corteza motora en el dolor neuropático periférico:  Validación de un nuevo algoritmo: Publicado originalmente en la Revista Pain 2025; 166(1): 34-41.  Traducción: Camila Casal

Nadine Attal; Samuel Branders; Alvaro Pereira; Didier Bouhassira

doi:10.47924/neurotarget2026604

Autores/as

Nadine Attal Hopital Ambroise Paré, Boulogne-Billancourt, France
Samuel Branders Cognivia, Mont-St-Guibert, Belgium.
Alvaro Pereira Cognivia, Mont-St-Guibert, Belgium.
Didier Bouhassira Cognivia, Mont-St-Guibert, Belgium.

DOI:

https://doi.org/10.47924/neurotarget2026604

Palabras clave:

rTMS, algoritmo modelo predictivo, dolor neuropático, terapia individualizada

Resumen

La estimulación magnética transcraneal repetitiva de la corteza motora primaria (M1-rTMS por sus siglas en inglés) induce efectos analgésicos en el dolor neuropático, pero no todos los pacientes son buenos respondedores y aún no se han identificado predictores clínicos de la respuesta. El presente estudio tiene como objetivo desarrollar y validar un algoritmo predictivo simple y fácil de usar para la respuesta individual a M1-rTMS en dolor neuropático periférico, que pueda ser potencialmente aplicable a cualquier condición de dolor crónico. Este estudio se basa en un análisis secundario de un ensayo reciente doble ciego y controlado con placebo, que demostró la eficacia de M1-rTMS de alta frecuencia frente a placebo-rTMS y rTMS de la corteza prefrontal dorsolateral, en 149 pacientes con dolor neuropático periférico. Las variables basales se incluyeron en el modelo sin preselección y se categorizaron en variables sociodemográficas, de dolor y psicológicas. Se definieron buenos respondedores a rTMS a aquellos con ≥50% de alivio del dolor a las 25 semanas, evaluado según la mejoría en la escala numérica de dolor del 0 al 10. Se emplearon Regresion Ridge, selección de características y validación cruzada Monte Carlo para construir y validar un modelo predictivo específico para la respuesta a M1-rTMS a las 25 semanas. El algoritmo incluyó 3 variables: 2 psicológicas (síntomas depresivos y grado de magnificación en la Escala de Catastrofización del Dolor) y 1 relacionada con la distribución del dolor (dolor distal en miembro inferior). Demostró 85% de sensibilidad (P = 0.005) y 84% de especificidad (P < 0.0001) para predecir una buena respuesta a M1-rTMS a las 25 semanas. No fue predictivo de la respuesta a placebo ni a rTMS de la corteza prefrontal dorsolateral. Este algoritmo simple y fácil de usar puede contribuir a individualizar el tratamiento con M1-rTMS en pacientes con dolor neuropático periférico en la práctica clínica y en futuros ensayos clínicos.
Registro del ensayo clínico: NCT02010281.

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