Navigated rTMS for Pain Therapy - A Practical View for Clinical Application Moussa A. Chalah, Samar S. Ayache, Alaa Mhalla, Jean-Pascal Lefaucheur Clinical.

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Navigated rTMS for Pain Therapy - A Practical View for Clinical Application Moussa A. Chalah, Samar S. Ayache, Alaa Mhalla, Jean-Pascal Lefaucheur Clinical Neurophysiology Department, EA 4391, Henri Mondor Hospital, University Paris-Est, Créteil, France Level of Evidence A for the analgesic role of rTMS Conventional or navigated procedures? Targeting the hand motor representation regardless of pain site or respecting the anatomical representation of the painful zone? To respect the somatotopic organization, the stimulation could be performed on the segment of the central sulcus facing the upper frontal gyrus (F1) for lower limb pain, the middle frontal gyrus (F2) for upper limb or hemibody pain and the lower frontal gyrus (F3) for facial pain. F1, F2 and F3: Superior, middle and inferior frontal gyri, respectively, separated by the superior frontal sulcus (sFS, in green) and the inferior frontal sulcus (iFS, in red). The projection of the sFS and iFS onto the central sulcus (CS, in yellow) divide it into three segments.