'Burning mouth' pain relieved with TCMS

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'Burning mouth' pain relieved with TCMS

by Heidi Splete

WASHINGTON -- "Burning mouth syndrome," a constellation of symptoms involving burning sensations of the tongue, palate, lips, and buccal mucosa, responds to transcranial magnetic stimulation and possibly to drugs that increase levels of [gamma]-aminobutyric acid, Robert I. Henkin, M.D., said at the Clinical Resefh 2005 meeting.

The neurologic condition, which occurs late in adulthood, is most common among postmenopausal women. The specific etiology remains unknown, said Dr. Henkin, director of the Taste and Small Clinic in Washington.

His study included 53 patients with the syndrome, 42 women and 11 men, aged 20-84 years. Dr. Henkin and radiologist Lucien Levy, M.D., of the George Washington University Medical Center, used magnetic resonance spectroscopy (MRS), specifically, a standard 2-dimensional J-point resolved excitation in the steady state (J-PRESS) sequence, to measure levels of [gamma]-aminobutyric acid (GABA), glutamic acid, N-acetylaspartate, choline, and creatine in various regions of patients' brains.

Prior to treatment, patients had significantly lower levels of GABA compared with healthy volunteer controls who were age- and sex-matched to the patients, Dr. Henkin said at the meeting, which was sponsored by the American Federation for Medical Research.

Treatment with transcranial magnetic stimulation (TCMS) increased the GABA concentrations in the brain and relieved the burning sensations in 31 (68%) of the 46 treated patients. Their response suggests that the etiology of burning mouth syndrome lies in changes in a specific inhibitory neurotransmitter in the central nervous system.

For the TCMS treatment, the patients, acting as their own controls, received TCMS on each shoulder and the neck at levels of 0.2-0.4 Tesla (T), the unit used to measure magnetic field intensity prior to the application of TCMS to the head at the level of 1.1 T. The patients reported no changes in their burning mouth sensations at the 0.2-0.4 T, but 31 of the 46 patients who received magnetic stimulation to the head at a level of 1.1 T reported improvement in the burning sensations.

The magnetic treatment had no apparent side effects, no associated pain, and relieved the burning feeling in a matter of hours or days, Dr. Henkin said in an interview. The main drawback is that some patients required more than one or two additional magnetic stimulation treatments to completely alleviate their burning symptoms.

The results of the study provide measurable evidence that brain GABA levels mirror patients' pain levels, going up or down with brain GABA levels as shown in the images of MR spectroscopy of brain neurotransmitters, which show a 2-dimensional spectrum of the inhibitory neurotransmitter GABA.

The patients in the poster study who did not respond to TCMS have been treated with GABA-ergic drugs, but this treatment is ongoing and the results have yet to be analyzed, Dr. Henkin said. Drug therapy for burning mouth syndrome requires careful supervision and time, compared with the simple, rapid, and direct improvements associated with TCMS.

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