# Neuronavigation‑guided rTMS of the facial motor cortex for atypical facial pain: Two case reports

## TL;DR

Neuronavigation-guided rTMS targeting the facial motor cortex provided rapid pain relief for two patients with atypical facial pain.

## Contribution

Demonstrates the safety and analgesic effect of neuronavigation-guided rTMS in atypical facial pain through two case reports.

## Key findings

- Two patients with refractory atypical facial pain experienced significant pain reduction after 10 rTMS sessions.
- Benefits lasted for days post-treatment with no serious adverse events observed.
- Pain scores improved from severe (BNI V) to mild (BNI II or III) in both cases.

## Abstract

•Neuronavigation precisely targeted the facial primary motor cortex for stimulation.•Ten 10 Hz sessions at 110 percent motor threshold produced rapid pain relief.•Pain scores improved markedly, benefits lasted days, with no serious adverse events.

Neuronavigation precisely targeted the facial primary motor cortex for stimulation.

Ten 10 Hz sessions at 110 percent motor threshold produced rapid pain relief.

Pain scores improved markedly, benefits lasted days, with no serious adverse events.

Evaluate safety and analgesic effect of neuronavigation-guided 10 Hz rTMS precisely targeting facial M1 in atypical facial pain (AFP).

Two adults with refractory AFP received 10 daily sessions (2,500 pulses/day) of 10 Hz rTMS at 110 % resting motor threshold. Targeting used MRI/CT-integrated neuronavigation to the facial M1. Pain severity (Barrow Neurological Institute [BNI] scale I–V) and adverse events were recorded through treatment and short follow-up.

Both completed treatment without serious adverse events. Case 1 improved from BNI V at baseline to II at end of treatment, persisting BNI III for 15 days. Case 2 improved from BNI IV to I, with BNI III for 2 days after therapy; both reported better sleep and mood.

Neuronavigation-guided 10 Hz rTMS of facial M1 was well tolerated and associated with rapid, clinically meaningful analgesia in two AFP cases.

Pilot data support sham-controlled studies to define dose–response and durability, identify responders, and formalize navigated rTMS as a physiological screen to select candidates and targets for implanted brain stimulations.