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

Objective: Evaluate safety and analgesic effect of neuronavigation-guided 10 Hz rTMS precisely targeting facial M1 in atypical facial pain (AFP). Methods: 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. Results: 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. Conclusions: Neuronavigation-guided 10 Hz rTMS of facial M1 was well tolerated and associated with rapid, clinically meaningful analgesia in two AFP cases. Significance: 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.