Direct demonstration of the effects of repetitive paired-pulse transcranial magnetic stimulation at I-wave periodicity
Direct demonstration of the effects of repetitive paired-pulse transcranial magnetic stimulation at I-wave periodicity
复制标题
DOI：
10.1016/j.clinph.2007.02.020
复制
发表时间：
2007-06-01
影响因子：
4.7
通讯作者：
Rothwell, J. C.
中科院分区：
文献类型：
--
作者：
Di Lazzaro, V.;Thickbroom, G. W.;Rothwell, J. C.
目的：探讨双脉冲重复I波周期经颅磁刺激(ITMS)对运动诱发电位(MEP)波幅易化的中枢神经系统水平。方法：对1例颈椎硬膜外间隙植入电极控制疼痛的清醒患者，记录ITMS前、中、后运动皮质脊髓诱发电位。此外，我们还比较了5名健康受试者ITMS前后MEP与TMS和颈髓交界处刺激的MEP。结果：在使用硬膜外电极的患者中，在ITMS期间MEP波幅进行性增加，在干预期结束时MEP增加了300%以上。MEP波幅显著增加的同时，硬膜外抽射的波幅也略有增加。ITMS结束后3min，MEP波幅仍明显增加(>200%)。在5名健康受试者中，ITMS促进了经颅磁刺激诱发的MEP，但对刺激颈髓交界处诱发的CMEP没有影响。结论：ITMS导致脊髓上水平的皮质运动兴奋性增加，这可能包括参与I波产生的回路。意义：ITMS增加皮质兴奋性的范围比它所针对的I波网络更广泛。(C)2007年国际临床神经生理学联合会。爱思唯尔爱尔兰有限公司出版。版权所有。
Objective: To investigate the central nervous system level at which paired-pulse repetitive transcranial magnetic stimulation at I-wave periodicity (iTMS) produces a facilitation of motor evoked potential (MEP) amplitude.Methods: In one conscious patient who had an electrode implanted in the cervical epidural space for the control of pain, we recorded corticospinal volleys evoked before, during and after iTMS of the motor cortex. Moreover, we compared MEPs to TMS and cervicomedullary junction stimulation before and after iTMS in a separate group of five healthy subjects.Results: In the patient with the epidural electrode, during iTMS there was progressive increase of MEP amplitude, and by the end of the intervention period MEP increased by more than 300%. The pronounced increase in MEP amplitude was paralleled by a slight increase in the amplitude of epidural volleys. An increased MEP amplitude (more than 200%) was still evident 3 min after the end of iTMS. In the five healthy subjects, iTMS produced a facilitation of MEPs evoked by transcranial magnetic stimulation but had no effect on CMEPs evoked by cervico-medullary junction stimulation.Conclusions: The results indicate that iTMS leads to an increase in corticomotor excitability at a supraspinal level, and that this may include circuits in addition to those involved in I-wave generation.Significance: iTMS increases cortical excitability more widely than the I-wave networks that it targets. (C) 2007 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.