Transcranial Magnetic Stimulation in Epilepsy.
Transcranial Magnetic Stimulation in Epilepsy.
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DOI：
10.1046/j.1535-7597.2003.03607.x
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发表时间：
2003-11-01
影响因子：
3.6
通讯作者：
Theodore, William H.
中科院分区：
文献类型：
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作者：
Theodore, William H.
经颅磁刺激（TMS）似乎是研究癫痫发作疾病的一个有吸引力的工具。这是简单的执行，相对便宜，通常是安全的，与潜在的神经元兴奋性提供非侵入性的临床测量。在癫痫患者中的应用包括调查潜在的皮质兴奋性和确定抗癫痫药物（AED）的影响;术前癫痫灶的定位;和功能映射。已经发表了几篇关于TMS治疗癫痫的综述文章（1-5）。最有趣的是，TMS可能成为一种新的癫痫治疗模式。TMS测量的参数包括运动阈值（目标肌肉运动反应的最小阈值）和运动诱发电位（MEP）振幅，两者均使用单脉冲测量（见表1）。皮层沉默期（CSP）是肌电图（EMG）的一种中断，当在强直性随意肌肉收缩期间给予TMS脉冲时;其持续时间与刺激强度有关。用成对脉冲刺激技术测量其他参数。例如，皮层内抑制（ICI），MEP幅度从第一个到第二个刺激的降低，当阈下条件脉冲之后是阈上脉冲，延迟2到5毫秒，而皮层内易化（ICF）发生在脉冲间隔7到20毫秒时。
Transcranial magnetic stimulation (TMS) seems an attractive tool for the study of seizure disorders. It is simple to perform, relatively inexpensive, and generally safe, with the potential to provide noninvasive clinical measurements of neuronal excitability. Applications in patients with epilepsy include investigation of underlying cortical excitability and determination of the effects of antiepileptic drugs (AEDs); preoperative localization of epileptic foci; and functional mapping. Several review articles have been published on the use of TMS for epilepsy (1–5). Most intriguingly, TMS could become a new seizure treatment modality.The parameters measured by TMS include motor threshold, which is the minimal threshold for motor response in target muscle and motor evoked potential (MEP) amplitude, both measured using single pulses (see Table 1). The cortical silent period (CSP) is a lapse in electromyogram (EMG), when a TMS pulse is given during tonic voluntary muscle contraction; its duration is related to stimulus intensity. Additional parameters are measured with paired-pulse stimulation techniques. For example, intracortical inhibition (ICI), a decrease in MEP amplitude from the first to the second stimulus, is seen when a subthreshold conditioning pulse is followed by a suprathreshold pulse after a 2-to 5-millisecond delay, whereas intracortical facilitation (ICF) occurs when the pulses are 7 to 20 milliseconds apart.