Cortical Excitability, Synaptic Plasticity, and Cognition in Benign Epilepsy With Centrotemporal Spikes: A Pilot TMS-EMG-EEG Study.
Cortical Excitability, Synaptic Plasticity, and Cognition in Benign Epilepsy With Centrotemporal Spikes: A Pilot TMS-EMG-EEG Study.
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DOI：
10.1097/wnp.0000000000000662
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2020-03
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患有良性癫痫伴中央颞区棘波（BECTS）的儿童具有从运动皮层出现的罕见癫痫发作，这些癫痫发作在青春期就消失了，此外还可能具有病因不明的语言缺陷。我们试验了经颅磁刺激与EMG和EEG（TMS-EMG，TMS-EEG）配对的使用，以测试净皮层兴奋性随年龄增长而降低以及使用依赖性可塑性预测学习的假设。我们评估了14名右撇子儿童的语言和运动学习与BECTS。我们量化了左运动皮层兴奋性的两个TMS指标：静息运动阈值（rMT;神经元膜兴奋性的测量）和N100诱发电位的振幅（GABA能张力的EEG测量）。为了测试可塑性，我们将1 Hz重复TMS应用于运动皮层，以诱导EMG和EEG诱发电位的长时程抑郁（LTD）样变化。患有BECTS的儿童耐受TMS;没有癫痫发作。rMT随着年龄的增长而降低，但对于一半的人来说，rMT高于最大刺激器输出。在控制rMT后，N100振幅随年龄增加而降低。运动皮层可塑性与语言学习显著相关，并与运动学习呈趋势水平。TMS对BECTS儿童是安全可行的，并且由于许多儿童具有不可测量的高rMT，因此TMS-EEG在该组中提供比TMS-EMG更可靠的结果测量。净皮质兴奋性随年龄增长而下降，运动皮质可塑性不仅预测运动，而且预测语言学习，这表明运动皮质癫痫发作可能与语言发育相互作用的机制。
Children with benign epilepsy with centrotemporal spikes (BECTS) have rare seizures emerging from the motor cortex, which they outgrow in adolescence and additionally may have language deficits of unclear etiology. We piloted the use of transcranial magnetic stimulation paired with EMG and EEG (TMS-EMG, TMS-EEG) to test the hypotheses that net cortical excitability decreases with age and that use-dependent plasticity predicts learning. We assessed language and motor learning in 14 right-handed children with BECTS. We quantified two TMS metrics of left motor cortex excitability: the resting motor threshold (rMT; measure of neuronal membrane excitability) and amplitude of the N100 evoked potential (an EEG measure of GABAergic tone). To test plasticity, we applied 1 Hz repetitive TMS to the motor cortex to induce long term depression (LTD)-like changes in EMG and EEG evoked potentials. Children with BECTS tolerate TMS; no seizures were provoked. rMT decreases with age, but is elevated above maximal stimulator output for half the group. N100 amplitude decreases with age after controlling for rMT. Motor cortex plasticity correlates significantly with language learning and at a trend level with motor learning. TMS is safe and feasible for children with BECTS, and TMS-EEG provides more reliable outcome measures than TMS-EMG in this group due to many children having unmeasurably high rMTs. Net cortical excitability decreases with age and motor cortex plasticity predicts not only motor but also language learning, suggesting a mechanism by which motor cortex seizures may interact with language development.