The number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a systematic review and meta-analysis.
The number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a systematic review and meta-analysis.
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DOI：
10.1186/s13643-017-0440-8
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发表时间：
2017-03-06
影响因子：
3.7
通讯作者：
Chipchase LS
中科院分区：
文献类型：
--
作者：
Cavaleri R;Schabrun SM;Chipchase LS
经颅磁刺激（TMS）是一种非侵入性的手段，通过它来评估中枢神经系统的结构和功能。目前的实践涉及在参与者头皮的目标区域上施用多种刺激。减少TMS评估期间提供的刺激数量将提高时间效率并降低参与者需求。然而，这样做也可能损害该技术的会话内或会话之间的可靠性。因此，本综述的目的是确定可靠测量（i）单个颅骨部位目标肌肉的皮质运动兴奋性和（ii）多个颅骨部位目标肌肉的初级运动皮质表征的地形图所需的TMS刺激的最小数量。进行数据库检索，以识别2015年5月之前发表的诊断可靠性研究。两位独立的评审员从采用单脉冲TMS的研究中提取数据，以测量（i）单个颅骨部位的皮质运动兴奋性或（ii）多个颅骨部位的靶肌肉的地形皮质组织。结果指标包括运动诱发电位振幅、标测图体积、活动标测图位点数量和标测图重心位置。只有研究比较了不同数量的刺激传递到一个单一的颅骨部位的可靠性被确定。五是最低数量的刺激，可以提供产生良好的会话内运动诱发电位（MEP）幅度的可靠性（组内相关系数（ICC）= 0.92，95% CI 0.87至0.95）。在健康参与者中，需要10个刺激来实现一致的会话间MEP幅度（ICC = 0.89，95%CI 0.76至0.95）。然而，会话间的可靠性受影响的参与者的特征，会话间隔和目标肌肉组织。需要进一步探索多站点TMS测绘的可靠性。五个刺激产生可靠的MEP记录在单站点TMS调查涉及一个会话。对于涉及多个会话的单点分析，当调查健康受试者或上肢肌肉组织的皮质运动兴奋性时，建议使用10种刺激。然而，对于涉及下肢的临床人群或评估，可能需要更多数量的刺激。PROSPERO CRD 42015024579本文的在线版本（doi：10.1186/s13643-017-0440-8）包含补充材料，可供授权用户使用。
Transcranial magnetic stimulation (TMS) is a non-invasive means by which to assess the structure and function of the central nervous system. Current practices involve the administration of multiple stimuli over target areas of a participant’s scalp. Decreasing the number of stimuli delivered during TMS assessments would improve time efficiency and decrease participant demand. However, doing so may also compromise the within- or between-session reliability of the technique. The aim of this review was therefore to determine the minimum number of TMS stimuli required to reliably measure (i) corticomotor excitability of a target muscle at a single cranial site and (ii) topography of the primary motor cortical representation of a target muscle across multiple cranial sites. Database searches were performed to identify diagnostic reliability studies published before May 2015. Two independent reviewers extracted data from studies employing single-pulse TMS to measure (i) the corticomotor excitability at a single cranial site or (ii) the topographic cortical organisation of a target muscle across a number of cranial sites. Outcome measures included motor evoked potential amplitude, map volume, number of active map sites and location of the map centre of gravity. Only studies comparing the reliability of varying numbers of stimuli delivered to a single cranial site were identified. Five was the lowest number of stimuli that could be delivered to produce excellent within-session motor evoked potential (MEP) amplitude reliability (intraclass correlation coefficient (ICC) = 0.92, 95% CI 0.87 to 0.95). Ten stimuli were required to achieve consistent between-session MEP amplitudes among healthy participants (ICC = 0.89, 95% CI 0.76 to 0.95). However, between-session reliability was influenced by participant characteristics, intersession intervals and target musculature. Further exploration of the reliability of multi-site TMS mapping is required. Five stimuli produce reliable MEP recordings during single-site TMS investigations involving one session. For single-site analyses involving multiple sessions, ten stimuli are recommended when investigating corticomotor excitability in healthy participants or the upper limb musculature. However, greater numbers of stimuli may be required for clinical populations or assessments involving the lower limb. PROSPERO CRD42015024579 The online version of this article (doi:10.1186/s13643-017-0440-8) contains supplementary material, which is available to authorized users.