Utility of threshold tracking transcranial magnetic stimulation in ALS
Utility of threshold tracking transcranial magnetic stimulation in ALS
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阈值跟踪经颅磁刺激在 ALS 中的效用
DOI：
10.1016/j.cnp.2018.10.002
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发表时间：
2018
影响因子：
1.7
通讯作者：
M. Kiernan
中科院分区：
文献类型：
--
作者：
S. Vucic;M. V. D. van den Bos;P. Menon;J. Howells;T. Dharmadasa;M. Kiernan
上运动神经元[UMN]和下运动神经元[LMN]功能障碍，在缺乏感觉功能的情况下，是肌萎缩侧索硬化症[ALS]的一个特征。虽然确切的机制尚未阐明，一个主要的假设是，UMN先于LMN功能障碍，这是由顺行性兴奋性神经元兴奋毒性引起的。经颅磁刺激（TMS）是一种神经生理学工具，可提供无创和无痛的皮质功能评估。阈值跟踪方法最近已被用于TMS，其中阈值而不是运动诱发电位（MEP）幅度的变化作为结果的措施。这项技术是可靠的，并提供了一个快速评估的皮质功能在ALS。利用阈值跟踪TMS技术，皮质过度兴奋被证明是LMN功能障碍发作前散发性ALS的早期特征，并可能有助于疾病传播。另外，皮质过度兴奋被报道先于家族性ALS的临床发作。进一步的相关性，阈值跟踪TMS技术被证明可以可靠地区分ALS与模仿疾病，即使在存在相当程度的LMN功能障碍的情况下，也表明TMS的诊断实用性。总的来说，阈值跟踪TMS提供了支持的皮质参与在最早可检测阶段的ALS，强调实用的技术探测潜在的病理生理。本综述将讨论TMS参数的生理过程，同时进一步评估阈值跟踪TMS在ALS中的病理生理和诊断效用。
Upper motor neuron [UMN] and lower motor neuron [LMN] dysfunction, in the absence of sensory features, is a pathognomonic feature of amyotrophic lateral sclerosis [ALS]. Although the precise mechanisms have yet to be elucidated, one leading hypothesis is that UMN precede LMN dysfunction, which is induced by anterograde glutamatergic excitotoxicity. Transcranial magnetic stimulation (TMS) is a neurophysiological tool that provides a non-invasive and painless assessment of cortical function. Threshold tracking methodologies have been recently adopted for TMS, whereby changes in threshold rather than motor evoked potential (MEP) amplitude serve as outcome measures. This technique is reliable and provides a rapid assessment of cortical function in ALS. Utilisng the threshold tracking TMS technique, cortical hyperexcitability was demonstrated as an early feature in sporadic ALS preceding the onset of LMN dysfunction and possibly contributing to disease spread. Separately, cortical hyperexcitability was reported to precede the clinical onset of familial ALS. Of further relevance, the threshold tracking TMS technique was proven to reliably distinguish ALS from mimicking disorders, even in the presence of a comparable degree of LMN dysfunction, suggesting a diagnostic utility of TMS. Taken in total, threshold tracking TMS has provided support for a cortical involvement at the earliest detectable stages of ALS, underscoring the utility of the technique for probing the underlying pathophysiology. The present review will discuss the physiological processes underlying TMS parameters, while further evaluating the pathophysiological and diagnostic utility of threshold tracking TMS in ALS.