Homeostatic effects of plasma valproate levels on corticospinal excitability changes induced by 1 Hz rTMS in patients with juvenile myoclonic epilepsy
Homeostatic effects of plasma valproate levels on corticospinal excitability changes induced by 1 Hz rTMS in patients with juvenile myoclonic epilepsy
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DOI：
10.1016/j.clinph.2006.02.015
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发表时间：
2006-06-01
影响因子：
4.7
通讯作者：
Valente, K
中科院分区：
文献类型：
--
作者：
Fregni, F;Boggio, PS;Valente, K
目的：无创脑刺激治疗癫痫的初步结果令人鼓舞，但好坏参半。两个重要的因素可能导致这种异质性：癫痫患者的大脑生理学改变和抗癫痫药物的不同存在。因此，我们旨在研究1 HzrTMS在两种不同条件下对幼年型肌阵挛癫痫(JME)患者皮质脊髓兴奋性的影响。结果：在长期服用丙戊酸盐且血浆浓度较低的JME患者中，IHzrTMS对皮质脊髓兴奋性的抑制作用与健康受试者相似。然而，在同一患者中，当血清丙戊酸浓度较高时，1赫兹rTMS显著增加皮质脊髓兴奋性。此外，rTMS治疗癫痫后的血浆丙戊酸水平与运动阈值变化呈显著正相关。结论：rTMS的调节作用与靶区大脑皮层的生理状态有关，可以用稳态可塑性机制来解释。意义：rTMS治疗癫痫时应考虑rTMS与改变皮质兴奋性的药物的相互作用。(C)2006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: The preliminary results of noninvasive brain stimulation for epilepsy treatment have been encouraging, but mixed. Two important factors may contribute to this heterogeneity: the altered brain physiology of patients with epilepsy and the variable presence of antiepileptic drugs. Therefore, we aimed to study the effects of 1 Hz rTMS on corticospinal excitability in patients with juvenile myoclonic epilepsy (JME) in two different conditions: low- or high-plasma valproate levels.Methods: Fifteen patients with WE and 12 age-matched healthy subjects participated in this study. Corticospinal excitability before and after I Hz rTMS was assessed in JME patients with low- and high-plasma valproate levels; and these results were compared with those in healthy subjects.Results: In patients with chronic use of valproate and low-plasma concentrations, I Hz rTMS had a similar significant inhibitory effect on corticospinal excitability as in healthy subjects. However, in the same patients when the serum valproate concentration was high, 1 Hz rTMS increased the corticospinal excitability significantly. In addition, there was a significant positive correlation between plasma valproate levels and the motor threshold changes after I Hz rTMS.Conclusions: Our findings can be accounted for by mechanisms of homeostatic plasticity and illustrate the dependency of the modulatory effects of rTMS on the physiologic state of the targeted brain cortex.Significance: The therapeutic use of rTMS in epilepsy should take into consideration the interaction between rTMS and drugs that change cortical excitability. (c) 2006 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.