Excitatory and inhibitory corticospinal responses to transcranial magnetic stimulation in patients with minor to moderate head injury
Excitatory and inhibitory corticospinal responses to transcranial magnetic stimulation in patients with minor to moderate head injury
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DOI：
10.1136/jnnp.70.5.580
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发表时间：
2001-05-01
影响因子：
11
通讯作者：
Feinsod, M
中科院分区：
文献类型：
--
作者：
Chistyakov, AV;Soustiel, JF;Feinsod, M
目的——比较轻度至中度头部损伤患者对经颅磁刺激（TMS）的兴奋性和抑制性反应的变化，并通过运动诱发电位（MEP）和静默期（SP）参数证明。方法——对 38 名脑震荡、弥漫性、局灶性和复合性脑损伤患者以及 20 名健康志愿者进行检查。头部创伤后 2 周，单脉冲 TMS 后记录拇短展肌的 MEP 和 SP。评估的参数是 MEP 静息阈值、MEP/M 波振幅比、中枢运动传导时间 (CMCT)、SP 阈值、阈值间差异 (ITD) 和 SP 持续时间 (SPD)。 结果-主要发现是，由于 MEP 阈值相对较大的增加，轻度和中度头部损伤患者的 ITD 增加。这与 MEP/M 波振幅比的降低有关。 MEP和SP变化的程度取决于头部损伤的严重程度，与脑损伤的类型无关。与对照组相比，脑震荡、弥漫性、局灶性和复合性脑损伤组的 SPD 没有显着差异。患有弥漫性和复合性脑损伤的患者的 CMCT 会延长。在主观主诉中，只有疲劳与 ITD、MEP 和 SP 阈值异常显着相关。结论 - 结果表明，涉及 MEP 和 SP 生成的机制在头部损伤中受到不同程度的影响，第一个受损更严重。 ITD 的增加伴随着 MEP/M 波振幅比的降低可能反映了头部创伤中中枢运动控制的抑制性和兴奋性成分的分离性损伤。
Objectives-The changes in excitatory and inhibitory responses to transcranial magnetic stimulation (TMS), as attested by motor evoked potential (MEP) and silent period (SP) parameters, were compared in patients who sustained minor to moderate head injury.Methods-A total of 38 patients with brain concussion, and diffuse, focal, and combined brain injury and 20 healthy volunteers were examined. The MEPs and SPs were recorded from the abductor pollicis brevis muscle after single pulse TMS 2 weeks after head trauma. The parameters assessed were the MEP resting threshold, the MEP/M wave amplitude ratio, the central motor conduction time (CMCT), the SP threshold, the interthreshold difference (ITD), and the SP duration (SPD).Results-The main finding was an increase in the ITD in patients with mild and moderate head injury due to the relatively greater augmentation of the MEP threshold. This was associated with a reduction of the MEP/M wave amplitude ratio. The degree of MEP and SP changes depended on severity of head injury and was not related to the type of brain lesions. The SPD did not differ significantly in brain concussion, or diffuse, focal and combined brain injury groups compared with the control group. The CMCT was prolonged in patients with diffuse and combined brain lesions. Among subjective complaints only fatigue was significantly related to ITD, MEP, and SP threshold abnormalities.Conclusions-The results suggest that mechanisms involved in MEP and SP generation are differently affected in head injury, the first being impaired more severely. The increase of the ITD accompanied by reduction of the MEP/M wave amplitude ratio may reflect a dissociated impairment of inhibitory and excitatory components of central motor control in head trauma.