Safety of transcranial magnetic stimulation in Parkinson's disease: a review of the literature.
Safety of transcranial magnetic stimulation in Parkinson's disease: a review of the literature.
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DOI：
10.1016/j.parkreldis.2013.01.007
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发表时间：
2013-06
影响因子：
4.1
通讯作者：
Kluger B
中科院分区：
文献类型：
--
作者：
Vonloh M;Chen R;Kluger B
经颅磁刺激（TMS）已被用于生理学研究，最近，帕金森病（PD）的治疗。在健康受试者和其他患者人群中进行的既往TMS研究表明，癫痫发作和其他不良事件的风险较低。我们的目标是估计这些风险并记录PD患者特有的其他安全性问题。我们通过PudMed进行了英语文献检索，以回顾所有涉及PD患者的TMS研究。我们记录了与这些研究相关的任何癫痫发作或其他不良事件。计算每例受试者和每次TMS的粗风险。我们确定了84项单脉冲（spTMS）和/或配对脉冲（ppTMS）TMS研究，涉及1091例患者和77项重复TMS（rTMS）研究，涉及1137例患者。所有方案的不良事件风险均较低。每例患者任何不良事件的spTMS和ppTMS风险为0.0018（95% CI：0.0002 - 0.0066），未发生癫痫发作。每例患者的rTMS不良事件风险为0.040（95% CI：0.029 - 0.053），未报告癫痫发作。其他不良事件包括短暂性头痛、头皮疼痛、耳鸣、恶心、原有疼痛加重和肌肉痉挛。在一项涉及辅助运动区（SMA）rTMS的研究中观察到帕金森病症状一过性恶化。我们的结论是，目前的TMS和rTMS协议不构成重大风险PD患者。我们建议该人群中的TMS使用者遵循最新的安全指南，但不需要额外的预防措施。
Transcranial magnetic stimulation (TMS) has been used in both physiological studies and, more recently, the therapy of Parkinson’s Disease (PD). Prior TMS studies in healthy subjects and other patient populations demonstrate a slight risk of seizures and other adverse events. Our goal was to estimate these risks and document other safety concerns specific to PD patients. We performed an English-Language literature search through PudMed to review all TMS studies involving PD patients. We documented any seizures or other adverse events associated with these studies. Crude risks were calculated per subject and per session of TMS. We identified 84 single pulse (spTMS) and/or paired pulse (ppTMS) TMS studies involving 1091 patients and 77 repetitive TMS (rTMS) studies involving 1137 patients. Risk of adverse events was low in all protocols. spTMS and ppTMS risk per patient for any adverse event was 0.0018 (95% CI: 0.0002 – 0.0066) per patient and no seizures were encountered. Risk of an adverse event from rTMS was 0.040 (95% CI: 0.029 – 0.053) per patient and no seizures were reported. Other adverse events included transient headaches, scalp pain, tinnitus, nausea, increase in pre-existing pain, and muscle jerks. Transient worsening of Parkinsonian symptoms was noted in one study involving rTMS of the supplementary motor area (SMA). We conclude that current TMS and rTMS protocols do not pose significant risks to PD patients. We would recommend that TMS users in this population follow the most recent safety guidelines but do not warrant additional precautions.
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影响因子：
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作者：
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