NONINVASIVE STIMULATION OF HUMAN CENTRAL NERVOUS SYSTEM

我们继续改进运动皮层地形图的技术 使用经颅磁刺激（TMS）。 我们发现汽车地图 随着技能和运动学习的获得而扩大，揭示了 在这些认知过程中的初级运动皮层。 培训 改变两个运动动作的执行时间可以提高他们的 皮质运动表征导致更大的重叠， 这表明时间是大脑皮层可塑性的强大触发器。 患者 皮层中风患者（已经康复）的运动神经图更大， 输出针对身体的受影响侧和较低的阈值， 激发 皮质运动兴奋性在肌张力障碍中增加， 在张力障碍的对侧半球， 侧，一种机制，可以解释运动活动的溢出， 这些病人。 磁刺激而非电刺激重置姿势 帕金森氏病和原发性震颤的震颤， 皮质内结构在其生成中的重要作用。 运动后MEP的运动后易化（PEF）随运动时间延长而降低 抑郁症（PED）在慢性疲劳患者中不受影响 综合征和抑郁症。 重复经颅磁刺激（rTMS）在 辅助运动区（SMA）引起复杂运动的中断 在初级运动神经上传递的潜伏期比rTMS长的序列 皮质，这表明中线结构在晚期 复杂运动动作的规划和执行。我们的研究还表明 SMA在节段性反射（H反射）调制中的作用。我们 发现手可能有两个同侧皮质代表， 其中一个在受到刺激时产生沉默期， 运动诱发电位在相同的刺激强度。 言语回忆在左颞中和 双侧背额叶rTMS。 rTMS输送至右侧 前额区产生情绪升高和TRH分泌增加 在正常受试者和难治性患者的临床改善 萧条

We continued improving techniques for topographic mapping of motor cortex using transcranial magnetic stimulation (TMS). We found that motor maps enlarge with acquisition of skills and motor learning, unveiling the role of the primary motor cortex in these cognitive processes. Training to change the timing of execution of two motor acts can enhance their cortical motor representations leading to greater overlapping and suggesting timing is a powerful trigger of cortical plasticity. Patients with cortical strokes (who have recovered) have larger maps of motor output targeting the affected side of the body and lower thresholds for excitation. Cortical motor excitability is increased in dystonia and maps of motor outputs are deranged in the hemisphere contralateral to the dystonic side, a mechanism that could explain the overflow of motor activity in these patients. Magnetic but not electrical stimulation reset postural tremor in Parkinson's disease and essential tremor suggesting an important role of intracortical structures in their generation. Post~exercise facilitation (PEF) of MEPs is decreased while postexercise depression (PED) is not affected in patients with chronic fatigue syndrome and depression. Repetitive transcranial magnetic stimulation (rTMS) delivered over the supplementary motor area (SMA) induces disruption of complex motor sequences with a longer latency than rTMS delivered over primary motor cortex, suggesting an important role for midline structures in advanced planning and performance of complex motor acts. Our studies also suggest a role of the SMA in modulation of segmental reflexes (H-reflexes). We found that the hand may have two ipsilateral cortical representations, one of which, upon stimulation, produces silent periods and the other motor evoked potentials at the same stimulus intensity. Verbal recall was consistently diminished after left midtemporal and bilateral dorsofrontal rTMS. rTMS delivered to the right lateral prefrontal area produces mood elevation and increases in TRH secretion in normal subjects and clinical improvement in patients with refractory depression.