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1.
Repetitive transcranial magnetic stimulation (rTMS) is emerging as a new therapeutic tool in epilepsy, where it can be used to suppress seizures or treat comorbid conditions such as mood disorder. However, as rTMS carries a risk of inducing seizures among other adverse events, its safety and tolerability in the population with epilepsy warrant distinct consideration, as this group is especially seizure-prone. Accordingly, we performed a review of the literature to estimate the risk of seizures and other adverse events associated with rTMS in patients with epilepsy. We performed an English-language literature search, and reviewed all studies published from January 1990 to February 2007 in which patients with epilepsy were treated with rTMS, and complemented the literature search with personal correspondence with authors when necessary. We identified 30 publications that described patients with epilepsy who underwent rTMS, and noted total number of relevant subjects, medication usage, incidence of adverse events, and rTMS parameters including stimulus frequency, number of stimuli, train duration, intertrain interval, coil type, and stimulation sites. The data were analyzed for adverse events related to rTMS. Crude per-subject risk, as well as per-subject mean risk weighted by sample size and risk per 1000 stimuli weighted by number of stimuli in each study, were computed for seizures and for other adverse events. Adverse events or lack thereof was reported in 26 studies (n=280 subjects). Adverse events attributed to rTMS were generally mild and occurred in 17.1% of subjects. Headache was most common, occurring in 9.6%. The most serious adverse event was seizure during treatment, which occurred in four patients (1.4% crude per-subject risk). All but one case were the patients' typical seizures with respect to duration and semiology, and were associated with low-frequency rTMS. A single case of an atypical seizure appearing to arise from the region of stimulation during high-frequency rTMS is reported. No rTMS-related episodes of status epilepticus were reported. We cautiously conclude that the risk of seizure in patients with epilepsy undergoing rTMS is small, and the risk of other mild adverse events is comparable to that seen when rTMS is used to treat other diseases. Status epilepticus or life-threatening seizures have not been reported in patients undergoing rTMS treatment. rTMS thus appears to be nearly as safe in patients with epilepsy as in nonepileptic individuals, and warrants further investigation as a therapy in this population.  相似文献
2.
The cerebellum regulates execution of skilled movements through neural connections with the primary motor cortex. A main projection from the cerebellum to the primary motor cortex is a disynaptic excitatory pathway relayed at the ventral thalamus. This dentatothalamocortical pathway receives inhibitory inputs from Purkinje cells of the cerebellar cortex. These pathways (cerebellothalamocortical pathways) have been characterized extensively using cellular approaches in animals. Advances in non-invasive transcranial activation of neural structures using electrical and magnetic stimulation have allowed us to investigate these neural connections in humans. This review summarizes various studies of the cerebellothalamocortical pathway in humans using current transcranial electrical and magnetic stimulation techniques. We studied effects on motor cortical excitability elicited by electrical or magnetic stimulation over the cerebellum by recording surface electromyographic (EMG) responses from the first dorsal interosseous (FDI) muscle. Magnetic stimuli were given with a round or figure eight coil (test stimulation) for primary motor cortical activation. For cerebellar stimulation, we gave high-voltage electrical stimuli or magnetic stimuli through a cone-shaped coil ipsilateral to the surface EMG recording (conditioning stimulation). We examined effects of interstimulus intervals (ISIs) with randomized condition-test paradigm, using a test stimulus given preceded by a conditioning stimulus by ISIs of several milliseconds. We demonstrated significant gain of EMG responses at an ISI of 3 ms (facilitatory effect) and reduced responses starting at 5 ms, which lasted 3-7 ms (inhibitory effect). We applied this method to patients with ataxia and showed that the inhibitory effect was only absent in patients with a lesion at cerebellar efferent pathways or dentatothalamocortical pathway. These results imply that this method activates the unilateral cerebellar structures. We confirmed facilitatory and inhibitory natures of cerebellothalamocortical pathways in humans. We can differentiate ataxia attributable to somewhere in the cerebello-thalamo-cortical pathways from that caused by other pathways.  相似文献
3.
Self–other discrimination is fundamental to social interaction,however, little is known about the neural systems underlyingthis ability. In a previous functional magnetic resonance imagingstudy, we demonstrated that a right fronto-parietal networkis activated during viewing of self-faces as compared with thefaces of familiar others. Here we used image-guided repetitivetranscranial magnetic stimulation (rTMS) to create a ‘virtuallesion’ over the parietal component of this network totest whether this region is necessary for discriminating self-facesfrom other familiar faces. The current results indeed show that1 Hz rTMS to the right inferior parietal lobule (IPL) selectivelydisrupts performance on a self–other discrimination task.Applying 1 Hz rTMS to the left IPL had no effect. It appearsthat activity in the right IPL is essential to the task, thusproviding for the first time evidence for a causal relationbetween a human brain area and this high-level cognitive capacity.  相似文献
4.
目的探讨重复经颅磁刺激(rTMS)对局灶性脑缺血大鼠海马内源性神经干细胞增殖的影响。方法线栓法制备大鼠大脑中动脉闭塞(MCAO)模型,50只造模成功的大鼠随机分为自然恢复组(n=25)和rTMS治疗组(n=25),评定不同缺血时间点两组大鼠的神经行为,并用免疫荧光法检测不同缺血时间点两组大鼠海马BrdU-Nestin双标阳性细胞的数量。结果缺血后1d、3d、7d。两组大鼠的神经缺失行为无明显差异;缺血后14d、28d,rTMS治疗组大鼠的神经缺失行为较自然恢复组明显改善。两组大鼠海马BrdU-Nestin双标阳性细胞在缺血后1d开始增加,3d明显增加,7d达到高峰,14d下降;rTMS治疗组大鼠海马BrdU—Nest访双标阳性细胞数明显高于自然恢复组。结论rTMS可促进海马内源性神经干细胞增殖和脑缺血受损神经功能的恢复。  相似文献
5.
Motor cortical excitability in patients with poststroke epilepsy   总被引:3,自引:0,他引:3  
Kim JH  Lee HW  Cohen LG  Park KD  Choi KG 《Epilepsia》2008,49(1):117-124
PURPOSE: To gain insight into the mechanisms underlying poststroke epilepsy (PSE), we evaluated motor cortical function in chronic stroke patients with (N = 18) and without (N = 18) PSE. METHODS: We measured resting motor threshold (RMT), motor evoked potential (MEP) amplitudes, cortical silent period (CSP), intracortical inhibition (ICI), influenced by GABAergic neurotransmission, and intracortical facilitation (ICF), influenced by glutamatergic activity, to transcranial magnetic stimulation. RESULTS: We found (1) larger MEP amplitudes and ICF, in the affected than unaffected hemispheres of patients in the PSE group but not in patients without epilepsy, and (2) comparably higher RMT and longer CSP in the absence of differences in ICI, H-reflexes or F-waves in the affected and unaffected hemispheres of both PSE and non-PSE patients. CONCLUSIONS: Enhanced cortical excitability in the affected hemisphere, possibly related to increased glutamatergic activity, could be one of the mechanisms contributing to the development of poststroke epilepsy.  相似文献
6.
Lately it has been indicated that the stimulation of both sides of the motor cortices with different frequencies of rTMS can improve the behaviour of a paretic arm. We studied the effect of rTMS in severe cases of post-stroke after nearly 10 years. They had wide hemispheric lesion and their paresis had not changed for more than 5 years. The majority of patients could not move their fingers on the affected side. In our study we examined whether the active movement could be induced by rTMS even several years after stroke and which hemisphere (affected or unaffected) stimulated by rTMS would be the best location for attenuating the spasticity and for developing movement in the paretic arm.Sixty-four patients (more than 5 years after stroke in a stable state) were followed for 3 months. They were treated with rTMS with 1 Hz at 30% of 2.3 T 100 stimuli per session twice a day for a week. The area to be stimulated was chosen according to the evoked movement by TMS in the paretic arm. That way, four groups were created and compared. In group A, where both hemispheres were stimulated (because of the single stimulation of TMS could induce movement from both sides of hemispheres) the spasticity decreased but the movement could not be influenced. A highly significant improvement in spasticity, in movement induction and in the behaviour of paresis was observed in group B, where before treatment, there was no evoked movement in the paretic arm from stimulating either hemispheres of the brain. For treatment we stimulated the unaffected hemisphere from where the intact arm is moved (ipsilateral to the paretic side). In both groups C (contralateral hemisphere to the paretic arm) and D (ipsilaterally evoked movement in the paretic arm), the spasticity decreased during the first week, but the movement of the paretic arm improved only in group C.It seems that spasticity can be modified by the stimulation either the affected or the unaffected hemisphere, but the induction of movement can be achieved only by the stimulation of an intact motor pathway and its surrounding area (groups B and C). The improvement in paretic extremities can be achieved with rTMS even after years of stroke when the traditional rehabilitation has failed.  相似文献
7.
Motor practice is associated with the formation of elementary motor memories. Here we tested in human subjects the hypothesis that observation of a motor training associated with physical practice will modulate the encoding process of a motor memory relative to physical practice alone. Voluntary thumb motions were practiced (i) alone in a direction opposite to the baseline direction of transcranial magnetic stimulation (TMS)-evoked movements (physical practice, PP) and in combination with observation of synchronous movements that were either (ii) directionally congruent (same direction, PP + AOc) or (iii) non-congruent (opposite direction, PP + AOnc) to the practiced ones. We evaluated the following measures of motor memory formation: percentage of TMS-evoked thumb movements falling in the direction of practiced motions, acceleration of TMS-evoked movements along the principal movement axis and corticomuscular excitability of training muscles as indexed by motor-evoked potential amplitudes. Both PP and PP + AOc, but not PP + AOnc, significantly increased the percentage of TMS-evoked movements falling in the practiced direction, changed the compound acceleration vector into the trained direction and enhanced the motor-evoked potential amplitudes in the training agonist muscle. The percentage of TMS-evoked movements falling in the practiced direction increased significantly more after PP + AOc than after PP. Across all measures of motor memory formation, PP + AOc was most efficacious, followed by PP and PP + AOnc. Action observation modulates practice effects on formation of a motor memory. Strengthening of the process of motor memory encoding depends on the directional congruency of the observed model.  相似文献
8.
Most animal studies have failed to demonstrate pathologic changes in the brain after transcranial magnetic stimulation (TMS). Nevertheless, vacuolar lesions in the cortex of rats after TMS have been reported. We report the first histopathologic studies of human brains after TMS in 2 patients with epilepsy who underwent temporal lobectomies. They had been involved in a study to determine the speech-dominant hemisphere by TMS and had received approximately 2,000 stimuli centered over the resected temporal lobe. Histologic study of the surgical specimens did not show any lesions attributable to TMS in these 2 patients.  相似文献
9.
Illusory own-body perceptions are 'body in space' misinterpretations of the brain and belong to the class of out-of-body experiences wherein the angular gyrus seems importantly implicated. In the present study additional cerebellum involvement in illusory own-body perceptions was investigated in a healthy young female right-handed volunteer. Transcranial magnetic stimulation (TMS) was applied over the cerebellum. Placebo cerebellum TMS and occipital TMS served as control conditions. Illusory own-body perceptions accompanied by electric brain activity over the somatosensory cortex were only observed after cerebellum TMS. The data provide the first evidence that the cerebellum might be involved in a neuronal network underlying illusory own-body perceptions.  相似文献
10.
重复经颅磁刺激治疗精神分裂症阴性症状的随机双盲研究   总被引:2,自引:1,他引:1  
目的探讨重复经颅磁刺激(rTMS)治疗精神分裂症阴性症状的疗效。方法 30例精神分裂症患者被随机分为rTMS真刺激组(治疗组,15例)和rTMS伪刺激组(对照组,15例),采用θ短阵快速脉冲刺激(TBS)模式刺激左侧前额叶背外侧皮质(DLPFC),每周5次,共干预20次。于基线、治疗2周及治疗4周时应用阳性与阴性症状量表(PANSS)的阴性因子分和阴性症状量表(SANS)进行疗效评定。结果共有27例患者完成研究,对照组有3例脱落。经rTMS干预4周后,治疗组与对照组的PANSS阴性因子分减分值分别为(4.67±2.47)分和(2.33±1.87)分,两组比较有统计学差异(z=-2.41,P=0.016);SANS总分减分值分别为(11.87±8.04)分和(5.92±6.47)分,两组比较有统计学差异(z=2.08,P=0.038)。根据PANSS阴性因子分评定,治疗组的有效率达到46.7%,对照组的有效率为16.7%;根据SANS总分评定治疗组的有效率达到46.7%,而对照组的有效率为8.3%;阴性症状的组间疗效差异有统计学意义(P〈0.05)。除了轻微的一过性头痛和入睡困难,未见有其他严重不良反应。结论 TBS模式可改善精神分裂症患者的阴性症状。  相似文献
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