重复经颅磁刺激导致神经不良反应一例

<正>经颅磁刺激（Transcranial magnetic stimulation,TMS）TMS是一种新兴的非侵入式的电生理刺激技术,神经科、康复科主要将其用于脑血管意外后的所致的各种功能障碍康复,特别是对于运动、言语和认知障碍的康复,疗效显著。重复经颅磁刺激（repetitive TMS,rTMS）rTMS对脑血管意外的作用和机制有大量的基础和临床研究,已经在国际经颅磁刺激协会制定的治疗指南中被作为A级推荐,     

高频重复经颅磁刺激治疗卒中后抑郁的临床研究

运用高频重复经颅磁刺激（rTMS）技术探索卒中后抑郁（PSD）新的治疗方法，我们进行了以下研究。     

rTMS技术在精神和神经科临床的应用

重复经颅磁刺（repetive transcranial magnetic stimulate，rTMS）是在经颅磁刺激（TMS）的基础上发展起来的新的神经电生理技术。本文就其基本原理和精神与神经科临床应用及安全性予以介绍。     

无创电/磁刺激治疗颅脑损伤后慢性意识障碍的体会

目的 探讨无创电/磁刺激治疗慢性意识障碍的效果。方法 回顾性分析2019年6月~2021年9月无创电/磁刺激治疗的144例慢性意识障碍的临床资料。常规对症治疗36例（对照组）,正中神经电刺激（MNS）治疗36例（MNS组）,重复经颅磁刺激（rTMS）治疗36例（rTMS组）,MNS联合rTMS治疗36例（MNS+rTMS组）。应用昏迷恢复量表（CRS-R）评估疗效。结果 治疗2周、1个月,无创神经电刺激治疗病人CRS-R评分明显高于对照组（P<0.05）,而且MNS+rTMS组明显高于MNS组和rTMS组（P<0.05）,MNS组和rTMS组之间无统计学差异（P>0.05）。四组治疗后不良事件（肺部感染、癫痫、交感神经兴奋发作）发生率均无统计学差异（P>0.05）。结论 对于慢性意识障碍病人,无创电/磁刺激治疗可改善病人意识状态,联合应用MNS+rTMS的效果更好。     

重复经颅磁刺激治疗缺血性脑卒中后认知障碍的研究进展

重复经颅磁刺激（rTMS）是一种安全无创的非侵入性干预技术,在各种神经和精神疾病中已得到广泛应用。目前,rTMS在改善缺血性脑卒中后认知障碍（PISCI）方面也取得一定疗效。本文从rTMS的基本原理、治疗PISCI的作用机制、在PISCI中的应用、安全性等方面进行综述,以期为rTMS在PISCI中的应用提供理论依据。     

经颅磁刺激和癫痫

经颅磁刺激(TMS)技术是一项相对无痛无创的电生理技术。本文主要阐述了经颅磁刺激的基本原理和部分参数;讨论了TMS在探索癫痫患者皮质兴奋性的作用,与抗癫痫药物的关系和安全性,以及重复经颅磁刺激(rTMS)在治疗癫痫中的作用。     

间歇经口至食管管饲法联合重复经颅磁刺激对脑卒中吞咽障碍患者的干预效果

目的 观察间歇经口至食管管饲法（IOE）联合重复经颅磁刺激（rTMS）对脑卒中吞咽障碍患者的干预效果。方法 随机将成都医学院附属第二医院2021-09—2022-05治疗的脑卒中后吞咽障碍患者分为IOE组、NGT组、rTMS+IOE组3组,IOE组采用IOE+假经颅磁刺激,NGT组采用经鼻留置胃管管饲法+假经颅磁刺激,rTMS+IOE组在IOE基础上加用真实rTMS治疗。3组均干预4周,在干预前后采用标准吞咽功能评价量表（SSA）和洼田饮水试验评估患者的吞咽功能,采用肱三头肌皮褶厚度（TSF）、血清白蛋白（ALB）、血清总蛋白（TP）观察患者营养状况改善情况,配合电视透视吞咽功能检查(VFSS)和表面肌电图（s EMG）检查。结果 与治疗前比较,3组SSA评分和洼田饮水试验无统计学差异（P>0.05）;治疗4周后rTMS+IOE组在SSA评分和洼田饮水试验优于其余2组（P<0.05）。在营养状况方面,治疗前3组TSF、ALB、TP无统计学差异（P>0.05）;治疗4周后,rTMS+IOE组在ALB、TP高于其余2组（P<0.05）;在TSF指标rTMS+IOE组...     

经颅磁刺激技术在研究工作记忆中的应用

一、经颅磁刺激概述 经颅磁刺激（transcranial magnetic stimulation,TMS）是一种无电极刺激形式,通过颅外放置的电磁刺激器在大脑皮质诱导产生感生电流直接刺激特定的皮质神经元,受到刺激的皮质产生瞬间可逆性功能障碍,可看作是一种“虚拟性损毁”.对比磁刺激前后发生的功能变化,可以粗略了解和判断特定时刻所刺激的皮质结构的脑功能.重复经颅磁刺激（rTMS）是在TMS基础上发展起来的一项新技术,与单脉冲TMS（sTMS）比,rTMS不仅影响刺激局部和功能相关的远隔皮质功能,而且产生的生物学效应可持续到刺激停止后一段时间,已成为研究神经网络功能重建的良好工具.     

重复经颅磁刺激抗癎作用及其机制研究进展

重复经颅磁刺激（rTMS）是一门新兴的电生理技术。近年来,实验和临床研究显示rTMS具有潜在抗癎作用。本文对rTMS抗癎的安全性、有效性及可能存在的抗癎机制予以阐述。     

高频重复经颅磁刺激治疗抑郁症的研究进展

重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)已被越来越多的应用于多种神经精神疾病的治疗。其中高频重复经颅磁刺激在治疗抑郁症方面取得了很大进展。本文就高频重复经颅磁刺激治疗抑郁症的研究进展做一综述。     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.