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。     

重复经颅磁刺激治疗耐药性癫痫的有效性及安全性(附4例报告)

目的探讨重复经颅磁刺激(rTMS)治疗耐药性癫痫患者的有效性及安全性。方法回顾性分析4例接受rTMS治疗的耐药性癫痫患者的临床资料,观察其治疗效果及不良反应。结果本组4例患者中3例癫痫患者经rTMS治疗后癫痫发作频率降低50%以上,1例癫痫合并偏头痛患者在接受rTMS治疗后癫痫发作没有明显减少但偏头痛发作消失,4例患者均未出现不良反应。结论 rTMS是一种潜在的耐药性癫痫的治疗手段,最佳的治疗参数及便携式经颅磁刺激仪器在未来应该得到更多的重视及研究。     

经颅磁刺激用于大脑语言优势半球定位及相关研究

经颅磁刺激(transcranialmagneticstimulation,TMS)是一种用于了解、调节和干预大脑功能的方法[1],重复经颅磁刺激(repetitiveTMS,rTMS)是在TMS基础上发展起来的一项新的神经生理技术,频率在1Hz以上的高频率rTMS有易化局部神经元的作用,使大脑皮质的兴奋性增加[2],低频率rTMS有     

经颅磁刺激辅助治疗精神分裂症的临床研究进展

20世纪60年代初,经颅磁刺激(transcranial magneticstimulation,TMS)开始应用于精神科领域,这是一种非侵入性治疗方法,无痛,无明显不良反应.20世纪80年代中期发展为重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS),即在一定频率下给予相同密度的刺激串,初期许多研究用于治疗抑郁症,近些年来对精神分裂症的治疗备受关注.数年的临床研究显示,rTMS可以辅助治疗精神分裂症.我们就近些年来rTMS辅助治疗精神分裂症的阳性症状、阴性症状、认知症状的研究加以综述.     

低频重复经颅磁刺激对颞叶癫痫大鼠海马NF-κB及COX-2表达的影响

目的 研究低频重复经颅磁刺激(rTMS)对颞叶癫痫模型大鼠海马核转录因子κB(NF-κB)和环争化酶2(COX-2)表达的影响,进而从炎症反应角度探讨rTMS治疗癫痫的可能机制.方法 30只雄性SD大鼠随机分为颞叶癫痫刺激组(TIE+rTMS)、颢叶癫痫假刺激组(TLE+s-rTMS)和生理盐水对照组(NS),每组10只.利用立体定位仪向大鼠海马CA,区微量注射海人酸(KA)制备颞叶癫痫模型,对照组于同部位注射等量生理盐水.刺激组连续接受rTMS治疗10d.采用免疫组织化学染色、蛋白质印迹法(western blotting)研究大鼠海马NF-κBp65和COX-2表达情况.结果 与生理盐水对照组大鼠比较,造模后大鼠海马组织中NF-κBp65和COX-2表达明显增强NF-κBp65核移位增多,差异均有统计学意义(P＜0.05),TLE+rTMS组大鼠海马组织中NF-κBp65和COX-2表达较TLE+s-rTMS组明显降低,NF-κBp65核移位减少,差异均有统计学意义(P＜0.05).结论 rTMS可能通过降低癫痫大鼠海马NF-κB和COX-2的表达,阻止NF-κB核移位,从而抑制炎症反应发挥抗癫痫作用.     

重复经颅磁刺激对甲基苯丙胺诱导的大鼠条件性位置偏爱复吸行为的作用（英文）

背景:甲基苯丙胺(Methamphetamine,METH)滥用已成为全球性的公共卫生问题,这类新型毒品不仅能够导致患者成瘾,还会造成认知功能损伤,目前尚无有效的治疗方法。重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)是一种无痛、无创的绿色物理治疗方法,目前可用于临床治疗抑郁、焦虑、精神分裂、帕金森等神经精神疾病,并获得较好的疗效;但其对甲基苯丙胺成瘾的疗效与机制尚不明确,有待进一步研究。目的:探索rTMS对甲基苯丙胺成瘾复吸行为的作用。方法:本研究应用甲基苯丙胺诱导的条件性位置偏爱模型(Conditioned Place Preference,CPP),结合rTMS技术,在条件性位置偏爱行为消退后,分别对大鼠进行为期1天(实验一)和3天(实验二)的高频rTMS(10Hz)刺激,并于刺激结束后24小时进行复吸测试,探索急慢性rTMS对甲基苯丙胺诱导的大鼠CPP复吸行为的影响。结果:急性rTMS(刺激1天)对大鼠CPP的复吸行为具有一定的抑制作用,但与伪刺激组相比没有统计学意义(t=1.48,p=0.431);而慢性rTMS(刺激3天)对大鼠CPP的复吸行为有明显的抑制作用,与假刺激组相比,结果具有统计学意义(t=3.33,p=0.004)。结论:r TMS慢性刺激能够抑制甲基苯丙胺诱导的大鼠CPP的复吸行为。     

经颅重复磁刺激的研究和临床应用新进展

经颅磁刺激技术(transcranial magnetic stimulation．TMS)出现于1985年，通过时变磁场(time-varying)产生感应电流直接刺激皮层神经元而改变后者功能。单脉冲TMS、重复TMS(rTMS)、配对TMS、围刺激期时间直方图等与其他检查方法联合应用，可描述不同脑区的功能，不同脑区之间或内部和(或)投射纤维之间的联系和变化及继发行为改变。     

经颅磁刺激技术在缺血性脑血管病中的研究进展

近几年的研究表明重复经颅磁刺激(rTMS)可增强脑缺血耐受,对缺血后再灌注脑损伤有明显的保护作用.不同频率和强度的rTMS能促进脑梗死后患肢运动、语言、时空间忽略、学习记忆等功能的康复及抑郁情绪的改善,经颅磁刺激(TMS)还可客观地反映脑梗死患者运动功能缺失的情况,具有一定的病情判断和预后评估的价值.     

重复经颅磁刺激技术及其治疗性应用进展

经颅磁刺激(transcranial magnetic stimulate,TMS)由Barker等1985年首先创立,作为一种无痛、无损伤的皮层刺激方法及其具有操作简便、安全可靠等优点,很快得以临床应用。重复经颅磁刺激(rTMS)是在TMS基础上发展起来的新的神经电生理技术.但由于技术水平和工艺方面的限制,一直停留在低频率、刺激次数少的水平上。近年来,Dantec Ma-glite-r25、Cadwell Rapid-Rate Sitmulator(CRRMS)等刺激     

经颅磁刺激的基础与临床应用

1985年Barker等[1]首次将磁刺激技术从周围神经系统应用到中枢神经系统,从而产生了一种新的神经生理刺激手段.随后,经颅磁刺激(transcranial magnetic stimulation,TMS)技术快速发展,被广泛应用于基础和临床.1989年又出现了重复TMS(repetitive TMS,rTMS),其突出特点是具有持续生物学效应,因而可作为一种治疗手段,应用于难治性抑郁、难治性癫癎、帕金森病(PD)等药物治疗不理想的神经精神疾病,还可通过激发神经网络重塑,应用于神经系统损伤的康复.     

Transcranial magnetic stimulation can measure and modulate learning and memory

The potential uses for Transcranial Magnetic Stimulation (TMS) in the study of learning and memory range from a method to map the topography and intensity of motor output maps during visuomotor learning to inducing reversible lesions that allow for the precise temporal and spatial dissection of the brain processes underlying learning and remembering. Single-pulse TMS appears to be adequate to examine motor output maps but repetitive TMS (rTMS) appears necessary to affect most cognitive processes in measurable ways. The results we have reviewed in this article indicate that rTMS may have a potential clinical application in patients with epilepsy in whom it is important to identify the lateralization of verbal memory. Single-pulse TMS can help identify changes in motor output maps during training, that may indicate improved or diminished learning and memory processes following a stroke or other neurological insult. Other evidence indicates that rTMS may even have the capability of facilitating various aspects of memory performance. From a research perspective. rTMS has demonstrated site- and time-specific effects primarily in interfering with explicit retrieval of episodic information from long-term memory. rTMS may also be able to modulate retrieval from semantic memory as evidenced by response-time and accuracy changes after rTMS. All these findings suggest that the use of transcranial magnetic stimulation in the study of learning and memory will increase in the future and that it is already a valuable tool in the cognitive neuroscientists' belt.     

Transcranial Magnetic Stimulation in Neurology: What We Have Learned From Randomized Controlled Studies

Background. Initially developed to excite peripheral nerves, magnetic stimulation was quickly recognized as a valuable tool to noninvasively activate the cerebral cortex. The subsequent discovery that repetitive transcranial magnetic stimulation (rTMS) could have long‐lasting effects on cortical excitability spawned a broad interest in the use of this technique as a new therapeutic method in a variety of neuropsychiatric disorders. Although the current outcomes from initial trials include some conflicting results, initial evidence supports that rTMS might have a therapeutic value in different neurologic conditions. Methods. We reviewed the results of clinical trials of rTMS on four different disorders: stroke, Parkinson's disease, chronic refractory pain, and epilepsy. We reviewed randomized, controlled studies only in order to obtain the strongest evidence for the clinical effects of rTMS. Results. An extensive literature review revealed 32 articles that met our criteria. From these studies, we found evidence for the therapeutic efficacy of rTMS, particularly in the relief of chronic pain and motor neurorehabilitation in single hemisphere stroke patients. Repetitive TMS also seems to have a therapeutic effect on motor function in Parkinson's disease, but the evidence is somewhat confounded by the uncontrolled variability of multiple factors. Lastly, only two randomized, sham‐controlled studies have been performed for epilepsy; although evidence indicates rTMS may reduce seizure frequency in patients with neocortical foci, more research is needed to confirm these initial findings. Conclusions. There is mounting evidence for the efficacy of rTMS in the short‐term treatment of certain neurologic conditions. More long‐term research is needed in order to properly evaluate the effects of this method in a clinical setting.     

French guidelines on the use of repetitive transcranial magnetic stimulation (rTMS): safety and therapeutic indications

During the past decade, a large amount of work on transcranial magnetic stimulation (TMS) has been performed, including the development of new paradigms of stimulation, the integration of imaging data, and the coupling of TMS techniques with electroencephalography or neuroimaging. These accumulating data being difficult to synthesize, several French scientific societies commissioned a group of experts to conduct a comprehensive review of the literature on TMS. This text contains all the consensual findings of the expert group on the mechanisms of action, safety rules and indications of TMS, including repetitive TMS (rTMS). TMS sessions have been conducted in thousands of healthy subjects or patients with various neurological or psychiatric diseases, allowing a better assessment of risks associated with this technique. The number of reported side effects is extremely low, the most serious complication being the occurrence of seizures. In most reported seizures, the stimulation parameters did not follow the previously published recommendations (Wassermann, 1998) [430] and rTMS was associated to medication that could lower the seizure threshold. Recommendations on the safe use of TMS / rTMS were recently updated (Rossi et al., 2009) [348], establishing new limits for stimulation parameters and fixing the contraindications. The recommendations we propose regarding safety are largely based on this previous report with some modifications. By contrast, the issue of therapeutic indications of rTMS has never been addressed before, the present work being the first attempt of a synthesis and expert consensus on this topic. The use of TMS/rTMS is discussed in the context of chronic pain, movement disorders, stroke, epilepsy, tinnitus and psychiatric disorders. There is already a sufficient level of evidence of published data to retain a therapeutic indication of rTMS in clinical practice (grade A) in chronic neuropathic pain, major depressive episodes, and auditory hallucinations. The number of therapeutic indications of rTMS is expected to increase in coming years, in parallel with the optimisation of stimulation parameters.     

Comparison between short train, monophasic and biphasic repetitive transcranial magnetic stimulation (rTMS) of the human motor cortex.

OBJECTIVE: To compare motor evoked potentials (MEPs) elicited by short train, monophasic, repetitive transcranial magnetic stimulations (rTMS) with those by short train, biphasic rTMS. METHODS: Subjects were 13 healthy volunteers. Surface electromyographic (EMG) responses were recorded from the right first dorsal interosseous muscle (FDI) in several different stimulation conditions. We gave both monophasic and biphasic rTMS over the motor cortex at a frequency of 0.5, 1, 2 or 3Hz. To study excitability changes of the spinal cord, we also performed 3Hz rTMS at the foramen magnum level [Ugawa Y, Uesaka Y, Terao Y, Hanajima R, Kanazawa I. Magnetic stimulation of corticospinal pathways at the foramen magnum level in humans. Ann Neurol 1994;36:618-24]. We measured the size and latency of each of 20 MEPs recorded in the different stimulation conditions. RESULTS: 2 or 3Hz stimulation with either monophasic or biphasic pulses evoked MEPs that gradually increased in amplitude with the later MEPs being significantly larger than the earlier ones. Monophasic rTMS showed much more facilitation than biphasic stimulation, particularly at 3Hz. Stimulation at the foramen magnum level at 3Hz elicited fairly constant MEPs. CONCLUSIONS: The enhancement of cortical MEPs with no changes of responses to foramen magnum level stimulation suggests that the facilitation occurred at the motor cortex. We hypothesize that monophasic TMS has a stronger short-term effect during repetitive stimulation than biphasic TMS because monophasic pulses preferentially activate one population of neurons oriented in the same direction so that their effects readily summate. Biphasic pulses in contrast may activate several different populations of neurons (both facilitatory and inhibitory) so that summation of the effects is not so clear as with monophasic pulses. When single stimuli are applied, however, biphasic TMS is thought to be more powerful than monophasic TMS because the peak-to-peak amplitude of stimulus pulse is higher and its duration is longer when the same intensity of stimulation (the same amount of current is stored by the stimulator) is used. SIGNIFICANCE: This means that when using rTMS as a therapeutic tool or in research fields, the difference in waveforms of magnetic pulses (monophasic or biphasic) may affect the results.     

New advances in the rehabilitation of CNS diseases applying rTMS

Transcranial magnetic stimulation (TMS) can directly stimulate the CNS, modifying the brain's plasticity to enhance the behavior of the paretic extremities. Studies with low-frequency repetitive TMS (rTMS) on the intact hemisphere and those with high frequencies on the affected hemisphere could increase the speed of movement in the hand affected by CNS injury. Stimulation of the motor pathway may contribute to faster improvement in patients with spinal cord injury. Symptoms of Parkinson's disease (such as cognition and working memory, neglect syndrome and global aphasia) can be influenced by rTMS. However, the site of stimulation and the parameters of rTMS are different. Processes that contribute to the behavior of rTMS include the modification of brain plasticity, induction of neurogenesis, growth of new fibers in the spinal cord or all of these together. According to previous research, rTMS may be suitable as an add-on therapy to rehabilitation in CNS diseases.     

Transcranial magnetic stimulation in persons younger than the age of 18

OBJECTIVES: To review the use of transcranial magnetic stimulation (single-pulse TMS, paired TMS, and repetitive TMS [rTMS]) in persons younger than the age of 18 years. I discuss the technical differences, as well as the diagnostic, therapeutic, and psychiatric uses of TMS/rTMS in this age group. METHODS: I evaluated English-language studies from 1993 to August 2004 on nonconvulsive single-pulse, paired, and rTMS that supported a possible role for the use of TMS in persons younger than 18. Articles reviewed were retrieved from the MEDLINE database and Clinical Scientific index. RESULTS: The 48 studies reviewed involved a total of 1034 children ages 2 weeks to 18 years; 35 of the studies used single-pulse TMS (980 children), 3 studies used paired TMS (20 children), and 7 studies used rTMS (34 children). Three studies used both single and rTMS. However, the number of subjects involved was not reported. CONCLUSIONS: Single-pulse TMS, paired TMS, and rTMS in persons younger than 18 has been used to examine the maturation/activity of the neurons of various central nervous system tracts, plasticity of neurons in epilepsy, other aspects of epilepsy, multiple sclerosis, myoclonus, transcallosal inhibition, and motor cortex functioning with no reported seizure risk. rTMS has been applied to psychiatric disorders such as ADHD, ADHD with Tourette's, and depression. Adult studies support an antidepressant effect from repetitive TMS, but there is only one study that has been reported on 7 patients that used rTMS to the left dorsal prefrontal cortex on children/adolescents with depression (5 of the 7 subjects treated responded). Although there are limited studies using rTMS (in 34 children), these studies did not report significant adverse effects or seizures. Repetitive TMS safety, ethical, and neurotoxicity concerns also are discussed.     

Effects of low-frequency repetitive transcranial magnetic stimulation on electroencephalogram and seizure frequency in 15 patients with temporal lobe epilepsy following dipole source localization

BACKGROUND:Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been shown to significantly reduce epileptiform discharges and control clinical seizures in intractable epilepsy patients. The location of epileptic foci and magnetic stimulation sites remain uncertain. The effects of rTMS on electroencephalogram and seizure remain unclear in epileptic patients following dipole source localization. OBJECTIVE: To investigate the effects of low-frequency rTMS on electroencephalogram and seizure i...     

Antiepileptic effects of low-frequency repetitive transcranial magnetic stimulation by different stimulation durations and locations.

OBJECTIVE: To evaluate the antiepileptic effect of low-frequency rTMS (repetitive transcranial magnetic stimulation) in the patients with intractable epilepsy. METHODS: We enrolled 35 patients with localization-related epilepsy who had experienced at least one complex partial seizure or a secondarily generalized seizure per week on a constant antiepileptic drug regimen over an 8-week period. rTMS was administered using a Rapid(2) magnetic stimulator with an air-cooled coil at 0.5Hz for 5 consecutive days at 100% of rMT (resting motor threshold). Patients were divided into a focal stimulation group with a localized epileptic focus, or a non-focal stimulation group with a non-localized or multifocal epileptic focus. These two groups were then randomly subdivided into four subgroups depending on the total number of stimulations administered, i.e., 3000 pulse and 1500 pulse subgroups. Weekly seizure frequencies were determined for 8 weeks before and after rTMS. To compare the number of interictal spikes before and after rTMS, EEG was recorded twice before (1st day) and after rTMS (5th day). RESULTS: Mean weekly seizure frequency was non-significantly decreased after rTMS (8.4-->6.8/week, -13.9%). Longer stimulation subgroups (3000 pulses, -23.0%) tended to have fewer seizures than shorter stimulation subgroups (1500 pulses, -3.0%), without statistical significance. TMS stimulation site and structural brain lesions did not influence seizure outcome. However, interictal spikes significantly decreased (-54.9%, P=0.012) after rTMS and they totally disappeared in 6 patients (17.1%, 6/35). CONCLUSIONS: Low-frequency rTMS reduced interictal spikes, but its effect on seizure outcome was not significant. Focal stimulation for a longer duration tended to further reduce seizure frequency. SIGNIFICANCE: These findings may help clinicians to further investigate the therapeutic potential of the rTMS for patients with intractable epilepsy.     

Myoclonus and transcranial magnetic stimulation

The neural dysfunction at the origin of myoclonus may locate at various anatomical levels within the central nervous system, including the motor cortices. Transcranial magnetic stimulation (TMS) can be used to assess the balance between inhibitory and excitatory processes involved in the regulation of motor cortex activity and thereby, may be of value to determine the pathophysiological mechanisms of myoclonus. Using paired-pulse paradigms with various interstimulus intervals, TMS studies showed that intracortical inhibition (ICI) was reduced in progressive myoclonic epilepsy (PME). In contrast, ICI was decreased only for short interstimulus intervals in patients with juvenile myoclonic epilepsy (JME). Transcallosal inhibition and sensorimotor integration were also both altered in PME but not in JME. Actually, the loss of inhibitory regulation within the central nervous system might represent an intrinsic mechanism of myoclonus, whether of epileptic origin or not. Finally, the other TMS parameters of excitability (motor threshold, silent period, intracortical facilitation) were found normal in most cases of myoclonus. According to these observations, it was quite conceivable that the application of repetitive trains of TMS (rTMS) at inhibitory low-frequency (around 1 Hz) might be able to relieve myoclonus by restoring ICI. A few reported cases illustrate the efficacy of low-frequency rTMS to alleviate myoclonic symptoms. Therapeutic-like perspectives are opened for rTMS in these forms of myoclonus that are related to motor cortical hyperexcitability secondary to the loss of ICI.     

Transcranial magnetic stimulation: a new investigational and treatment tool in psychiatry

Transcranial magnetic stimulation (TMS) is a new investigational technique used to explore various neural processes and treat a variety of neuropsychiatric illnesses. The most notable advantage of TMS is its ability to directly stimulate the cortex with little effect on intervening tissue. Single-pulse stimulation techniques can measure cortical inhibition, facilitation, connectivity, reactivity, and cortical plasticity, providing valuable insights into the cortical physiology. Repetitive TMS (rTMS) is currently being used to investigate cognitive processes and as a treatment tool in disorders such as depression and schizophrenia. Both TMS and rTMS are safe and well tolerated. The most serious side effect of high-frequency rTMS is seizures. TMS represents an exciting new frontier in neuroscience research, providing insights into the pathophysiology and treatment of various neuropsychiatric disorders.