磁刺激运动诱发电位对大脑半球切除术前运动功能的评估价值

目的探讨应用经颅磁刺激运动诱发电位（TMS—MEP）评估双侧肢体运动功能的半球支配情况。方法对10例顽固性癫痫、准备行改良大脑半球切除术的病人进行TMS—MEP检查。检查时蝶形线圈置于双侧大鱼际肌的皮质运动功能区，单侧刺激，同时记录双侧大鱼际肌的皮质TMS—MEP。将结果分为功能完全代偿、部分代偿和不能代偿。结果功能完全代偿2例，部分代偿6例．不能代偿2例。完全代偿的病人术后无运动功能损害加重．部分代偿的病人术后短期运动功能损害加重，3个月内运动功能恢复到术前水平。不能代偿的病人行改良大脑半球切除术。结论TMS—MEP能够客观评估顽固性癫痫病人双侧肢体运动功能的半球支配情况．是一种有效、可靠且无创的评估手段。

Value of magnetic motor evoked potentials in the motor function evaluation before hemispherectomy

Objective To assess motor function of the extremities before hemispherectomy by transcranial magnetic stimulation motor evoked potential (TMS-MEP). Methods Ten patients with intractable epilepsy were examined by TMS-MEP before surgical treatments. MEPs of the bilateral thenar muscle were simultaneously recorded following TMS of the motor cortex in the respective hemisphere, where a circular coil was placed. The results measured were classified as full compensation, partial compensation and no compensation. Results Two patients with full compensation had no motor function impairment, 6 with partial compensation had short-term impairment in the affected hemisphere and the motor function recovered within 3 months, and 2 without compensation received modified hemispherectomy. Conclusion TMS-MEP is a very useful non-invasive method for objectively assessing domination of the hemisphere in motor function of the extremities in patients with intractable epilepsy.