Gilio F, Currà A, Inghilleri M, Lorenzano C, Manfredi M, Berardelli Alfredo
Dipartimento Scienze Neurologiche, Università di Roma La Sapienza, Rome, Italy.
Mov Disord. 2002 May;17(3):467-73. doi: 10.1002/mds.1255.
We investigated the neurophysiological and clinical effects of repetitive magnetic stimulation (rTMS) delivered to the cortical motor areas in healthy subjects and patients with Parkinson's disease. rTMS was delivered with a high speed magnetic stimulator (Cadwell, Kennewick, WA) through a figure-eight coil centred on the primary motor area at a stimulus intensity of 120% motor threshold. Trains of 10 stimuli were delivered at frequencies of 5 Hz while subjects were at rest and during a voluntary contraction of the contralateral first dorsal interosseous muscle. In normal subjects at rest, the muscle evoked responses (MEPs) to each stimulus in a train of magnetic stimuli progressively increased in size during the train. rTMS left the MEPs unchanged in patients off therapy and had a small facilitatory effect in those on therapy. In normal subjects and patients, 5-Hz rTMS trains delivered during a voluntary contraction of the target muscle left the MEP unchanged in size. MEPs were followed by a silent period that increased in duration during the course of the train. The silent period duration increased to a similar extent in patients and controls. The reduced rTMS-induced facilitation of MEPs in patients with Parkinson's disease reflects a decreased facilitation of the excitatory cells in the cortical motor areas.
我们研究了重复磁刺激（rTMS）作用于健康受试者和帕金森病患者皮质运动区的神经生理及临床效应。rTMS通过一个高速磁刺激器（Cadwell，华盛顿州肯纳威克），经由一个以初级运动区为中心的8字形线圈施加，刺激强度为运动阈值的120%。在受试者休息及对侧第一背侧骨间肌进行随意收缩期间，以5赫兹的频率施加10次刺激的序列。在正常受试者休息时，磁刺激序列中每次刺激诱发的肌肉反应（MEP）在序列过程中逐渐增大。rTMS对未接受治疗的患者的MEP无影响，而对接受治疗的患者有轻微的易化作用。在正常受试者和患者中，在目标肌肉随意收缩期间施加5赫兹的rTMS序列，MEP大小不变。MEP之后有一个静息期，在序列过程中静息期持续时间增加。患者和对照组的静息期持续时间增加程度相似。帕金森病患者中rTMS诱发的MEP易化作用减弱反映了皮质运动区兴奋性细胞的易化作用降低。
