Conte A, Lenzi D, Frasca V, Gilio F, Giacomelli E, Gabriele M, Bettolo C Marini, Iacovelli E, Pantano P, Pozzilli C, Inghilleri M
Department of Neurological Sciences, University of Rome Sapienza, Viale dell'Università, 30, 00185, Rome, Italy.
J Neurol. 2009 Jun;256(6):933-8. doi: 10.1007/s00415-009-5047-0. Epub 2009 Mar 1.
We designed this study to investigate possible correlations between variables measuring primary motor cortex excitability detected by single and paired-pulse transcranial magnetic stimulation (TMS) and the severity of clinical manifestations in patients with multiple sclerosis (MS). Thirty patients with MS in remission, 16 with relapsing-remitting (RR), 14 with secondary progressive disease (SP) and 17 healthy subjects participated in the study. In each subject, the central motor conduction time (CMCT) was calculated, and single-pulse and paired-pulse TMS at 3 and 10 ms interstimulus intervals was delivered over the primary motor cortex of the dominant hemisphere to measure the amplitude of motor-evoked potentials (MEPs), motor threshold (MTh), intracortical inhibition (ICI) and facilitation (ICF). Correlations were determined between the patients' TMS findings and magnetic resonance imaging (MRI) (lesion load) and clinical features (expanded disability status scale, EDSS score). EDSS scores were significantly higher in SPMS than in RRMS patients. The MTh was significantly higher, and the MEP was significantly smaller in SPMS patients than in RRMS patients and control subjects. All patients had longer CMCTs than healthy subjects. In all patients, paired-pulse TMS elicited an inhibited test MEP at the 3-ms ISI and a facilitated test MEP at the 10 ms ISI. Post hoc analysis showed that ICI was significantly lower in SPMS patients than in those with RRMS and healthy subjects. EDSS scores correlated significantly with TMS measures (MEP, ICI, CMCT and MTh), but not with MRI lesion load. It was found that intracortical excitability as measured with TMS differs according to the clinical course of MS; it remains normal in patients with low EDSS scores and is altered in patients with high EDSS scores.
我们设计了这项研究，以调查通过单脉冲和双脉冲经颅磁刺激（TMS）检测到的测量初级运动皮层兴奋性的变量与多发性硬化症（MS）患者临床表现严重程度之间的可能相关性。30例缓解期MS患者，16例复发缓解型（RR），14例继发进展型疾病（SP），17名健康受试者参与了该研究。在每个受试者中，计算中枢运动传导时间（CMCT），并在优势半球的初级运动皮层上以3毫秒和10毫秒的刺激间隔进行单脉冲和双脉冲TMS，以测量运动诱发电位（MEP）的幅度、运动阈值（MTh）、皮质内抑制（ICI）和易化（ICF）。确定患者的TMS结果与磁共振成像（MRI）（病灶负荷）和临床特征（扩展残疾状态量表，EDSS评分）之间的相关性。SPMS患者的EDSS评分显著高于RRMS患者。SPMS患者的MTh显著更高，MEP显著更小，与RRMS患者和对照受试者相比。所有患者的CMCT均比健康受试者更长。在所有患者中，双脉冲TMS在3毫秒刺激间隔时诱发抑制性测试MEP，在10毫秒刺激间隔时诱发易化性测试MEP。事后分析显示，SPMS患者的ICI显著低于RRMS患者和健康受试者。EDSS评分与TMS测量值（MEP、ICI、CMCT和MTh）显著相关，但与MRI病灶负荷无关。发现用TMS测量的皮质内兴奋性根据MS的临床病程而不同；EDSS评分低的患者保持正常，而EDSS评分高的患者则发生改变。
