Matsumoto Hideyuki, Ugawa Yoshikazu
Department of Neurology, Japanese Red Cross Medical Center.
Rinsho Shinkeigaku. 2010 Nov;50(11):803-7. doi: 10.5692/clinicalneurol.50.803.
To date, various kinds of transcranial magnetic stimulation (TMS) methods have been widely used in clinical neurology. For the clinical examination, single-pulse TMS is generally used, whereas, for the future therapy, repetitive TMS (rTMS) is widely researched. To evaluate the function of corticospinal tract, central motor conduction time (CMCT) is measured using single-pulse TMS. For precise analyses, single-pulse and double-pulse magnetic brainstem stimulation are performed to measure the cortical-brainstem conduction time and brainstem-spinal conduction time. To evaluate corticospinal tract function for leg muscles, cortico-conus motor conduction time (CCCT) is considered to be more accurate than CMCT. Magnetic cerebellar stimulation is effective to distinguish the cerebellar afferent pathway dysfunction from cerebellar efferent or cerebellar cortical dysfunctions. In animal research, rTMS releases the dopamine in monkey's brain and induces functional changes lasting over one week. In fact, as compared to sham-rTMS, high-frequency rTMS (5Hz) over the supplementary motor area has been shown to be significantly effective in the patients with Parkinson's disease. A new patterned rTMS protocol, quadripulse stimulation (QPS), can produce a bidirectional motor cortical plasticity depending on the interval of the pulses within a burst. rTMS including QPS might relieve symptoms in patients with neurological and psychiatric disorders.
迄今为止，各种经颅磁刺激（TMS）方法已在临床神经学中广泛应用。对于临床检查，一般使用单脉冲TMS，而对于未来的治疗，重复经颅磁刺激（rTMS）正在被广泛研究。为了评估皮质脊髓束的功能，使用单脉冲TMS测量中枢运动传导时间（CMCT）。为了进行精确分析，进行单脉冲和双脉冲磁脑干刺激以测量皮质-脑干传导时间和脑干-脊髓传导时间。为了评估腿部肌肉的皮质脊髓束功能，皮质-圆锥运动传导时间（CCCT）被认为比CMCT更准确。磁小脑刺激对于区分小脑传入通路功能障碍与小脑传出或小脑皮质功能障碍是有效的。在动物研究中，rTMS可使猴子大脑中的多巴胺释放，并诱导持续超过一周的功能变化。事实上，与假rTMS相比，在辅助运动区进行高频rTMS（5Hz）已被证明对帕金森病患者有显著疗效。一种新的模式化rTMS方案，四脉冲刺激（QPS），可根据一串脉冲内脉冲的间隔产生双向运动皮质可塑性。包括QPS在内的rTMS可能会缓解神经和精神疾病患者的症状。
