Ni Zhen, Chen Robert
Division of Neurology, Krembil Neuroscience Centre and Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, ON Canada.
Division of Neurology, Krembil Neuroscience Centre and Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, ON Canada ; 7MC-411, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada.
Transl Neurodegener. 2015 Nov 16;4:22. doi: 10.1186/s40035-015-0045-x. eCollection 2015.
Common neurodegenerative diseases include Parkinson's disease (PD), Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS) and Huntington's disease (HD). Transcranial magnetic stimulation (TMS) is a noninvasive and painless method to stimulate the human brain. Single- and paired-pulse TMS paradigms are powerful ways to study the pathophysiological mechanisms of neurodegenerative diseases. Motor evoked potential studied with single-pulse TMS is increased in PD, AD and ALS, but is decreased in HD. Changes in motor cortical excitability in neurodegenerative diseases may be related to functional deficits in cortical circuits or to compensatory mechanisms. Reduction or even absence of short interval intracortical inhibition induced by paired-pulse TMS is common in neurodegenerative diseases, suggesting that there are functional impairments of inhibitory cortical circuits. Decreased short latency afferent inhibition in AD, PD and HD may be related to the cortical cholinergic deficits in these conditions. Cortical plasticity tested by paired associative stimulation or theta burst stimulation is impaired in PD, AD and HD. Repetitive TMS (rTMS) refers to the application of trains of regularly repeating TMS pulses. High-frequency facilitatory rTMS may improve motor symptoms in PD patients whereas low-frequency inhibitory stimulation is a potential treatment for levodopa induced dyskinesia. rTMS delivered both to the left and right dorsolateral prefrontal cortex improves memory in AD patients. Supplementary motor cortical stimulation in low frequency may be useful for HD patients. However, the effects of treatment with multiple sessions of rTMS for neurodegenerative diseases need to be tested in large, sham-controlled studies in the future before they can be adopted for routine clinical practice.
常见的神经退行性疾病包括帕金森病（PD）、阿尔茨海默病（AD）、肌萎缩侧索硬化症（ALS）和亨廷顿舞蹈病（HD）。经颅磁刺激（TMS）是一种刺激人脑的非侵入性无痛方法。单脉冲和双脉冲TMS范式是研究神经退行性疾病病理生理机制的有力手段。用单脉冲TMS研究的运动诱发电位在PD、AD和ALS中升高，但在HD中降低。神经退行性疾病中运动皮质兴奋性的变化可能与皮质回路的功能缺陷或代偿机制有关。双脉冲TMS诱导的短间隔皮质内抑制的减少甚至缺失在神经退行性疾病中很常见，这表明抑制性皮质回路存在功能损害。AD、PD和HD中短潜伏期传入抑制的降低可能与这些疾病中的皮质胆碱能缺陷有关。通过配对联想刺激或theta爆发刺激测试的皮质可塑性在PD、AD和HD中受损。重复经颅磁刺激（rTMS）是指应用一系列有规律重复的TMS脉冲。高频促进性rTMS可能改善PD患者的运动症状，而低频抑制性刺激是左旋多巴诱导的运动障碍的一种潜在治疗方法。对AD患者双侧背外侧前额叶皮质进行rTMS可改善记忆。低频刺激辅助运动皮质可能对HD患者有用。然而用多疗程rTMS治疗神经退行性疾病的效果在未来需要在大规模、有假刺激对照的研究中进行测试，之后才能用于常规临床实践。
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