Kimiskidis V K
Laboratory of Clinical Neurophysiology, Aristotle Univertasity of Thessaloniki, AHEPA University Hospital, 1 St Kiriakidi Street, 54636 Thessaloniki, Greece.
Rev Neurol (Paris). 2016 Feb;172(2):123-6. doi: 10.1016/j.neurol.2015.11.004. Epub 2016 Feb 5.
In recent years, a number of novel brain-stimulation techniques have been developed (such as TMS-EEG, TMS-fMRI and TMS-NIRS), yet they remain underutilized in the field of epilepsy. Accumulating evidence suggests that transcranial magnetic stimulation (TMS) combined with electroencephalography (TMS-EEG) is a highly relevant technique for exploration of the pathophysiology of human epilepsies as well as a promising biomarker with diagnostic and prognostic potential.
In genetic generalized epilepsies, TMS-EEG has provided pathophysiological insight by revealing quasi-stable, covert states of excitability, a subclass of which is associated with the generation of TMS-induced epileptiform discharges (EDs). In focal epilepsy, TMS-induced EDs were successfully employed to identify the epileptogenic zone. In addition, TMS trains applied during focal EDs can terminate them, and appear to restore the effective connectivity of the brain network significantly altered by EDs. This abortive effect of TMS on EDs may possibly serve as a biomarker of response to invasive neuromodulatory techniques.
TMS-EEG-based stimulation paradigms can provide insight into the mechanisms underlying human epilepsies and, thus, warrant further study as diagnostic and prognostic biomarkers.
近年来，已开发出多种新型脑刺激技术（如经颅磁刺激-脑电图、经颅磁刺激-功能磁共振成像和经颅磁刺激-近红外光谱），但它们在癫痫领域的应用仍未得到充分利用。越来越多的证据表明，经颅磁刺激（TMS）与脑电图相结合（TMS-EEG）是探索人类癫痫病理生理学的高度相关技术，也是一种具有诊断和预后潜力的有前景的生物标志物。
在遗传性全身性癫痫中，TMS-EEG通过揭示准稳定的、隐蔽的兴奋性状态提供了病理生理学见解，其中一个亚类与TMS诱发的癫痫样放电（EDs）的产生有关。在局灶性癫痫中，TMS诱发的EDs被成功用于识别致痫区。此外，在局灶性EDs期间应用的TMS序列可以终止它们，并且似乎能显著恢复被EDs显著改变的脑网络的有效连接性。TMS对EDs的这种终止作用可能作为对侵入性神经调节技术反应的生物标志物。
基于TMS-EEG的刺激范式可以深入了解人类癫痫的潜在机制，因此，作为诊断和预后生物标志物值得进一步研究。
