使用经颅磁刺激（TMS）可靠评估皮质运动兴奋性和初级运动皮层表征所需的刺激次数：一项系统综述和荟萃分析。

The number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a systematic review and meta-analysis.

作者信息

Cavaleri Rocco, Schabrun Siobhan M, Chipchase Lucy S

机构信息

Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW, 2560, Australia.

出版信息

Syst Rev. 2017 Mar 6;6(1):48. doi: 10.1186/s13643-017-0440-8.

DOI:10.1186/s13643-017-0440-8

PMID:28264713

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5340029/

Abstract

BACKGROUND

Transcranial magnetic stimulation (TMS) is a non-invasive means by which to assess the structure and function of the central nervous system. Current practices involve the administration of multiple stimuli over target areas of a participant's scalp. Decreasing the number of stimuli delivered during TMS assessments would improve time efficiency and decrease participant demand. However, doing so may also compromise the within- or between-session reliability of the technique. The aim of this review was therefore to determine the minimum number of TMS stimuli required to reliably measure (i) corticomotor excitability of a target muscle at a single cranial site and (ii) topography of the primary motor cortical representation of a target muscle across multiple cranial sites.

METHODS

Database searches were performed to identify diagnostic reliability studies published before May 2015. Two independent reviewers extracted data from studies employing single-pulse TMS to measure (i) the corticomotor excitability at a single cranial site or (ii) the topographic cortical organisation of a target muscle across a number of cranial sites. Outcome measures included motor evoked potential amplitude, map volume, number of active map sites and location of the map centre of gravity.

RESULTS

Only studies comparing the reliability of varying numbers of stimuli delivered to a single cranial site were identified. Five was the lowest number of stimuli that could be delivered to produce excellent within-session motor evoked potential (MEP) amplitude reliability (intraclass correlation coefficient (ICC) = 0.92, 95% CI 0.87 to 0.95). Ten stimuli were required to achieve consistent between-session MEP amplitudes among healthy participants (ICC = 0.89, 95% CI 0.76 to 0.95). However, between-session reliability was influenced by participant characteristics, intersession intervals and target musculature.

CONCLUSIONS

Further exploration of the reliability of multi-site TMS mapping is required. Five stimuli produce reliable MEP recordings during single-site TMS investigations involving one session. For single-site analyses involving multiple sessions, ten stimuli are recommended when investigating corticomotor excitability in healthy participants or the upper limb musculature. However, greater numbers of stimuli may be required for clinical populations or assessments involving the lower limb.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015024579.

摘要

背景

经颅磁刺激（TMS）是一种评估中枢神经系统结构和功能的非侵入性方法。目前的做法是在参与者头皮的目标区域施加多个刺激。减少TMS评估期间施加的刺激数量将提高时间效率并减少参与者的需求。然而，这样做也可能会损害该技术在会话内或会话间的可靠性。因此，本综述的目的是确定可靠测量（i）单个颅骨部位目标肌肉的皮质运动兴奋性和（ii）多个颅骨部位目标肌肉的初级运动皮质代表区地形图所需的最少TMS刺激次数。

方法

进行数据库检索以识别2015年5月之前发表的诊断可靠性研究。两名独立评审员从采用单脉冲TMS测量（i）单个颅骨部位的皮质运动兴奋性或（ii）多个颅骨部位目标肌肉的地形皮质组织的研究中提取数据。结果指标包括运动诱发电位幅度、图谱体积、活跃图谱部位数量和图谱重心位置。

结果

仅识别出比较向单个颅骨部位施加不同数量刺激的可靠性的研究。五个是能够施加以产生出色的会话内运动诱发电位（MEP）幅度可靠性（组内相关系数（ICC）=0.92，95%CI 0.87至0.95）的最少刺激次数。在健康参与者中，需要十个刺激才能实现会话间MEP幅度的一致性（ICC=0.89，95%CI 0.76至0.95）。然而，会话间可靠性受参与者特征、会话间隔和目标肌肉组织的影响。