Nardone Raffaele, Versace Viviana, Sebastianelli Luca, Brigo Francesco, Golaszewski Stefan, Christova Monica, Gallasch Eugen, Saltuari Leopold, Trinka Eugen
Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Department of Neurorehabilitation, Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy.
Clin Neurophysiol. 2017 Oct;128(10):1971-1977. doi: 10.1016/j.clinph.2017.07.410. Epub 2017 Aug 3.
There is increasing evidence that an involvement of central nervous system (CNS) can occur in several myopathies. Transcranial magnetic stimulation (TMS) may represent a valuable tool for investigating important neurophysiological and pathophysiological aspects of cortical involvement in neuromuscular disorders. In this review paper we aimed to perform a systematic search of the studies employing TMS techniques in subjects suffering from myopathies.
A literature search was conducted using PubMed and Embase. We identified and reviewed 9 articles matching the inclusion criteria. One hundred twenty patients were included in these studies, which have applied TMS in patients with muscle disorders.
To date, a few studies using TMS have been performed in myopathic patients and detected subclinical abnormalities in cortical reactivity and plasticity. The most consistent finding was a decrease in intracortical inhibition, which likely represents a non-specific compensatory mechanism of the CNS in an attempt to overcome the muscle deficit through an increase of the motor cortex output to deficient muscles.
Application of TMS to characterize the pathophysiology of the CNS in these subjects appears to be safe and may lead to the development of valuable biomarkers. Well-defined motor cortical excitability patterns can be identified in the different muscle diseases, even if preliminary findings should be confirmed in future studies in larger cohorts of patients.
TMS studies may shed new light on the physiological and pathophysiological mechanisms underlying the cortical involvement in muscle disorders.
越来越多的证据表明，中枢神经系统（CNS）受累可发生于多种肌病中。经颅磁刺激（TMS）可能是研究神经肌肉疾病中皮质受累的重要神经生理和病理生理方面的一种有价值的工具。在这篇综述文章中，我们旨在对采用TMS技术研究肌病患者的相关研究进行系统检索。
使用PubMed和Embase进行文献检索。我们识别并回顾了9篇符合纳入标准的文章。这些研究共纳入了120例肌肉疾病患者并对其应用了TMS。
迄今为止，仅有少数针对肌病患者的TMS研究，检测到了皮质反应性和可塑性方面的亚临床异常。最一致的发现是皮质内抑制降低，这可能代表了中枢神经系统的一种非特异性代偿机制，试图通过增加运动皮质向功能不足肌肉的输出，来克服肌肉功能缺陷。
应用TMS来描述这些患者中枢神经系统的病理生理学似乎是安全的，并且可能会促成有价值的生物标志物的开发。在不同的肌肉疾病中可以识别出明确的运动皮质兴奋性模式，尽管初步研究结果有待未来更大规模患者队列研究加以证实。
TMS研究可能会为肌肉疾病中皮质受累的生理和病理生理机制提供新的线索。
