Tsuboyama Melissa, Lee Kaye Harper, Rotenberg Alexander
Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, United States.
FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, United States.
Front Integr Neurosci. 2019 Oct 30;13:57. doi: 10.3389/fnint.2019.00057. eCollection 2019.
Epilepsy is associated with numerous neurodevelopmental disorders. Transcranial magnetic stimulation (TMS) of the motor cortex coupled with electromyography (EMG) enables biomarkers that provide measures of cortical excitation and inhibition that are particularly relevant to epilepsy and related disorders. The motor threshold (MT), cortical silent period (CSP), short interval intracortical inhibition (SICI), intracortical facilitation (ICF), and long interval intracortical inhibition (LICI) are among TMS-derived metrics that are modulated by antiepileptic drugs. TMS may have a practical role in optimization of antiepileptic medication regimens, as studies demonstrate dose-dependent relationships between TMS metrics and acute medication administration. A close association between seizure freedom and normalization of cortical excitability with long-term antiepileptic drug use highlights a plausible utility of TMS in measures of anti-epileptic drug efficacy. Finally, TMS-derived biomarkers distinguish patients with various epilepsies from healthy controls and thus may enable development of disorder-specific biomarkers and therapies both within and outside of the epilepsy realm.
癫痫与多种神经发育障碍相关。运动皮层的经颅磁刺激（TMS）结合肌电图（EMG）能够产生生物标志物，这些生物标志物可提供与癫痫及相关疾病特别相关的皮质兴奋和抑制的测量指标。运动阈值（MT）、皮质静息期（CSP）、短间隔皮质内抑制（SICI）、皮质内易化（ICF）和长间隔皮质内抑制（LICI）是经TMS得出的指标，这些指标会受到抗癫痫药物的调节。由于研究表明TMS指标与急性药物给药之间存在剂量依赖关系，TMS可能在抗癫痫药物治疗方案的优化中发挥实际作用。长期使用抗癫痫药物后，癫痫发作自由度与皮质兴奋性正常化之间的密切关联突出了TMS在抗癫痫药物疗效测量中的合理效用。最后，经TMS得出的生物标志物可将患有各种癫痫的患者与健康对照区分开来，因此可能有助于在癫痫领域内外开发针对特定疾病的生物标志物和治疗方法。
