Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden.
Department of Clinical Neurophysiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
Dev Med Child Neurol. 2020 Jul;62(7):793-798. doi: 10.1111/dmcn.14490. Epub 2020 Feb 16.
To evaluate cortical excitability with transcranial magnetic stimulation (TMS) in children with new-onset epilepsy before and after antiepileptic drugs (AEDs).
Fifty-five drug-naïve patients (29 females, 26 males; 3-18y), with new-onset epilepsy were recruited from 1st May 2014 to 31st October 2017 at the Child Neurology Department, Queen Silvia's Children's Hospital, Gothenburg, Sweden. We performed TMS in 48 children (23 females, 25 males; mean [SD] age 10y [3y], range 4-15y) with epilepsy (27 generalized and 21 focal) before and after the introduction of AEDs. We used single- and paired-pulse TMS. We used single-pulse TMS to record resting motor thresholds (RMTs), stimulus-response curves, and cortical silent periods (CSPs). We used paired-pulse TMS to record intracortical inhibition and facilitation at short, long, and intermediate intervals.
There were no differences in cortical excitability between children with generalized and focal epilepsy at baseline. After AED treatment, RMTs increased (p=0.001), especially in children receiving sodium valproate (p=0.005). CSPs decreased after sodium valproate was administered (p=0.050). As in previous studies, we noted a negative correlation between RMT and age in our study cohort. Paired-pulse TMS could not be performed in most children because high RMTs made suprathreshold stimulation impossible.
Cortical excitability as measured with RMT decreased after the introduction of AEDs. This was seen in children with both generalized and focal epilepsy who were treated with sodium valproate, although it was most prominent in children with generalized epilepsy. We suggest that TMS might be used as a prognostic tool to predict AED efficacy.
Resting motor threshold (RMT) correlated negatively with age in children with epilepsy. No differences in cortical excitability were noted between patients with generalized and focal epilepsy. Treatment with antiepileptic drugs decreased cortical excitability as measured with transcranial magnetic stimulation (TMS). Decreased cortical excitability with increased RMT was recorded, especially after sodium valproate treatment. Paired-pulse TMS was difficult to perform because of high RMTs in children.
使用经颅磁刺激（TMS）评估新诊断癫痫患儿在使用抗癫痫药物（AEDs）前后的皮质兴奋性。
2014 年 5 月 1 日至 2017 年 10 月 31 日，我们在瑞典哥德堡皇后西尔维亚儿童医院儿童神经病学系招募了 55 名新诊断为癫痫的药物初治患者（29 名女性，26 名男性；3-18 岁）。我们对 48 名癫痫患儿（23 名女性，25 名男性；平均[标准差]年龄 10 岁[3 岁]，范围 4-15 岁）进行了 TMS 检查，这些患儿在使用 AED 前后均患有癫痫（27 例全身性癫痫，21 例局灶性癫痫）。我们使用单脉冲和双脉冲 TMS。我们使用单脉冲 TMS 记录静息运动阈值（RMT）、刺激-反应曲线和皮质静息期（CSP）。我们使用双脉冲 TMS 记录短、长和中等间隔的皮质内抑制和易化。
基线时，全身性癫痫和局灶性癫痫患儿的皮质兴奋性无差异。AED 治疗后，RMT 增加（p=0.001），特别是接受丙戊酸钠治疗的患儿（p=0.005）。丙戊酸钠治疗后 CSP 降低（p=0.050）。与之前的研究一样，我们在研究队列中发现 RMT 与年龄呈负相关。由于 RMT 较高，大多数患儿无法进行双脉冲 TMS 检查。
AED 治疗后，RMT 测量的皮质兴奋性下降。这在接受丙戊酸钠治疗的全身性和局灶性癫痫患儿中均可见，但在全身性癫痫患儿中更为明显。我们认为 TMS 可能被用作预测 AED 疗效的预后工具。
在患有癫痫的儿童中，静息运动阈值（RMT）与年龄呈负相关。未发现全身性癫痫和局灶性癫痫患者之间的皮质兴奋性存在差异。经颅磁刺激（TMS）测量的皮质兴奋性降低与抗癫痫药物治疗有关。记录到皮质兴奋性降低，RMT 升高，尤其是在接受丙戊酸钠治疗后。由于儿童的 RMT 较高，因此很难进行双脉冲 TMS 检查。
