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On the Use of TMS to Investigate the Pathophysiology of Neurodegenerative Diseases.

作者信息

Rawji Vishal, Latorre Anna, Sharma Nikhil, Rothwell John C, Rocchi Lorenzo

机构信息

Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.

出版信息

Front Neurol. 2020 Nov 3;11:584664. doi: 10.3389/fneur.2020.584664. eCollection 2020.


DOI:10.3389/fneur.2020.584664
PMID:33224098
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7669623/
Abstract

Neurodegenerative diseases are a collection of disorders that result in the progressive degeneration and death of neurons. They are clinically heterogenous and can present as deficits in movement, cognition, executive function, memory, visuospatial awareness and language. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation tool that allows for the assessment of cortical function . We review how TMS has been used for the investigation of three neurodegenerative diseases that differ in their neuroanatomical axes: (1) Motor cortex-corticospinal tract (motor neuron diseases), (2) Non-motor cortical areas (dementias), and (3) Subcortical structures (parkinsonisms). We also make four recommendations that we hope will benefit the use of TMS in neurodegenerative diseases. Firstly, TMS has traditionally been limited by the lack of an objective output and so has been confined to stimulation of the motor cortex; this limitation can be overcome by the use of concurrent neuroimaging methods such as EEG. Given that neurodegenerative diseases progress over time, TMS measures should aim to track longitudinal changes, especially when the aim of the study is to look at disease progression and symptomatology. The lack of gold-standard diagnostic confirmation undermines the validity of findings in clinical populations. Consequently, diagnostic certainty should be maximized through a variety of methods including multiple, independent clinical assessments, imaging and fluids biomarkers, and post-mortem pathological confirmation where possible. There is great interest in understanding the mechanisms by which symptoms arise in neurodegenerative disorders. However, TMS assessments in patients are usually carried out during resting conditions, when the brain network engaged during these symptoms is not expressed. Rather, a context-appropriate form of TMS would be more suitable in probing the physiology driving clinical symptoms. In all, we hope that the recommendations made here will help to further understand the pathophysiology of neurodegenerative diseases.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e05a/7669623/24289c73857b/fneur-11-584664-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e05a/7669623/24289c73857b/fneur-11-584664-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e05a/7669623/24289c73857b/fneur-11-584664-g0001.jpg

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本文引用的文献

[1]
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Classification Accuracy of Transcranial Magnetic Stimulation for the Diagnosis of Neurodegenerative Dementias.

Ann Neurol. 2020-1-23

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