Fujiki Minoru, Hata Nobuhiro, Anan Mitsuhiro, Matsushita Wataru, Kawasaki Yukari, Fudaba Hirotaka
Department of Neurosurgery, School of Medicine, Oita University, Oita, Japan.
Front Neurosci. 2023 May 25;17:1163779. doi: 10.3389/fnins.2023.1163779. eCollection 2023.
A stable, reliable, non-invasive, quantitative assessment of swallowing function remains to be established. Transcranial magnetic stimulation (TMS) is commonly used to aid in the diagnosis of dysphagia. Most diagnostic applications involve single-pulse TMS and motor evoked potential (MEP) recordings, the use of which is not clinically suitable in patients with severe dysphagia given the large variability in MEPs measured from the muscles involved in swallowing. Previously, we developed a TMS device that can deliver quadripulse theta-burst stimulation in 16 monophasic magnetic pulses through a single coil, enabling the measurement of MEPs related to hand function. We applied a system for MEP conditioning that relies on a 5 ms interval-monophasic quadripulse magnetic stimulation (QPS5) paradigm to produce 5 ms interval-four sets of four burst trains; quadri-burst stimulation (QBS5), which is expected to induce long-term potentiation (LTP) in the stroke patient motor cortex. Our analysis indicated that QBS5 conditioned left motor cortex induced robust facilitation in the bilateral mylohyoid MEPs. Swallowing dysfunction scores after intracerebral hemorrhage were significantly correlated with QBS5 conditioned-MEP parameters, including resting motor threshold and amplitude. The degree of bilateral mylohyoid MEP facilitation after left side motor cortical QBS5 conditioning and the grade of severity of swallowing dysfunction exhibited a significant linear correlation ( = -0.48/-0.46 and 0.83/0.83; = 0.23/0.21 and 0.68/0.68, < 0.001; Rt./Lt. side MEP-RMT and amplitudes, respectively). The present results indicate that RMT and amplitude of bilateral mylohyoid-MEPs after left motor cortical QBS5 conditioning as surrogate quantitative biomarkers for swallowing dysfunction after ICH. Thus, the safety and limitations of QBS5 conditioned-MEPs in this population should be further explored.
吞咽功能的稳定、可靠、非侵入性定量评估方法仍有待确立。经颅磁刺激(TMS)常用于辅助吞咽困难的诊断。大多数诊断应用涉及单脉冲TMS和运动诱发电位(MEP)记录,鉴于从参与吞咽的肌肉测量的MEP存在很大变异性,这种方法在严重吞咽困难患者中并不适合临床应用。此前,我们开发了一种TMS设备,该设备可通过单个线圈以16个单相磁脉冲传递四脉冲θ爆发刺激,从而能够测量与手部功能相关的MEP。我们应用了一种MEP调节系统,该系统依赖于5毫秒间隔的单相四脉冲磁刺激(QPS5)范式,以产生5毫秒间隔的四组四串爆发序列;四串爆发刺激(QBS5),预计可在中风患者运动皮层中诱导长时程增强(LTP)。我们的分析表明,QBS5调节左侧运动皮层可在双侧下颌舌骨肌MEP中诱导强烈的易化作用。脑出血后的吞咽功能障碍评分与QBS5调节的MEP参数显著相关,包括静息运动阈值和波幅。左侧运动皮层QBS5调节后双侧下颌舌骨肌MEP的易化程度与吞咽功能障碍的严重程度分级呈现显著的线性相关性(分别为=-0.48/-0.46和0.83/0.83;=0.23/0.21和0.68/0.68,<0.001;分别为右侧/左侧MEP-RMT和波幅)。目前的结果表明,左侧运动皮层QBS5调节后双侧下颌舌骨肌-MEP的RMT和波幅可作为脑出血后吞咽功能障碍的替代定量生物标志物。因此,应进一步探索QBS5调节的MEP在该人群中的安全性和局限性。
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