Matsumoto Hideyuki, Ugawa Yoshikazu
Department of Neurology, Mitsui Memorial Hospital, Tokyo, Japan.
Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
J Clin Neurol. 2024 May;20(3):241-255. doi: 10.3988/jcn.2023.0520.
Single-pulse magnetic stimulation is the simplest type of transcranial magnetic stimulation (TMS). Muscle action potentials induced by applying TMS over the primary motor cortex are recorded with surface electromyography electrodes, and they are called motor-evoked potentials (MEPs). The amplitude and latency of MEPs are used for various analyses in clinical practice and research. The most commonly used parameter is the central motor conduction time (CMCT), which is measured using motor cortical and spinal nerve stimulation. In addition, stimulation at the foramen magnum or the conus medullaris can be combined with conventional CMCT measurements to evaluate various conduction parameters in the corticospinal tract more precisely, including the cortical-brainstem conduction time, brainstem-root conduction time, cortical-conus motor conduction time, and cauda equina conduction time. The cortical silent period is also a useful parameter for evaluating cortical excitability. Single-pulse magnetic stimulation is further used to analyze not only the central nervous system but also the peripheral nervous system, such as for detecting lesions in the proximal parts of peripheral nerves. In this review article we introduce four types of single-pulse magnetic stimulation-of the motor cortex, spinal nerve, foramen magnum, and conus medullaris-that are useful for the diagnosis, elucidation of pathophysiology, and evaluation of clinical conditions and therapeutic effects. Single-pulse magnetic stimulation is a clinically useful technique that all neurologists should learn.
单脉冲磁刺激是经颅磁刺激（TMS）中最简单的类型。通过在初级运动皮层施加TMS诱导的肌肉动作电位，用表面肌电图电极进行记录，这些电位被称为运动诱发电位（MEP）。MEP的波幅和潜伏期在临床实践和研究中用于各种分析。最常用的参数是中枢运动传导时间（CMCT），它通过刺激运动皮层和脊神经来测量。此外，枕骨大孔或脊髓圆锥刺激可与传统的CMCT测量相结合，以更精确地评估皮质脊髓束中的各种传导参数，包括皮质-脑干传导时间、脑干-神经根传导时间、皮质-圆锥运动传导时间和马尾神经传导时间。皮质静息期也是评估皮质兴奋性的一个有用参数。单脉冲磁刺激不仅进一步用于分析中枢神经系统，还用于分析周围神经系统，例如检测周围神经近端的病变。在这篇综述文章中，我们介绍了四种单脉冲磁刺激——运动皮层、脊神经、枕骨大孔和脊髓圆锥——它们对诊断、阐明病理生理学以及评估临床状况和治疗效果都很有用。单脉冲磁刺激是一项所有神经科医生都应该学习的临床有用技术。
