神经变性疾病是导致神经元进行性变性和死亡的病症的集合。它们在临床上是异质的,可以表现为运动缺陷,认知,执行功能,记忆,视觉空间意识和语言。经颅磁刺激(TMS)是一种非侵入性脑刺激工具,可用于评估体内皮质功能。我们回顾了TMS如何用于研究三种神经解剖学轴不同的神经退行性疾病:(1)运动皮质-皮质脊髓束(运动神经元疾病),(2)非运动皮质区(痴呆),和(3)皮层下结构(帕金森病)。我们还提出了四项建议,希望对TMS在神经退行性疾病中的应用有益。首先,TMS传统上受到缺乏客观输出的限制,因此仅限于刺激运动皮层;可以通过使用并发神经成像方法(例如EEG)来克服这种限制。鉴于神经退行性疾病会随着时间的推移而发展,TMS措施应旨在跟踪纵向变化,特别是当研究的目的是观察疾病进展和症状时。缺乏黄金标准的诊断确认损害了临床人群中发现的有效性。因此,诊断确定性应通过多种方法最大化,包括多种方法,独立的临床评估,成像和流体生物标志物,并在可能的情况下进行验尸病理确认。人们对了解神经退行性疾病中症状产生的机制非常感兴趣。然而,患者的TMS评估通常在休息条件下进行,当参与这些症状的大脑网络不表达时。相反,适合上下文的TMS形式更适合于探测生理学驱动的临床症状。总之,我们希望这里提出的建议将有助于进一步了解神经退行性疾病的病理生理。
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 in vivo. 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.