Transkranielle Magnetstimulation: Neue Einsatzmöglichkeiten zur Messung kortikaler und kortikospinaler Erregbarkeit

Zusammenfassung

Die transkranielle Magnetstimulation (TMS) ist eine noch relativ neue Methode zur schmerzfreien und nichtinvasiven Reizung des Kortex, die in der neurophysiologischen Routineuntersuchung ganz überwiegend zur Messung der zentralmotorischen Leitungszeit und damit zur Erfassung der Integrität des kortikospinalen Traktes eingesetzt wird. Methodische Erweiterungen haben jetzt ein ganzes Szenario neuer Einsatzmöglichkeiten eröffnet. In dieser Übersicht werden vor allem Methoden zur exakten Bestimmung eines zentralen Leitungsblocks und zur fraktionierten Leitungszeitmessung entlang begrenzter Segmente des kortikospinalen Traktes sowie zahlreiche Techniken zur Messung motorkortikaler und kortikospinaler Erregbarkeit beschrieben. Der derzeitige Stellenwert dieser neuen TMS-Methoden wird durch die Besprechung der verfügbaren Patientendaten bewertet.

Transcranial Magnetic Stimulation: New Applications to Measure Cortical and Corticospinal Excitability

Transcranial magnetic stimulation (TMS) is a still relatively new method to stimulate the human cortex painlessly and non-invasively. In the neurophysiological routine situation, TMS was and is still used mainly for measurement of the central motor conduction time in order to evaluate the integrity of the corticospinal tract. Methodological improvement and innovation has now opened numerous opportunities for novel applications. This review will describe techniques to measure exactly central conduction block and fractionated conduction time along restricted segments of the corticospinal tract. Furthermore, several protocols will be discussed that allow the measurement of motor cortical and corticospinal excitability. The value of these novel techniques will be demonstrated by a survey of the available data in neurological patients.

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