Zusammenfassung
Pulsform und Stromflussrichtung beeinflussen die Effektivität transkranieller Magnetstimulation
beim Menschen. Dies betrifft bei Einzelreizen die motorische Schwelle sowie die Dauer
der Silent Period im Motorkortex und die Phosphenschwelle im visuellen Kortex, bei
Doppelreizen das Verhältnis intrakortikaler Inhibition und Fazilitation in einem konventionellen
Doppelreizparadigma der TMS über dem Motorkortex, und schließlich bei der repetitiven
transkraniellen Magnetstimulation das Ausmaß und die Spezifität der im Motorkortex
induzierten Bahnung und Hemmung. Mögliche Ursache dieser Unterschiede ist die unterschiedlich
starke und verschieden selektive Aktivierung hemmender und bahnender Interneurone
je nach Pulsform und Stromflussrichtung.
Abstract
Waveform and current direction determine the effectiveness of transcranial magnetic
stimulation in humans. For single pulse TMS these factors have been shown to influence
the motor threshold and the silent period duration detected by motor cortex stimulation
and the phosphene threshold tested by occipital stimulation, for paired pulses they
affect the balance of intracortical inhibition and facilitation within the motor cortex,
and for repetitive stimulation the extent and specificity of the induced motor cortex
inhibition and facilitation. Possibly, the extent and selectivity of activation of
inhibiting and facilitating interneurons depend on TMS waveform and current direction.
Key words
TMS - waveform - current direction - excitability - intracortical
Literatur
- 1
Barker A T, Jalinous R, Freeston I L.
Non-invasive magnetic stimulation of human motor cortex (letter).
Lancet.
1985;
1
1106-1107
- 2 Barker A T.
Magnetic nerve stimulation. Basic principles and development. In: Nilsson J, Panizza M, Grandori F (eds) Advances in magnetic stimulation. Mathematical
modeling and clinical applications. Pavia; Fondazione Salvatore Maugeri Edizioni 1996:
1-11
- 3 Kimura J (Hrsg).
Principles of nerve conduction studies. In: Electrodiagnosis in diseases of nerve and muscle: principles and practice. Philadelphia;
F. A. Davis 1989: 619
- 4 Claus D.
Motorisch evozierte Potentiale (MEP). In: Lowitsch K, Hopf HC, Buchner H, Claus D, Jörg J, Rappelsberger P, Tackmann W
(Hrsg) Das EP-Buch. Stuttgart, New York; Thieme 2000: 173-232
- 5
Maccabee P J, Nagaranjan S S, Amassian V E, Durand D M, Szabo A Z, Ahad A B, Cracco R Q,
Lai K S, Eberle L P.
Influence of pulse sequence, polarity and amplitude on magnetic stimulation of human
and porcine periheral nerve.
J Physiol.
1998;
513
571-585
- 6 Jalinous R. Guide to the Magstim QuadroPulse. Spring Gardens; The Magstim Company
1995
- 7 Bohning D E.
Introduction and overview of TMS physics. In: George MS, Belmaker RH (eds) Transcranial magnetic stimulation in neuropsychiatry. Washington,
D. C., London, England; American Psychiatric Press, Inc 2000: 13-44
- 8
Corthout E, Barker A T, Cowey A.
Transcranial magnetic stimulation Which part of the current waveform causes the stimulation?.
Exp Brain Res.
2001;
141
128-132
- 9
Lazzaro V Di, Oliviero A, Mazzone P, Insola A, Pilato F, Saturno E, Accurso A, Tonali P,
Rothwell J C.
Comparison of descending volleys evoked by monophasic and biphasic magnetic stimulation
of the motor cortex in conscious humans.
Exp Brain Res.
2001;
141
121-127
- 10
Sommer M, Lang N, Tergau F, Paulus W.
Neuronal tissue polarization induced by repetitive transcranial magnetic stimulation?.
Neuroreport.
2002;
13
809-811
- 11
Sommer M, Tergau F, Wischer S, Paulus W.
Paired-pulse repetitive transcranial magnetic stimulation of the human motor cortex.
Exp Brain Res.
2001;
139
465-472
- 12
Sommer M, Kamm T, Tergau F, Ulm G, Paulus W.
Repetitive paired-pulse transcranial magnetic stimulation affects corticospinal excitability
and finger tapping in Parkinson's disease.
Clin Neurophysiol.
2002;
113
944-950
- 13
Chiappa K H, Cros D, Cohen D.
Magnetic stimulation: Determination of coil current flow direction.
Neurology.
1991;
41
1154-1155
- 14
Niehaus L, Meyer B U, Weyh T.
Influence of pulse configuration and direction of coil current on excitatory effects
of magnetic motor cortex and nerve stimulation.
Clin Neurophysiol.
2000;
111
75-80
- 15
Kammer T, Beck S, Thielscher A, Laubis-Herrmann U, Topka H.
Motor threshold in humans: a transcranial magnetic stimulation study comparing different
pulse waveforms, current directions and stimulator types.
Clin Neurophysiol.
2001;
112
250-258
- 16
Brasil-Neto J P, Cohen L G, Panizza M, Nilsson J, Roth B J, Hallett M.
Optimal focal transcranial magnetic activation of the human motor cortex: effects
of coil orientation, shape of the induced current pulse, and stimulus intensity.
J Clin Neurophysiol.
1992;
9
132-136
- 17
Ziemann U, Rothwell J C, Ridding M C.
Interaction between intracortical inhibition and facilitation in human motor cortex.
J Physiol.
1996;
496
873-881
- 18
Kammer T, Beck S, Erb M, Grodd W.
The influence of current direction on phosphene thresholds evoked by transcranial
magnetic stimulation.
Clin Neurophysiol.
2001;
112
2015-2021
- 19
Orth M, Rothwell J C.
The cortical silent period: intrinsic variability and relation to the waveform of
the transcranial magnetic stimulation pulse.
Clin Neurophysiol.
2004;
115
1076-1082
- 20
Kujirai T, Caramia M D, Rothwell J C, Day B L, Thompson P D, Ferbert A, Wroe S, Asselman P,
Marsden C D.
Corticocortical inhibition in human motor cortex.
J Physiol.
1993;
471
501-519
- 21
Peinemann A, Lehner C, Conrad B, Siebner H R.
Age-related decrease in paired-pulse intracortical inhibition in the human primary
motor cortex.
Neurosci Lett.
2001;
313
33-36
- 22
Tokimura H, Ridding M C, Tokimura Y, Amassian V E, Rothwell J C.
Short latency facilitation between pairs of threshold magnetic stimuli applied to
human motor cortex.
Electroencephalogr Clin Neurophysiol.
1996;
101
263-272
- 23
Ziemann U, Tergau F, Wassermann E M, Wischer S, Hildebrandt J, Paulus W.
Demonstration of facilitatory I wave interaction in the human motor cortex by paired
transcranial magnetic stimulation.
J Physiol (Lond).
1998;
511
181-190
- 24
Sommer M, Ruge D, Tergau F, Beuche W, Altenmüller E, Paulus W.
Intracortical excitability in the hand motor representation in hand dystonia and blepharospasm.
Mov Disord.
2002;
17
1017-1025
- 25
Chen R, Classen J, Gerloff C, Celnik P, Wassermann E M, Hallett M, Cohen L G.
Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation.
Neurology.
1997;
48
1398-1403
- 26
Muellbacher W, Ziemann U, Boroojerdi B, Hallett M.
Effects of low-frequency transcranial magnetic stimulation on motor excitability and
basic motor behavior.
Clin Neurophysiol.
2000;
111
1002-1007
- 27
Siebner H R, Tormos J M, Ceballos-Baumann A O, Auer C, Catala M D, Conrad B, Pascual-Leone A.
Low-frequency repetitive transcranial magnetic stimulation of the motor cortex in
writer's cramp.
Neurology.
1999;
52
529-537
- 28
Touge T, Gerschlager W, Brown P, Rothwell J.
Are the after-effects of low-frequency rTMS on motor cortex excitability due to changes
in the efficacy of cortical synapses?.
Clin Neurophysiol.
2001;
112
2138-2145
- 29
Narici L, Romani G L, Salustri C, Pizella V, Modena I, Papanicolaou A C.
Neuromagnetic evidence of synchronized spontaneous activity in the brain following
repetitive sensory stimulation.
Int J Neuroscience.
1987;
32
831-836
- 30
Salmelin R, Hari R.
Spatiotemporal characteristics of sensorimotor neuromagnetic rhythms related to thumb
movement.
Neuroscience.
1994;
60
537-550
- 31
Antal A, Kincses T Z, Nitsche M A, Bartfai O, Demmer I, Sommer M, Paulus W.
Pulse configuration dependent effects of repetitive transcranial magnetic stimulation
on visual perception.
Neuroreport.
2002;
13
1-5
- 32
Pascual-Leone A, Valls-Sole J, Wassermann E M, Hallett M.
Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex.
Brain.
1994;
117
847-858
- 33
Tings T, Lang N, Tergau F, Paulus W, Sommer M.
Orientation-specific fast rTMS maximizes corticospinal inhibition and facilitation.
Exp Brain Res.
2005;
124
323-333
- 34
Lazzaro V Di, Oliviero A, Saturno E, Pilato F, Insola A, Mazzone P, Profice P, Tonali P,
Rothwell J C.
The effect on corticospinal volleys of reversing the direction of current induced
in the motor cortex by transcranial magnetic stimulation.
Exp Brain Res.
2001;
138
268-273
- 35
Lazzaro V Di, Oliviero A, Pilato F, Saturno E, Insola A, Mazzone P, Tonali P A, Rothwell J C.
Descending volleys evoked by transcranial magnetic stimulation of the brain in conscious
humans: effects of coil shape.
Clin Neurophysiol.
2002;
113
114-119
Martin Sommer
Abteilung Klinische Neurophysiologie · Georg-August-Universität Göttingen
Robert-Koch-Straße 40
37075 Göttingen
Email: msommer@gwdg.de
