이 작품은 자금의 다음 소스에 의해 지원됩니다 : MAN : NIH 2R01 DC05672-04A2 RHH : NIH / NINDS 1K01NS060995-01A1 RHH : 로버트 우드 존슨 재단 / 해롤드 모스 의학 교수 개발 프로그램

1. 전처리 평가 <ol><li> 연구를위한 자격 요건을 충족 모집 환자. 이 기준은 보조 운동 영역 (SMA)을 예비 한, 일방적, 왼쪽 반구 허혈성 뇌졸중, 비 유창한 연설 (의미있는 단어를 생산하고 최소한 2-4 단어 길이 문자열을 할 수있는 능력으로 정의) 중등도을 포함 18 75 세에서 6 개월 이상 후 뇌졸중 사이. </li><li> 또한, 모든 잠재적 인 환자는 노드 그래스에서 찍은 사진 - 명명 자극의 10 세트와 함께 제시하면 20 아웃 보스턴 명명 테스트 15 일 적어도 세 사진의 평균의 첫 번째 30 항목 중 적어도 세 가지 이름을 할 수해야합니다 Vanderwart 코퍼스 16, 그리고 보스턴 진단 실어증 검사 17 단어 이해와 명령에 대한 하위 검사에 25 번째 백분위 수 또는 그 이상의 점수입니다. </li><li> 환자가 H 보장하기 위해 의료 검사 시험을 실시자기 공명 영상 (MRI) 검사 또는 TMS를​​ 진행에 아무런 금기가없는 연구에 참여하기에 충분한 ealthy, 그. </li></ol> 2. 기본 테스트 <ol><li> 다른인지 영역에서 각 환자의 언어 장애와 결손의 정도를 평가하기 위해 별도의 세 가지 일에 표준화 된 테스트 배터리를 관리 할 수​​ 있습니다. 테스트 BDAE 18 BDAE의 쿠키 도난 그림 설명 하위 검사 등 (2 차 에드.) 워드 이해를위한 하위 테스트 (기본 워드 차별) 및 명령, 보스턴 명명 테스트 15, 스 노드 그래스와 Vanderwart에서 가져온 40 선 그리기 자극의 설정 사진 데이터베이스 16, 그리고인지 언어 빠른 테스트 19 (CLQT). </li><li> 환자가 경구 응답 그림 명명 작업을 수행하는 기본 BOLD-fMRI를 연구를 시작합니다. MPRAGE 순서로 높은 해상도 전체 - 뇌 T1-강조 영상을 수집 (RT = 1620 밀리 초, TE = 3.87 밀리 초, FA = 15, FOV = 192 X 256 조각 = 160, 복셀 크기 = 1mm 3). 전체 - 뇌 T2 * 강조 BOLD echoplanar 순서 (TR = 3000 초, TE = 35 밀리 초, FA = 90, FOV를 사용하여 기능성 볼륨을 취득 = 128 X 128 조각 = 31, 복셀 크기 = 1.875 mm 2, 슬라이스 두께 = 4mm). </li><li> 실제 반복 TMS (RTMS) 또는 RTMS (그림 1) 다음 초기 가짜 자극 (STMS)를 수신 그룹을받은 두 그룹으로 환자를 무작위. </li></ol> 3. 자극의 최적 장소의 식별 <ol><li> 정밀하고 정확한 방법으로 대뇌 피질의 사이트에 RTMS를 대상으로하기 위해, 위치에 (예를 들어 Brainsight, 악성 연구, 몬트리올)에 공동 등록 고해상도 전체 - 뇌 T1-강조 영상 (위의 2.2 참조) neuronavigational 시스템을 사용 환자와 코일. RTMS 그룹에 대해 올바른 운동 피질과 이후 육안 검사 (20)에 자극을 통해 휴식 모터 임계 값 (RMT)를 결정합니다. </li><lI&gt; 실시간 RTMS 동안, 방향 후방 및 하부 방향으로 핸들 코일 아래 위치에서 시계 방향으로 약 45 °. 가짜 그룹의 경우, 코일 접점 머리의 측면 날개의 단지 바깥 쪽 테두리 그래서 머리에 코일을 수직으로 STMS를 관리 할 수​​ 있습니다. 이 방향에서 최대 자기장 두개골에 평행하므로 대뇌 피질의 자극을 생성하지 않습니다. </li><li> 오일 (두 개의 세션이 세션 사이에 45 분 휴식 시간, 마지막 날에 실시)을 통해 진행 여섯 별도의 세션에서, ~ 10도 RTMS의 분 (90 % RMT의 강도에서 1 Hz에서 600 펄스) 또는 STMS 관리 오른쪽 하부 전두엽에있는 다른 사이트 (일차 운동 피질 (M1) 입에 해당하는 triangularis 동위 opercularis (BA 44), 전방 갈 거예요 (BA 45), 지느러미 후방 동위 triangularis (BA 45), 복부 후방 동위 triangularis BA 45), 그리고 동위 orbitalis (BA 47, 그림 2). stimulatio를 무작위환자 사이에 N 사이트 순서입니다. </li><li> 환자가 각 TMS 세션 직전 및 직후에 40 항목을 그림으로 명명 작업을 수행해야합니다. 그림 자극은 노드 그래스에서 가져온 16 아이템 세트, 피바디 그림 어휘 테스트 21 일, 국제 사진 네이밍 프로젝트 (IPNP) 데이터베이스 22 Vanderwart 있습니다. 40 항목 목록은 단어 길이, 주파수 및 의미 론적 범주에 대해 일치해야하며 우리의 항목 20 연습 효과를 평가하기 위해 테스트 세션에 걸쳐 반복하는 동안 20 항목을 새로운 있었다 나열합니다. 그들은 음소 8보다 더하여 대상과 다를 경우 발언은 올바른 것으로 간주되어야한다. 단어 목록의 순서는 과목에 걸쳐 무작위로해야하며, 각 과목마다 방문에 다른 단어 목록을 받아야한다. </li><li> T-테스트 performan 명명의 평균 변화에 각 사이트에서 그림 명명 성능의 변화를 비교 한 샘플을 수행하여 자극의 최적 위치를 결정다른 모든 사이트에 대한 CE. 다음으로, 여섯 사전 RTMS 세션에서의 성능 변화에 따라 최적의 사이트에서 성능 변화를 비교, RTMS 후 성능 변화는 평균 전 TMS 성능의 두 배 표준 편차보다 큰 경우, 그것은 가능성이다 성능을 명명의 장점은 검사 - 재검사 변화 9 때문이다. </li><li> 가짜 사이트 찾기위한, 파스 triangularis에 STMS를 관리 할 수​​ 있습니다. 이 위치는 프로토콜 4 장에 설명 된 처리 단계의 모의 팔을위한 &quot;최적의 위치&quot;로 역할을합니다. </li></ol> 4. 치료 단계 <ol><li> 열두 일간 (꺼짐 주말과 평일에 자극)는 10 일 동안 최적의 자극 사이트에 RTMS 또는 STMS를 관리 할 수​​ 있습니다. </li><li> 자극의 첫 번째 날에 이벤트의 순서는 다음과 같습니다 : 환자는 fMRI를을 (동시 그림 명명와, 기준선)을 받아야했습니다 40 항목 명명 작업을 관리, 최적의 자극ITE는 90 % RMT 또는 STMS에서 1 Hz에서 RTMS 하나의 20 분을 사용하여 다시 명명 작업을 관리하고, 마지막으로 환자가하는 그림 명명 동시로 두 번째 fMRI를을 받다. </li><li> 구를 통해 일 두에, 프로토콜은 90 % RMT 또는 STMS에서 1 Hz에서 RTMS를 사용하여 20 분 RTMS 세션 (1200 펄스)로 구성되어 있습니다. </li><li> 하루 열에서, 그림 명명 과제로 시작하고 다음에 1 Hz에서 RTMS와 함께 20 분 동안 최적의 사이트를 자극한다. 참고로, 사진 품목은 1 개에서 10가 달라야 일에 같이 나열하지만,​​ 주파수, 워드 길이, 위에서 언급 한 바와 같이 의미 범주에 대한 일치. </li></ol> 5. 두와 6 개월 후속 방문 <ol><li> RTMS 또는 STMS 하나의 하루에 열 후 2 개월, 포토 명명 동시과 기준 시험 (단계 2.1)뿐만 아니라, fMRI를 반복합니다. </li><li> 가짜 상태에있는 환자는 최적의 사이트 발견 단계 (그림 1)로 시작, 실제 TMS 상태로 건너해야합니다. </li><li> 여섯 달 FOL실제 RTMS 자극, 반복 기준선 테스트 (단계 2.1에서와 같이), 그리고 하루에 10 개를 lowing도 환자는 동시 영상 명명 작업과 다른 fMRI를를 받아야했다. </li></ol>

<ol>
	<li>Hamilton, R. H., Chrysikou, E. G., Coslett, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanisms+of+aphasia+recovery+after+stroke+and+the+role+of+noninvasive+brain+stimulation.">Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation.</a> Brain Lang. 118, 40-50 (2011).</li><li>Wade, D. T., Hewer, R. L., David, R. M., Enderby, P. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aphasia+after+stroke:+natural+history+and+associated+deficits.">Aphasia after stroke: natural history and associated deficits.</a> J. Neurol. Neurosurg. Psychiatry. 49, 11-16 (1986).</li><li>Maeda, F., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+magnetic+stimulation:+studying+motor+neurophysiology+of+psychiatric+disorders.">Transcranial magnetic stimulation: studying motor neurophysiology of psychiatric disorders.</a> Psychopharmacology (Berl). 168, 359-376 (2003).</li><li>Elkin-Frankston, S., Fried, P. J., Pascual-Leone, A., Rushmore, R. J., Valero-Cabr, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+approach+for+documenting+phosphenes+induced+by+transcranial+magnetic+stimulation.">A novel approach for documenting phosphenes induced by transcranial magnetic stimulation.</a> J. Vis. Exp. (38), e1762 (2010).</li><li>Najib, U., Horvath, J. C., Silvanto, J., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=State-dependency+effects+on+TMS:+a+look+at+motive+phosphene+behavior.">State-dependency effects on TMS: a look at motive phosphene behavior.</a> J. Vis. Exp. (46), e2273 (2010).</li><li>Horvath, J. C., Mathews, J., Demitrack, M. A., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+NeuroStar+TMS+device:+conducting+the+FDA+approved+protocol+for+treatment+of+depression.">The NeuroStar TMS device: conducting the FDA approved protocol for treatment of depression.</a> J. Vis. Exp. (45), e2345 (2010).</li><li>Martin, P. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+magnetic+stimulation+as+a+complementary+treatment+for+aphasia.">Transcranial magnetic stimulation as a complementary treatment for aphasia.</a> Semin. Speech Lang. 25, 181-191 (2004).</li><li>Naeser, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improved+picture+naming+in+chronic+aphasia+after+TMS+to+part+of+right+Broca's+area:+an+open-protocol+study.">Improved picture naming in chronic aphasia after TMS to part of right Broca's area: an open-protocol study.</a> Brain and Language. 93, 95-105 (2005).</li><li>Hamilton, R. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stimulating+conversation:+enhancement+of+elicited+propositional+speech+in+a+patient+with+chronic+non-fluent+aphasia+following+transcranial+magnetic+stimulation.">Stimulating conversation: enhancement of elicited propositional speech in a patient with chronic non-fluent aphasia following transcranial magnetic stimulation.</a> Brain Lang. 113, 45-50 (2010).</li><li>Turkeltaub, P. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimizing+within-experiment+and+within-group+effects+in+activation+likelihood+estimation+meta-analyses.">Minimizing within-experiment and within-group effects in activation likelihood estimation meta-analyses.</a> Hum. Brain Mapp. , (2011).</li><li>Medina, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Finding+the+Right+Words:+Transcranial+Magnetic+Stimulation+Improves+Discourse+Productivity+in+Non-fluent+Aphasia+After+Stroke.">Finding the Right Words: Transcranial Magnetic Stimulation Improves Discourse Productivity in Non-fluent Aphasia After Stroke.</a> Aphasiology. , (2012).</li><li>Barwood, C. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improved+language+performance+subsequent+to+low-frequency+rTMS+in+patients+with+chronic+non-fluent+aphasia+post-stroke.">Improved language performance subsequent to low-frequency rTMS in patients with chronic non-fluent aphasia post-stroke.</a> Eur. J. Neurol. , (2010).</li><li>Weiduschat, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Repetitive+Transcranial+Magnetic+Stimulation+in+Aphasic+Stroke:+A+Randomized+Controlled+Pilot+Study.">Effects of Repetitive Transcranial Magnetic Stimulation in Aphasic Stroke: A Randomized Controlled Pilot Study.</a> Stroke. , (2011).</li><li>Naeser, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=TMS+suppression+of+right+pars+triangularis,+but+not+pars+opercularis,+improves+naming+in+aphasia.">TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia.</a> Brain Lang. 119, 206-213 (2011).</li><li>Kaplan, E., Goodglass, H., Weintraub, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Boston Naming Test (BNT). , (2001).</li><li>Snodgrass, J. G., Vanderwart, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+standardized+set+of+260+pictures:+norms+for+name+agreement,+image+agreement,+familiarity,+and+visual+complexity.">A standardized set of 260 pictures: norms for name agreement, image agreement, familiarity, and visual complexity.</a> J. Exp. Psychol. Hum. Learn. 6, 174-215 (1980).</li><li>Goodglass, H., Kaplan, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> The assessment of aphasia and related disorders. , (1972).</li><li>Goodglass, H., Kaplan, E., Barresi, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Boston Diagnostic Aphasia Examination (BDAE). , (1983).</li><li>Helm-Estabrooks, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Cognitive linguistic quick test (CLQT): Examiner's manual. , (2001).</li><li>Rossini, P. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-invasive+electrical+and+magnetic+stimulation+of+the+brain,+spinal+cord+and+roots:+basic+principles+and+procedures+for+routine+clinical+application.+Report+of+an+IFCN+committee.">Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee.</a> Electroencephalogr. Clin. Neurophysiol. 91, 79-92 (1994).</li><li>Dunn, L. M., Peabody Hottel, J. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=picture+vocabulary+test+performance+of+trainable+mentally+retarded+children.">picture vocabulary test performance of trainable mentally retarded children.</a> Am. J. Ment. Defic. 65, 448-452 (1961).</li><li>Szekely, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+on-line+resource+for+psycholinguistic+studies.">A new on-line resource for psycholinguistic studies.</a> J. Mem. Lang. 51, 247-250 (2004).</li><li>Martin, P. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+with+transcranial+magnetic+stimulation+in+the+treatment+of+aphasia.">Research with transcranial magnetic stimulation in the treatment of aphasia.</a> Curr. Neurol. Neurosci. Rep. 9, 451-458 (2009).</li><li>Duffau, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+insights+into+the+anatomo-functional+connectivity+of+the+semantic+system:+a+study+using+cortico-subcortical+electrostimulations.">New insights into the anatomo-functional connectivity of the semantic system: a study using cortico-subcortical electrostimulations.</a> Brain. 128, 797-810 (2005).</li><li>Picht, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+the+functional+status+of+the+motor+system+in+brain+tumor+patients+using+transcranial+magnetic+stimulation.">Assessing the functional status of the motor system in brain tumor patients using transcranial magnetic stimulation.</a> Acta Neurochir. (Wien). , (2012).</li><li>Fertonani, A., Rosini, S., Cotelli, M., Rossini, P. M., Miniussi, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Naming+facilitation+induced+by+transcranial+direct+current+stimulation.">Naming facilitation induced by transcranial direct current stimulation.</a> Behav. Brain Res. 208, 311-318 (2010).</li><li>Schlaug, G., Marchina, S., Wan, C. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+non-invasive+brain+stimulation+techniques+to+facilitate+recovery+from+post-stroke+aphasia.">The use of non-invasive brain stimulation techniques to facilitate recovery from post-stroke aphasia.</a> Neuropsychol. Rev. 21, 288-301 (2011).</li></ol>

저자는 그들이 더 경쟁 재정적 이익이 없다는 것을 선언합니다.

이 문서의 목적은 세부 만성 비 유창한 실어증 환자의 오른쪽 반구 응답 대상 사이트를 식별하는 단계에있다. 그렇게함으로써, 우리는 치료 대상 영역을 자극하는 언어 능력을 자극의 효과를 평가하고, 이름과 만성 비 유창한 실어증 환자의 유창성에 장기적인 개선을 유도하기 위해 낮은 주파수 RTMS를 사용할 수 있습니다. 우리의 접근 방식은 사전 조사, 특히 Naeser 및 동료 8에서 사용하는...

실어증 - 언어의 획득 적자 능력이며, 뇌졸중 2의 일반적이고 자주 쇠약 결과. 급성 뇌졸중 후 실어증의 회복 어느 정도의 전형적인이지만, 많은 환자는 지속적인 적자 적어도 어느 정도 경험, 기존의 언어 치료는 일반적으로 복구 3-5 촉진 단지 겸손하게 효과적인 것으로 간주됩니다. 최근 몇 년 동안은 실어증 등 뇌졸중 후 적자의 다양한 유망한 잠재적 인 치료 접근과 같은 두개 자기 자극 (TMS)와 같은 비 침습적 자극 기법의 출현을 보았다. TMS는 전자기 유도의 원리를 채택하고 와이어의 코일 빠르게 플럭 싱 자기장의 생성을 포함한다. 코일 피사체의 머리에 인접하여 배치되면 자기장 신경 세포의 세포막과 유전자를 탈분극에 충분하다는 것을 대뇌 피질의 뉴런을 기본에 전류를 유도, 두피와 두개골을 관통속도 활동 전위 3. 같은 주파수, 강도, 및 펄스의 수와 같은 TMS 매개 변수는 4,5 다른 neurophysiologic, 행동, 지각 효과를 이끌어 위해 변경 될 수 있습니다. 반복 TMS (RTMS)는 소정의 주파수에서 펄스의 일련의 관리를 수반하고 자극의 응용 프로그램을 버틸 수있는 효과를 생산하고 있습니다. 현재 실험, 낮은 주파수 (0.5-2 Hz에서)에서 제공 RTMS 고주파 자극이 대뇌 피질의 흥분 3과 관련되어있는 동안 focally, 대뇌 피질의 흥분을 감소하는 경향이 있다는 증거 쇼에 밀접한. RTMS는 다양한 신경 및 정신 장애, 특히 우울증 6에 대한 치료로 탐구하고있다. 증거의 성장 시체는 낮은 주파수 RTMS는 만성 뇌졸중에 의한 실어증을 가진 사람의 언어 복구를 향상시키는 데 사용할 수 있습니다 제안합니다. Naeser와 동료 7,8 1 Hz에서 inhibito을 적용하는 첫번째이었다스피 만성 비 유창한 실어증 네 개의 오른 손잡이 환자에서 두 주 동안 일주일에 20 분 5 일 동안 오른쪽 하부 전두엽 이랑에 RTMS. 네이밍에 상당한 개선이 자극 8 완료 후 적어도 8 개월 동안 지속하는 관찰되었다. 우리는 이후 복제 및 확장이 결과를 1 Hz의 자극이 이름 지정 및 만성 비 유창한 실어증 환자의 9-11 자발적으로 이끌어 연설 모두에서 지속적인 개선으로 이어진 증명하고있다. 격려, 이와 같은 작은 연구 결과뿐만 아니라 급성 뇌졸중과 실어증 13 환자 등 만성 뇌졸중 12 환자에서 더 조사에 복제되었습니다. 비 유창한 실어증 환자의 이전 TMS 연구의 중요한 한 거의 유비 쿼터스 기능은 자극의 유익한 효과를 특정 사이트로 나타날 것입니다. 처음 Naeser에 의해 고용 된 접근 방식을 채택와 동료, RTMS는 언어 회복을 촉진하는 데 사용되었습니다하는 대부분의 조사 1 (브로드 만 영역 45) triangularis 오른쪽 동위를 대상으로했다. 사실, 최근의 증거는 오른쪽 하부 전두엽 이랑의 다른 지역의 자극 효과가있을 수 있다는 것을 제안했다, 또는 언어의 성능을 14 해로운 영향을 미칠 수 있으며, 최적의 자극 위치에주의 개인 식별의 필요성을 강조. Naeser와 동료 (8)에 의해 설립 된 방식에 따라 구축, 지속적인 조사가 언어 능력 하부 전두엽 이랑에 억제 RTMS의 효과를 탐구하고, 또한 오른쪽 전두엽에있는 RTMS 효과의 지형 특성을 검사합니다. 이 문서에서는, 우리는 자극을위한 최적의 사이트가 만성 비 유창한 실어증 환자 식별 할 수있는 방법에 대한 자세한 설명을 제공합니다. 우리는 그 치료 RTMS의 관리를 설명하고 OU를 설명이 인구의 향상 언어 복구 자극의 효과를 평가하기위한 연구 기술.

<table border="1">
 <tbody>
 <tr>
 <td>Name of Reagent/Material</td>
 <td>Company</td>
 <td>Catalog Number</td>
 <td>Comments</td>
 </tr>
 <tr>
 <td>Rapid transcranial magnetic stimulator</td>
 <td>Magstim</td>
 <td></td>
 <td></td>
 </tr>
 <tr>
 <td>3.0 Trio Scanner</td>
 <td>Siemens</td>
 <td></td>
 <td></td>
 </tr>
 <tr>
 <td>8 channel head coil</td>
 <td>Siemens</td>
 <td></td>
 <td></td>
 </tr>
 <tr>
 <td>Brainsight neuronavigational system</td>
 <td>Rogue Research</td>
 <td></td>
 <td></td>
 </tr>
 </tbody>
</table>

utilizing repetitive transcranial magnetic stimulation to improve language function in stroke patients with chronic non-fluent aphasia

두개 자기 자극 (TMS)은 크게 비 유창한 실어증 1 환자의 언어 기능을 개선하기 위해 표시되었습니다. 이 실험에서 우리는 만성 비 유창한 실어증 환자의 오른쪽 반구에 최적의 자극 사이트에 저주파 반복적 인 TMS (RTMS)의 관리를 보여줍니다. 표준화 된 언어 조치의 배터리는 기본 성능을 평가하기 위해 관리됩니다. 환자는 실제 RTMS 또는 초기 가짜 자극을받을 연속적으로 무작위입니다. 실제 자극에있는 환자 5 일 동안 투여 여섯 RTMS 세션의 시리즈로 구​​성된 사이트 찾는 단계를 거쳐, 자극은 각 세션 동안 오른쪽 전두엽에있는 다른 사이트로 전달됩니다. 각 사이트 발견 세션은 그림 명명 과제로 시작하고 다음에 1 Hz에서 RTMS, 600 펄스로 구성되어 있습니다. 기능 이름의 일시적인 변화의 정도를 비교하여 모시의 자극에 의​​해 이끌어사이트 IDATE, 우리는 각각의 환자에 대한 최적 반응 영역을 찾을 수 있습니다. 우리는 그 다음 처리 단계에서이 사이트에 RTMS를 관리 할 수​​ 있습니다. 치료 기간 동안, 환자는 2 주 기간에 자극을 10 일 총 거쳐, 각 세션은 90 % 휴식 모터 임계 값에 전달 1 Hz에서 RTMS의 20 분으로 구성되어 있습니다. 자극 치료의 처음과 마지막 날에 fMRI를 명명 작업과 쌍을 이룹니다. 치료 단계가 완료되면 초기에 얻은 언어 배터리 성능 RTMS에 의한 변화를 확인하기 위하여 자극에 따라 두 6 개월 반복됩니다. fMRI를 명명 작업은 또한 다음과 같은 치료 두 6 개월 반복됩니다. 연구의 가짜 팔에 무작위 인 환자는 가짜 사이트 발견, 가짜 처리, fMRI를 이름 지정 연구 및 모의 치료를 마친 후 2 개월 테스트를 반복 언어를 받다. 가짜 환자는 실제 사이트 발견, 실제 트리트을 완료, 실제 자극의 팔에 건너천만에, fMRI를, 및 2와 6 개월 후 자극 언어 테스트.

이 조사의 사이트 발견 단계에서는, 전부는 아니지만, 대부분의 환자는 14 triangularis 오른쪽 동위의 자극에 그림 명명 과제에 적절하게 응답. 우리의 경험에서 그림 이름 지정에 대한 환자의 성능이 가장 일관되게 파스 triangularis (그림 3)의 복부 후방 측면의 자극에 의해 촉진됩니다. 표준화 된 언어 평가의 성능에 장기적인 개선은 그림 ...

Watch this Scientific Journal Video about Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia at JoVE.com

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

우리는 만성 뇌졸중과 비 유창한 실어증 환자의 언어 능력을 향상시키기 위해 반복적 경 두개 자기 자극 (RTMS)의 사용을 탐험 해보세요. 자극 최적의 응답 각 환자의 오른쪽 전두엽 이랑있는 사이트를 식별 한 후, 우리는 RTMS 치료 10 일 동안이 사이트를 대상으로.

만성 비 유창한 실어증과 뇌졸중 환자의 언어 기능을 개선하기 위해 반복적 경 두개 자기 자극을 활용

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this ...

utilizing-repetitive-transcranial-magnetic-stimulation-to-improve

Research

JoVE Journal

Medicine

17.6K 조회수.  University of Pennsylvania. 우리는 만성 뇌졸중과 비 유창한 실어증 환자의 언어 능력을 향상시키기 위해 반복적 경 두개 자기 자극 (RTMS)의 사용을 탐험 해보세요. 자극 최적의 응답 각 환자의 오른쪽 전두엽 이랑있는 사이트를 식별 한 후, 우리는 RTMS 치료 10 일 동안이 사이트를 대상으로.

비디오: Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

인간 신경근육학 시스템을 공부하기 Transcranial 자기 자극을 활용

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

연구

의학

Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily life, despite similar visual deficits. We assume this could be due to variable development of compensatory strategies such as altered visual scanning behavior. Scanning compensatory therapy (SCT) is studied as part of the visual training after infarction next to vision restoration therapy. SCT consists of learning to make larger eye movements into the blind field enlarging the visual field of search, which has been proven to be the most useful strategy1, not only in natural search tasks but also in mastering daily life activities2. Nevertheless, in clinical routine it is difficult to identify individual levels and training effects of compensatory behavior, since it requires measurement of eye movements in a head unrestrained condition. Studies demonstrated that unrestrained head movements alter the visual exploratory behavior compared to a head-restrained laboratory condition3. Martin et al.4 and Hayhoe et al.5 showed that behavior demonstrated in a laboratory setting cannot be assigned easily to a natural condition. Hence, our goal was to develop a study set-up which uncovers different compensatory oculomotor strategies quickly in a realistic testing situation: Patients are tested in the clinical environment in a driving simulator. SILAB software (Wuerzburg Institute for Traffic Sciences GmbH (WIVW)) was used to program driving scenarios of varying complexity and recording the driver's performance. The software was combined with a head mounted infrared video pupil tracker, recording head- and eye-movements (EyeSeeCam, University of Munich Hospital, Clinical Neurosciences).
The positioning of the patient in the driving simulator and the positioning, adjustment and calibration of the camera is demonstrated. Typical performances of a patient with and without compensatory strategy and a healthy control are illustrated in this pilot study. Different oculomotor behaviors (frequency and amplitude of eye- and head-movements) are evaluated very quickly during the drive itself by dynamic overlay pictures indicating where the subjects gaze is located on the screen, and by analyzing the data. Compensatory gaze behavior in a patient leads to a driving performance comparable to a healthy control, while the performance of a patient without compensatory behavior is significantly worse. The data of eye- and head-movement-behavior as well as driving performance are discussed with respect to different oculomotor strategies and in a broader context with respect to possible training effects throughout the testing session and implications on rehabilitation potential.

Patients with visual deficits after stroke report about different constraints in daily life most likely due to variable compensatory strategies, which are difficult to differentiate in clinical routine. We present a clinical set-up which allows measurement of different compensatory head- and eye-movement-strategies and evaluating their effects on driving performance.

클리닉에서 시뮬레이션 운전 : 비주얼 필드 결함으로 환자의 일상 생활 활동에서 Visual 탐색 행동 테스트

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily ...

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As such, primary or &#39;neuronal-like&#39; cell culture systems are commonly utilized. While&#160;these systems are relatively easy to work with, and are useful model systems in which various functional outcomes (such as cell death) can be readily quantified, the examined outcomes and pathways in cultured immature neurons (such as excitotoxicity-mediated cell death pathways) are not necessarily the same as those observed in mature brain, or in intact tissue. Therefore, there is the need to develop models in which cellular mechanisms in mature neural tissue can be examined. We have developed an in vitro technique that can be used to investigate a variety of molecular pathways in intact nervous tissue. The technique described herein utilizes rat cortical tissue, but this technique can be adapted to use tissue from a variety of species (such as mouse, rabbit, guinea pig, and chicken) or brain regions (for example, hippocampus, striatum, etc.). Additionally, a variety of stimulations/treatments can be used (for example, excitotoxic, administration of inhibitors, etc.). In conclusion, the brain slice model described herein can be used to examine a variety of molecular mechanisms involved in excitotoxicity-mediated brain injury.

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

We have developed a brain slice model which can be used to examine molecular mechanisms involved in excitotoxicity-mediated brain injury.&#160;This technique generates viable mature brain tissue and reduces animal numbers required for experimentation, whilst keeping the neuronal circuitry, cellular interactions, and postsynaptic compartments partly intact.

같은 뇌 Microslices의 흥분 독성 자극<em&gt; 체외</em&gt; 스트로크의 모델

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As ...

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression.

The degree of vascular dysfunction and contributing physiological mechanisms can be assessed in patients with chronic kidney disease by measuring brachial artery flow-mediated dilation, aortic pulse-wave velocity, and vascular endothelial cell protein expression.

만성 신장 질환 환자에서 혈관 기능의 평가

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

깊은 뇌 자극과 Saccadometry를 사용하여 정상 및 병적 뇌 기능을 연구하는

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases.

Resting-state functional-connectivity MRI has identified abnormalities in patients with a wide range of neuropsychiatric disorders, including epilepsy due to malformations of cortical development. Transcranial Magnetic Stimulation in combination with EEG can demonstrate that patients with epilepsy have cortical hyperexcitability in regions with abnormal connectivity.

간질 환자의 뇌 흥분을 연결 관련 평가하는 멀티 모달 Imaging- 및 자극 기반 방법

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations ...

Home-Based Transcranial Direct Current Stimulation Device Development: An Updated Protocol Used at Home in Healthy Subjects and Fibromyalgia Patients

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the cerebral cortex by a low-intensity direct current. tDCS is a low-cost technique with minimal adverse effects and easy application. This neurostimulation method has a promising future to improve pain therapy, treatment of neuropsychiatric disorders, and physical rehabilitation.
Current studies demonstrate the benefits of using tDCS over consecutive multiple sessions. However, the daily displacement to the specialized centers, travel costs, and disruptions to daily activities are some of the difficulties faced by patients. Thus, to be more comfortable, easy-to-use, and not disrupt daily commitments, a home-based tDCS was designed. Therefore, the objective of this study was to evaluate the feasibility of a portable tDCS device for home use in healthy subjects and fibromyalgia patients.
Despite increased tDCS use and a reasonably large body of research on the effects across a range of clinical conditions, there is a limited amount of research on developing secure devices that guarantee the dose and contain a block system to avoid excessive use. Therefore, we used a tDCS device with a security system to permit daily use for 20 minutes with a minimal interval of 12 hours between sessions. A programmer preconfigures the equipment, which has a neoprene cap that allows the electrode positions in any assembly, according to individualized protocols for treatments or research. After, researchers can assess the effectiveness of treatment, and its adherence using information kept in the device software.
Results suggest that the device is feasible for home use, with proper monitoring of adherence and contact impedance. There were reports of a few adverse effects, which do not differ from those reported in the literature in studies with the treatment under direct supervision.

This study provides an updated home-based tDCS protocol that enables subjects to receive the beneficial effects of tDCS at home with an easy to use device with settings to control the use and dosage, enhancing the feasibility for long-term use at home.

홈 기반 Transcranial 직접 현재 자극 장치 개발: 업데이트 프로토콜 에서도 집에서 건강 한 과목 및 주창한 환자

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the ...

Updated Technique for Reliable, Easy, and Tolerated Transcranial Electrical Stimulation Including Transcranial Direct Current Stimulation

Transcranial direct current stimulation (tDCS) is a noninvasive method of neuromodulation using low-intensity direct electrical currents. This method of brain stimulation presents several potential advantages compared to other techniques, as it is noninvasive, cost-effective, broadly deployable, and well-tolerated provided proper equipment and protocols are administered. Even though tDCS is apparently simple to perform, correct administration of the tDCS session, especially the electrode positioning and preparation, is vital for ensuring reproducibility and tolerability. The electrode positioning and preparation steps are traditionally also the most time consuming and error-prone. To address these challenges, modern tDCS techniques, using fixed-position headgear and pre-assembled sponge electrodes, reduce complexity and setup time while also ensuring that the electrodes are consistently placed as intended. These modern tDCS methods present advantages for research, clinic, and remote-supervised (at home) settings. This article provides a comprehensive step-by-step guide for administering a tDCS session using fixed-position headgear and pre-assembled sponge electrodes. This guide demonstrates tDCS using commonly applied montages intended for motor cortex and dorsolateral prefrontal cortex (DLPFC) stimulation. As described, selection of the head size and montage-specific headgear automates electrode positioning. Fully assembled pre-saturated snap-electrodes are simply affixed to the set position snap-connectors on the headgear. The modern tDCS method is shown to reduce setup time and reduce errors for both novice and expert operators. The methods outlined in this article can be adapted to different applications of tDCS as well as other forms of transcranial electrical stimulation (tES) such as transcranial alternating current stimulation (tACS) and transcranial random noise stimulation (tRNS). However, since tES is application specific, as appropriate, any methods recipe is customized to accommodate subject, indication, environment, and outcome specific features.

When administering transcranial direct current stimulation (tDCS), reproducible electrode preparation and placement are vital for a tolerated and effective session. The purpose of this article is to demonstrate updated modern setup procedures for the administration of tDCS and related transcranial electrical stimulation techniques, such as transcranial alternating current stimulation (tACS).

경두개 직접 전류 자극을 포함한 신뢰할 수 있고 쉬우며 용인된 경두개 전기 자극을 위한 기술 업데이트

Transcranial direct current stimulation (tDCS) is a noninvasive method of neuromodulation using low-intensity direct electrical currents. This method of ...

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

Atrial fibrillation (AF) is the most common form of arrhythmia. Atrial remodeling is considered the most critical mechanism for the presence and development of atrial fibrillation. Also, atrial remodeling can lead to the enlargement and dysfunction of the left atrium (LA), resulting in thrombosis and heart failure. Functional changes in left atrial strain and strain rate occur before structural alterations and are closely associated with structural remodeling and left atrial fibrosis. These parameters are sensitive biomarkers for atrial function. Cardiac magnetic resonance feature tracking (CMR-FT) is a novel, non-invasive, post-processing technique that can evaluate left atrial strain and strain rate. The CMR-FT was utilized in this investigation to assess the bilateral atrium strain rate in individuals with paroxysmal AF. Modifications in each segmental strain were evaluated using segmental analysis. The CMR-FT is recommended for non-invasive evaluations in the clinical assessment of atrial strain among existing strain imaging techniques. Further, it is a flexible parameter measurement with good reproducibility, high soft-tissue resolution, and post-processing based on standard cine balanced steady-state free precision (bSSFP) long-axis images without requiring a new sequence acquisition.

The atrial function is associated with the strain and strain rate. The cardiac magnetic resonance feature tracking (CMR-FT) technique was used in this study to quantify left and right atrial global and segmental longitudinal strain and strain rate in individuals with paroxysmal atrial fibrillation.

발작성 심방세동 환자에서 심혈관 자기공명 특징 추적에 의한 양측 심방 기능 추정

Atrial fibrillation (AF) is the most common form of arrhythmia. Atrial remodeling is considered the most critical mechanism for the presence and ...

Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional mapping of language areas for surgical decision-making is usually done invasively by electrical direct cortical stimulation (DCS), which is used to identify the organization of the crucial cortical and subcortical structures within each patient. Accurate preoperative non-invasive mapping aids surgical planning, reduces time, costs, and risks in the operating room, and provides an alternative for patients not suitable for awake craniotomy. Non-invasive imaging methods like MRI, fMRI, MEG, and PET are currently applied in presurgical design and planning. Although anatomical and functional imaging can identify the brain regions involved in speech, they cannot determine whether these regions are critical for speech. Transcranial magnetic stimulation (TMS) non-invasively excites the cortical neuronal populations by means of electric field induction in the brain. When applied in its repetitive mode (rTMS) to stimulate a speech-related cortical site, it can produce speech-related errors analogous to those induced by intraoperative DCS. rTMS combined with neuronavigation (nrTMS) enables neurosurgeons to preoperatively assess where these errors occur and to plan the DCS and the operation to preserve the language function. A detailed protocol is provided here for non-invasive speech cortical mapping (SCM) using nrTMS. The proposed protocol can be modified to best fit the patient- and site-specific demands. It can also be applied to language cortical network studies in healthy subjects or in patients with diseases that are not amenable to surgery.

Navigated repetitive transcranial magnetic stimulation is a highly efficient non-invasive tool for mapping speech-related cortical areas. It helps in designing brain surgery and speeds up the direct cortical stimulation conducted during the surgery. This report describes how to perform speech cortical mapping reliably for preoperative evaluation and research.

음성 피질 매핑을 위한 탐색된 반복적 경두개 자기 자극을 위한 연구 설계

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional ...