Revistă de Medicină şi Farmacie - Clujul Medical - Iuliu Haţieganu

Patologie neurologică
nonsteroidiene [23].
Artefactele acustice ale aparatului de stimulare magnetică
pot depăşi pragul sonor, devenind supărătoare pentru
pacient, fapt ce se poate ameliora prin aplicarea de dopuri pentru
urechi [24].
Singura complicaţie importantă descrisă până acum
este declanşarea crizelor epileptice. La frecvenţe şi intensităţi
crescute de stimulare şi interval scurt între stimulări, precum şi
după serii prelungite de stimulări apare o creştere a excitabilităţii
corticale ce predispune la aparţia de crize epileptice [5]. Chiar
şi la pacienţii fără epilepsie sau modificări structurale cerebrale
se pot declanşa crize epileptice [25,26]. Dacă pacienţii sunt
sub tratament cu neuroleptice sau antidepresive creşte riscul
de crize epileptice [25]. Cel mai adesea crizele sunt declanşate
de stimularea cortexului motor, dar s-au întâlnit crize şi după
stimularea cortexului prefrontal [27]. S-au stabilit criterii de
siguranţă pentru TMS, dar cu toate acestea, crizele pot apărea.
rTMS este o metodă cu efecte secundare rare, dar care pot fi
importante, de aceea ea trebuie aplicată numai sub atenta
supraveghere a unui medic specializat în această tehnică [28].
Bibliografie
1. Jankovic J., Tolosa E., Editors: Parkinson ‘s Disease and Movement
Disorders. 5 th edition. Lippincott Williams&Wilkins. Philadelphia;
2007, p: 1-14
2. Rothwell J.C., Thompson P.D., Day B.L., Boyd S., Marsden C.D.:
Stimulation of the human motor cortex through the scalp. Experimental
Physiology 1992;76:159-200
3. Siebner H.R.: Neues aus der Neurophysiologie: die repetitive
transkranielle magnetstimulation. Nervenheilkunde 1999;18:467-74
4. Wassermann E.M.: Risk and safety of repetitive transcranial
magnetic stimulation: report and suggested guidelines from the
International Workshop on Safety of Repetitive Transcranial Magnetic
Stimulation. Electroenceph Clin Neurophys l08(l998):l-16.
5. Schönfeldt-Lecuona C, Herwig U.: Die transkranielle
Magnetstimulation (TMS) in der Psychiatrie. Nervenheilkunde 1999;
18:342-52.
6. Wassermann E.M., Cohen L.G., Flitman S.S., Chen R., Hallett M.:
Seizures in health people with repeated ‘safe’ trains of transcranial
magnetic stimuli. Lancet 1996; 347: 825-826.
7. Boyd S.G., Tothwell J.C., Cowan J.M.A.: A method of monitoring
function in cortical pathways during scoliosis surgery with a note on
motor conduction velocities. J Neurol Neurosurg Psych 1986;49:251-
257
8. Day B.L., Dressler D., Maertens De Noordhout A.: Electric and
magnetic stimulation of human motor cortex: surface EMG and single
motor unit responses. J Physiol 1989;412:449-473
9. Berardelli A., Rona S., inghilleriM., ManfrediM.: Cortical inhibition
in Parkinson’s disease. A study with paired magnetic stimulation. Brain
1996; 119,71-77
10. Cantello R., Gianelli M., Bettucci D., Civardi C, De Angelis
M.S., Mutani R.: Parkinson’s disease rigidity: magnetic motor evoked
potentials in a small hand muscle. Neurology 1991; 41: 1449-56.
11. Davey N.J., Dick J.P.R., Ellaway P.H., Maskill D.W. : Raised
motor cortical threshold associated with bradykinesia as revealed by
transcranial magnetic stimulation in normal man and Parkinson’s
disease [abstract]. J Physiol (Lond) 1991; 438: 35P
12. Priori A., Berardelli A., Inghilleri M., Accornero N., Manfredi M.:
Motor cortical inhibition and the dopaminergic system. Brain 1994;
117: 317-23
13. Valls-Sole’ J., Pascual-Leone A., Brasil-Neto J.P., Cammarota
A., McShane L., Hallett M.: Abnormal facilitation of the response to
transcranial magnetic stimulation in patients with Parkinson’s disease.
Neurology 1994; 44: 735-41.
14. Ridding M.C., Inzelberg R., Rothwell J.C.: Changes in excitability
of motor cortical circuitry in patients with Parkinson’s disease. Ann
Neural 1995; 37: 181-8.
15. Fuhr P., Agostino R., Hallett M.: Spinal motor neuron excitability
during the silent period after cortical stimulation. Electroencephalogr
Clin Neurophysiol 1991; 81: 257-62.
16. Inghilleri M., Berardelli A., Cruccu G.,
Manfredi M.: Silent period evoked by transcranial
stimulation of the human cortex and cervicomedullary junction. J
Physiol (Lond) 1993; 466: 521-34
17. Roick H., Von Giesen H.J., Benecke R.: On the origin of the
postexcitatory inhibition seen after transcranial magnetic brain
stimulation in awake human subjects. Exp Brain Res 1993; 94:489-
98.
18. Wilson S.A., Lockwood R.J., Thickbroom G.W., Mastaglia F.L.
:The muscle silent period following transcranial magnetic cortical
stimulation. J Neurol Sci 1993; 114:216-22
19. George M.S., Nahas Z., Kozel A., Xingbao L., Yamanaka K.,
Mishory A., Bohning D.E.: Mechanism and the current state of
transcranial magnetic stimulation. CNS Spectrums 2003 ;8(7): 496-
514.
20. Buhmann C, Gorsler A., Baumer T., Hidding U., Demiralaz C,
Hinkelmann K.: Abnormal excitability of premotor-motor connections
in de novo Parkinson’s disease. Brain 2004,124:2732-2746
21. lefaucheur J.P.: Repetitive transcranial magnetic stimulation
(rTMS): insights into the treatment of Parkinson’s disease by cortical
stimulation. Neurophysiol Clin 2006 May-Jun;36(3): 125-33
22. Popescu CD., Bohotin V., Ignat B., Bohotin C: Stimularea
magnetica transcraniana, Rev Medic.ro, nr 31 suplim, [25.06.2008]
http://medic.pulsmedia.ro/article--x-Supliment-Stimularea_
magnetica_transcraniana— 2081.html
23. Machii K., Cohen D., Ramos-Estebanez C, Pascual-Leone A.:
Safety of rTMS to non-motor cortical areas in healthy participants and
patients. Clin Neurophysiol. 2006 Feb; 117(2):455-71.
24. Wassermann E.M.: Side effects of repetitive transcranial magnetic
stimulation. Depress Anxiety 200; 12: 124-129.
25. Pascual-Leone A., Houser CM., Reese K., Shotland LX, Grafman
J., Sato S. et al.: Safety of rapid-rate transcranial magnetic stimulation
in normal volunteers. Electroencephalogr Clin Neurophysiol.
1993;89(2):120-30.
26. Conca A., König P.D., Hausmann A.: Transcranial magnetic
stimuation induces ‘pseudoabsence seizure’. Acta Psychiatr Scand
2000; 101: 246-249
27. Lorberbaum J.P., Wassermann E.M.: Safety concerns of TMS.
Transcranial Magnetic Stimulation in Neuropsychiatry. R. H. Belmaker.
Washington, DC, American Psychiatrie Press, Inc.: 2000;S. 141-163.
28. Belmaker R.H., Fitzgerald P., George M.S., Lisanby S.H., Pascual-
Leone A., Schlaepfer T.E., Wassermann E.M.: Managing the risks of
repetitive transcranial magnetic stimulation. CNS Spectrums 2003;8(7):
489.
332
Clujul Medical 2009 Vol. LXXXII - nr. 3