Transcranial Magnetic Stimulating and Usage in Neurorehabilitation

Öz

Transcranial magnetic stimulation (TMS) is a non-invasive, painless and safe method used to identify changes in cortical excitability as a marker of neurological changes. TMS, which creates a magnetic field in a coil placed on the scalp with the electric current given by the high-voltage capacitor, causes some changes at the cellular level in the cortical region tissue. Obtained changes can also be viewed macroscopically with various imaging tools. With the coil types used in the TMS device, stimulation is given to cortical tissues of different depths and widths. In TMS, there are various measurement parameters used to evaluate the integrity of the corticospinal pathways, the conduction velocity of the peripheral nerve pathways, the function of the motor pathways, the mechanisms of spinal inhibition, and the motor cortex excitability. With these measurement parameters, some diseases can be diagnosed and prognosis can be followed. Stimulation parameters used for treatment in TMS application also differ. While single-pulse TMS is generally used for diagnostic purposes, repetitive TMS (rTMS) is mostly used for therapeutic purposes because it can modulate the level of cortical activity. TMS is a popular application that is mostly used in the diagnosis and treatment of neurological and psychological diseases. It has been reported to be beneficial, especially in addition to neurorehabilitation. It has been stated that low-frequency rTMS application may be beneficial for the treatment of post-stroke spasticity and motor problems in individuals with multiple sclerosis, and high-frequency rTMS application for the treatment of motor freezing in individuals with Parkinson's. In this review, general information about the application of TMS, its working principle, various measurement and stimulation parameters and its use in neurorehabilitation will be given.

Anahtar Kelimeler

• Transcranial magnetic stimulation
• Neurorehabilitation
• Magnetic field

Transkraniyal Manyetik Stimülasyon ve Nörorehabilitasyonda Kullanımı

Öz

Transkraniyal manyetik stimülasyon (TMS), nörolojik değişikliklerin belirteci olarak kortikal eksitabilite değişikliklerini belirlemek için kullanılan non-invazif, ağrısız ve güvenilir bir yöntemdir. Yüksek voltajlı kapasitör tarafından verilen elektrik akımı ile kafa derisi üzerine yerleştirilmiş bir koilde manyetik alan oluşturan TMS, kortikal bölge dokusunda birtakım hücresel düzeyde değişiklikler meydana getirmektedir. Elde edilen değişiklikler çeşitli görüntüleme araçlarıyla makroskopik olarak da görüntülenebilmektedir. TMS cihazında kullanılan koil çeşitleri ile farklı derinlik ve genişlikteki kortikal dokulara stimülasyon verilmektedir. TMS’de, kortikospinal yolların bütünlüğünü, periferik sinir yollarının iletim hızını, motor yolların fonksiyonunu, spinal inhibisyon mekanizmalarını, motor korteks eksitabilitesinin durumlarını değerlendirmek için kullanılan çeşitli ölçüm parametreleri bulunmaktadır. Bu ölçüm parametreleri ile bazı hastalıkların tanısı konulabilmekte ve prognoz takibi yapılabilmektedir. TMS uygulamasında tedavi amaçlı kullanılan stimülasyon parametreleri de farklılık göstermektedir. Tek atım TMS genellikle tanı amaçlı kullanılmaktayken, tekrarlayıcı TMS (rTMS) ise kortikal aktivite düzeyini modüle edebildiğinden dolayı daha çok tedavi amacıyla kullanılmaktadır. TMS günümüzde daha çok nörolojik ve psikolojik hastalıkların tanısında ve tedavisinde kullanılmakta olan popüler bir uygulamadır. Özellikle nörorehabilitasyona ek olarak kullanımının faydalı olduğu bildirilmiştir. İnme sonrası spastisite tedavisi ve multipl sklerozlu bireylerde motor problemlerin tedavisi için düşük frekanslı rTMS uygulaması, parkinsonlu bireylerde ise motor donmaların tedavisi için yüksek frekanslı rTMS uygulamasının yararlı olabileceği belirtilmiştir. Bu derlemede TMS uygulamasına ilişkin genel bilgiler, çalışma prensibi, çeşitli ölçüm ve stimülasyon parametreleri ve nörorehabilitasyonda kullanımı hakkında bilgi verilecektir.

Anahtar Kelimeler

• Transkraniyal manyetik stimülasyon
• Nörorehabilitasyon
• Manyetik alan

Kaynakça

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