神经导航经颅磁刺激在癫痫术前语言区评估中的应用

The application of navigated transcranial magnetic stimulation in preoperative language mapping for epilepsy

目的探讨神经导航经颅磁刺激（n TMS）在术前皮质语言区评估中的临床应用价值。方法选取14例接受颅内硬膜下电极埋置术的癫痫患者,在神经导航引导下,采用4-10Hz重复经颅磁刺激（rTMS）,对患者语言区进行定侧、定位分析。通过与颅内电极皮质电刺激（ECS）语言功能定位结果进行比较,评估nTMS在术前语言区定位中的临床应用价值。结果在14例患者中,nTMS诱发出明确语言停顿或明显语言干扰的患者12例,2例未出现明显语言干扰现象。术前nTMS诱发出语言障碍的12例患者,在ECS过程中均出现明确语言功能障碍。提高刺激强度可以提高诱发语言干扰的几率,频率4-6Hz刺激在语言区定位中,可以较好地兼顾患者的耐受性和刺激效果。结论对于不适合接受ECS等有创性评估的患者,术前nTMS可以提供有价值的语言功能定位信息。

Objective To investigate the application of navigated transcranial magnetic stimulation applied in preoperative language mapping.Methods Fourteen epilepsy patients were selected who were going to accept intracranial electrode implantation.The cortices were stimulated by 4-10Hz repetitive transcranial magnetic stimulation （ rTMS） guided by neuronavigation system in order to identify the cortical location.By comparing with the results of electrical cortical stimulation （ ECS） , the nTMS cortical language mapping results could be investigated and verified. Results Language arrest or disturbance was elicited in twelve of the fourteen patients, no definite language deficit was noted in two patients.The twelve patients who showed positive response in nTMS also showed language deficits in ECS.The probability of language disturbance can be raised by increasing the intensity of TMS.There were good tolerance for patients and effectiveness for language mapping in 4-6Hz TMS.Conclusion Preoperative nTMS language mapping could provide important functional information for patient who is not suitable for invasive language evaluation.