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Klinische Neurophysiologie 2005; 36(4): 155-160
DOI: 10.1055/s-2005-915310
Originalia
© Georg Thieme Verlag KG Stuttgart · New York

Transkranielle Magnetstimulation bei multipler Sklerose

Transcranial Magnetic Stimulation in Multiple SclerosisP.  Jung1 , U.  Ziemann1
  • 1Klinik für Neurologie der Johann Wolfgang Goethe-Universitätskliniken, Frankfurt am Main
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Publication History

Publication Date:
08 December 2005 (online)

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Zusammenfassung

In den aktuellen diagnostischen Kriterien der multiplen Sklerose (MS) finden Messparameter der transkraniellen Magnetstimulation (TMS) keine Berücksichtigung mehr. Dies beruht primär auf der Tatsache einer deutlich geringeren Identifikation subklinischer und räumlich disseminierter zerebraler Läsionen durch TMS und andere evozierte Potenziale (EP) im Vergleich zur konventionellen Magnetresonanztomographie (MRT). Motorisch evozierte Potenziale (MEP) liefern jedoch andere Informationen als die MRT. Sie können gegebenenfalls den demyelinisierenden Charakter einer Erkrankung mit hoher Wahrscheinlichkeit nahe legen und rein subjektive bzw. zurückliegende, aktuell klinisch nicht mehr nachweisbare Schubsymptome objektivieren und somit die Glaubwürdigkeit eigenanamnestisch berichteter Beschwerden unterstützen. Im Vergleich zu der MRT zeigen MEP einen stärkeren Zusammenhang mit klinisch-motorischen Funktionsausfällen in transversalen und longitudinalen Studien und eignen sich daher besser als Marker progredienter klinisch-motorischer Defizite. Bei sicherer MS fanden sich durch die Integration der MEP in Werteskalen multimodaler EP in neueren Studien enge Korrelationen mit den in der klinischen Routine und in Studien gebräuchlichen EDSS-Werten sowie mit der EDSS-Progression im Follow-up, woraus ein potenzieller Nutzen für Therapieentscheidungen oder zukünftige Therapiestudien resultiert. Zusammenfassend sind TMS-Messungen bei der Erstdiagnostik der MS von untergeordneter Bedeutung, nach Diagnosestellung einer sicheren MS bilden multimodale EP-Messungen unter Einbeziehung von MEP die klinische Krankheitsprogression jedoch besser ab als die MRT.

Abstract

Measures of transcranial magnetic stimulation (TMS) are currently not considered in the diagnostic criteria of multiple sclerosis (MS). This is due to a less sensitive identification of subclinical and spatial disseminated cerebral lesions with TMS and other evoked potential (EP) measures compared to conventional magnetic resonance imaging (MRI) techniques. However, motor evoked potentials (MEP) provide different information than MRI. MEP may be strongly suggestive of a demyelinating disorder and they may help to verify clinically not evident former or current subjective complaints. In contrast to MRI, MEP show more strictly relations to clinical motor impairment in transversal and longitudinal studies. Thus, MEP are a better surrogate marker of motor disability than MRI. In definite MS, MEP integrated into a multimodal EP score, revealed close correlations with the Expanded Disability Status Scale (EDSS) and with EDSS progression in the follow-up which is of potential value for therapeutic decisions or future therapeutic trials. In conclusion, TMS measures are of minor importance in diagnosing a MS but once the MS is definite multimodal EP measures including MEP are better suited as a marker of clinical disease progression than MRI.

Key words

Transcranial magnetic stimulation - multiple sclerosis - diagnostic value - central motor conduction time - disease progression marker

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Dr. med. Patrick Jung

Klinik für Neurologie

Schleusenweg 2 - 16

60528 Frankfurt am Main

Email: Patrick.Jung@em.uni-frankfurt.de

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