经颅磁刺激技术在大脑语言优势半球定侧中的价值  

Value of Transcranial Magnetic Stimulation in Localization of Brain Language Dominant Hemisphere

作　　者：孙红[1,2] 付伟[1] 王玉平[1] 

机构地区：[1]首都医科大学宣武医院神经科,北京市100053 [2]山东省临沂市精神卫生中心

出　　处：《中国全科医学》2010年第20期2208-2212,共5页Chinese General Practice

摘　　要：目的探讨重复经颅磁刺激(rTMS)对于难治性癫痫患者术前大脑半球语言功能区定位的可靠程度,预测术后发生语言功能障碍的风险性。方法对7例难治性癫痫患者,依据国际脑电10/20电极安装系统在各患者双侧大脑半球头皮表面标记各刺激点。嘱患者行自发言语作业时,在各刺激点上给予高频、阈上强度的rTMS,同时观察rTMS对言语输出的影响。结果 7例患者均被rTMS诱导出言语中断。诱导位点在F8(F7)/T4(T3)之间的颞前区,大致位于Broca区头皮投影区附近。结合其他评估结果,最终有5例患者接受手术治疗,术后语言功能无损害;所有患者评估中未见癫痫发作。结论高频rTMS对难治性癫痫患者语言优势半球的术前定侧评估是较为安全、可靠的,有望取代侵入性的Wada试验。Objective To explore the reliability of repetitive transcranial magnetic stimulation （rTMS） in preoperative localization of cerebral hemisphere language areas in refractory epilepsy patients, and to predict the risks of postoperative language dysfunction. Methods Stimulating points were marked, according to international 10/20 EEG electrode installing system, on the surfaces of bilateral brain hemisphere scalp in 7 patients with refractory epilepsy. The patients were required to do spontane- ous speech operations; high -frequency, threshold -intensity rTMS given on stimulating points; the effect of rTMS on language output observed. Results Speech disruption was induced by rTMS in 7 patients. The inductive site was at anterior temporal area between F8 （FT） and T4 （ 33）, generally near the scalp projection of Broca area. Based on other assessment results, 5 patients received surgical treatment, and language function was not damaged after operation. No epilepsy occurred in evaluation. Conclusion High - frequency rTMS is safe and reliable in preoperative localization assessment of language dominant hemisphere of refractory epilepsy language patients, and is expected to replace invasive Wada test.

关 键 词：经颅磁刺激 语言功能 难治性癫痫 术前评估 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R44[医药卫生—临床医学]