Transkranielle Magnetstimulation bei amyotropher Lateralsklerose

Zusammenfassung

Die amyotrophe Lateralsklerose (ALS) ist eine progrediente neurodegenerative Erkrankung, die das erste und zweite Motoneuron betrifft. Klinisch neurophysiologische Untersuchungen stellen eine Hauptkomponente der Diagnose dar. Die transkranielle Magnetstimulation (TMS) stellt ein weit verbreitetes, sicheres und nicht invasives Verfahren zum Studium der Physiologie des ZNS dar. Darüber hinaus ist sie ein hilfreiches Diagnostikum bei der Lokalisation von Schädigungen des motorischen Nervensystems. Die Beteiligung des ersten Motoneurons ist ein obligates Kriterium für die Diagnose der ALS. Bei fehlenden klinischen Zeichen wie positivem Babinski-Zeichen oder gesteigerten Muskeleigenreflexen kann TMS als nicht invasive Untersuchungsmethode hilfsreich sein. Mithilfe der TMS können verschiedene Parameter bestimmt werden, die in der Routinediagnostik oder zur Untersuchung der Pathophysiologie der ALS-Erkrankung herangezogen werden können. In vorliegender Übersicht werden zuerst wichtige Grundbegriffe und Techniken beschrieben und dann deren Anwendung in Diagnostik und Erforschung der ALS besprochen.

Abstract

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder involving motoneurons in the spinal cord, brain stem and motor cortex. Clinical neurophysiological assessments are an important component in the diagnosis of ALS. Transcranial magnetic stimulation (TMS) is a non-invasive method to evaluate the function of the upper motoneuron (UMN). UMN deficit is an essential component of the diagnosis criteria for ALS. Definite clinical evidence of UMN involvement may be elusive. Hyperreflexia may be undetectable in a wasted limb. TMS can be very useful in such cases. Different techniques of TMS will be explained in this review. We will also discuss different parameters revealed by these techniques and their meaning in the diagnosis and investigation of ALS.

Key words

Amyotrophic lateral sclerosis - transcranial magnetic stimulation - upper motor neuron

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