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Нервно-мышечные болезни

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Безопасность транскраниальной магнитной стимуляции: обзор международных рекомендаций и новые данные


https://doi.org/10.17650/2222-8721-2017-7-2-21-36

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Аннотация

Транскраниальная магнитная стимуляция (ТМС) – активно развивающийся метод нейромодуляции. В последние годы значительно увеличилась частота применения ТМС как в исследовательской, так и в клинической практике, что постоянно открывает новые возможности метода, позволяет оценивать риски и последствия как для здоровых лиц, так и для пациентов с болезнями нервной системы. В 1998 и 2009 гг. были опубликованы рекомендации международной группы экспертов по безопасности и этическими аспектами ТМС, которые и сегодня остаются основной инструкцией по использованию данного метода в исследовательской и клинической практике.
 Безопасность процедуры стимуляции мозга – многоуровневая задача, включающая профилактику и устранение нежелательных эффектов, стратегию отбора пациентов и протоколов стимуляции, а также обеспечение безопасности и мониторинга состояния пациента во время процедуры. К распространенным нежелательным эффектам ТМС относятся боль в шее и головная боль, синкопе, преходящие изменения слуха. По данным литературы, риск провокации эпилептического приступа крайне низок и минимизирован при тщательном отборе пациентов и использовании безопасных протоколов стимуляции. При планировании процедуры ТМС значение имеет отбор пациентов с учетом большого числа факторов риска нежелательных эффектов, а также абсолютных и относительных противопоказаний проведения стимуляции. На этом этапе перед проведением ТМС рекомендуется использовать специальные опросники. Следующим важным вопросом безопасности ТМС является протокол стимуляции с подбором таких параметров, как интенсивность, частота, продолжительность одной серии стимулов и межстимульный интервал. Сегодня максимально допустимые значения перечисленных параметров регламентированы в рекомендациях по безопасности, а их изменение допускается только в клинических исследованиях. Для обеспечения безопасности необходимо соблюдение ряда организационных мер, в том числе мониторинг состояния пациента во время процедуры и возможность оказания квалифицированной помощи при развитии нежелательных явлений.

 

 

Об авторах

Н. А. Супонева
ФГБНУ «Научный центр неврологии»
Россия


И. С. Бакулин
ФГБНУ «Научный центр неврологии»
Россия


А. Г. Пойдашева
ФГБНУ «Научный центр неврологии»
Россия


М. А. Пирадов
ФГБНУ «Научный центр неврологии»
Россия


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Для цитирования:


Супонева Н.А., Бакулин И.С., Пойдашева А.Г., Пирадов М.А. Безопасность транскраниальной магнитной стимуляции: обзор международных рекомендаций и новые данные. Нервно-мышечные болезни. 2017;7(2):21-36. https://doi.org/10.17650/2222-8721-2017-7-2-21-36

For citation:


Suponeva N.A., Bakulin I.S., Poydasheva A.G., Piradov M.A. Safety of transcranial magnetic stimulation: review of international guidelines and new findings. Neuromuscular Diseases. 2017;7(2):21-36. (In Russ.) https://doi.org/10.17650/2222-8721-2017-7-2-21-36

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