ТМС-картирование моторной коры: обзор метода, исследовательское и клиническое значение

Транскраниальная магнитная стимуляция (ТМС) позволяет неинвазивно проводить картирование моторной коры и получать корковые представительства мышц. ТМС‑картирование нашло применение в исследовательской и клинической практике для оценки реорганизации моторной коры под действием различных факторов, уточнения патофизиологии и разработки новых биомаркеров поражения двигательной системы при различных заболеваниях. В статье обсуждаются основные методологические аспекты проведения ТМС‑картирования моторной коры: выбор интенсивности стимуляции и межстимульного интервала, использование сеточных алгоритмов, навигационных и роботизированных систем, выбор мышцы‑мишени и др. Отдельное внимание уделяется параметрам, характеризующим корковые представительства (локализация «горячей точки», центра масс, площадь и др.), и их воспроизводимости при использовании различных протоколов картирования. Приведен анализ публикаций, посвященных применению ТМС‑картирования моторной коры при опухолях, инсульте, боковом амиотрофическом склерозе. Наиболее значимое практическое применение ТМС‑картирование моторной коры получило при опухолях для предоперационного определения локализации функционально значимых моторных зон. Применение этого метода позволяет улучшить функциональные исходы операции и увеличить выживаемость пациентов без прогрессирования опухолевого процесса.

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