Аннотация:Objectives: Recovery of both mental and motor functions is one of
the key problems of neurorehabilitation of patients with traumatic
brain injury (TBI), accompanied by posttraumatic unconsciousness
state (PUS). The purpose of pilot study is to clarify the diagnostic
and therapeutic potential of TMS in patients after TBI with impaired
motor activity and consciousness.
Methods: Observation groups: (1) 15 patients after TBI at the age
of 17–56, in which the diagnostic TMS (cortical motor areas (M1)
bilaterally, CVII bilaterally, registration of MEPs from musculus
abductor pollicis brevis) was performed; (2) 9 patients after TBI at
the age of 16–44 with a prolonged (from 60 to 220 days) unconscious
state in which the rhythmic TMS was performed; (3)
Control group: 5 healthy men aged 22–28. Diagnostic TMS evaluated
cortical, radicular latency and amplitude of MEPs,time of central
motor conduction. In the second and third groups changes of neurological
status, indicators of the memory and attention, and N100,
N200 and P300 components of auditory ERP hour before and hour
after stimulation were estimated.
Results: Diagnostic TMS in patients with positive or ambiguous
clinical dynamics showed initial difference of conductivity of tracts
in comparison with normal data by 20–30% or 30–40%, respectively,
with progressive improvement as motor and cognitive functions
recovered.
In patients with negative clinical dynamics TMS values had significantly
larger deviation of cortical latency and amplitudes of
MEPs (over 45%), and also the time of central motor conduction.
Statistical analysis of acquired data revealed the greatest prognostic
significance for determining the level of the amplitudes of
MEPs with undeniable importance for the indicators of cortical
latency and the time of central motor conduction.
Therapeutic TMS of the sagittal premotor cortex areas in groups 2
and 3 concurred with improvement of any attention and normalization
of amplitude and latency of all ERP components, as well as indicators
of their spatial synchronism, especially for P300.
Conclusions: The obtained data clarifies diagnostic parameters of
TMS and proposes the availability of using rTMS for therapeutic purposes
in patients with PUS.
Supported by: RFFIN16-29-08304.
Keywords: TMS, MEP, rTMS, TBI, PUS, ERP