Diagnostic Transcranial Magnetic Stimulation Research Articles

The Use of Diagnostic Transcranial Magnetic Stimulation as a Predictor of the Functional Outcome in Ischemic Stroke

ABSTRACT. Determination of rehabilitation potential (RP) is necessary for optimal rehabilitation strategy and the best rehabilitation measures. Navigational transcranial magnetic stimulation (nTMS) has been proposed as a method for PR determination in after-stroke patients.THE AIM. was to study the importance of navigational diagnostic transcranial magnetic stimulation as a neurofunctional predictor of motor function recovery after ischemic stroke.MATERIAL AND METHODS. The study included 28 after-stroke patients, 19 men and 9 women, the mean age was 60.07±5.67 years, who underwent a course of inpatient medical rehabilitation at the Moscow Research and Practice Center for Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky in 2022–2023. Clinical examination and assessment were conducted before and after the rehabilitation course using validated scales and questionnaires — the Medical Research Committee (MRCs) scale, the Box and Block Test (BBT), the modified Rankin scale (mRS); the rehabilitation routing scale (RRS). The patients were also examined using nTMS at the N.V. Sklifosovsky Research Institute for Emergency Medicine with the determination of motor evoked potential (MEP) parameters from the muscles of the upper and lower extremities.RESULTS. In patients with preserved MEP, there was a significant increase in the strength of the paretic limb on the MRCs scale from 4.00 (2.94–4.06) to 4.22 (3.83–4.89) points (p <0.001) for the upper limb and from 4.00 (3.67–4.00) to 4.44 (3.83–4.61) (p<0.001) for the lower limb. Improvements were revealed according to the mRS scale — the number of patients with an mRS score of 2 points in the group of patients with defined MEP increased by 26.1%, reached values of 1 point — 13.0% of patients, and the number of patients with an assessment of disability and self-care ability of 4 points decreased by 8.7%.CONCLUSION. Navigational transcranial magnetic stimulation is one of the methods for assessing the rehabilitation potential in patients with ischemic stroke. But TMS should not be used as the only method of evaluating rehabilitation potential. The assessment of RP should be comprehensive and based on the complex data obtained.

Search for approaches to transcranial neuromodulation in patients with post-stroke hemiparesis in real clinical practice

BACKGROUND: To increase the efficiency of motor recovery after a stroke in routine clinical practice, the search for selective biomarkers that determine the choice of the optimal strategy for noninvasive neuromodulation of the brain remains relevant. The study of interhemispheric interaction patterns can hypothetically help in determining the correct conceptual model of neuromodulation. AIM: To determine variants of interhemispheric interaction based on a correlation analysis of motor cortex excitability in patients with poststroke hemiparesis stratified by the degree of motor deficit. MATERIALS AND METHODS: This retrospective observational study involved 185 people (men, 56.2%; women, 43.8%) aged 19–88 years with verified poststroke hemiparesis and 40 healthy volunteers (men, 55.0%; women, 45.0%) aged 20–85 years. The patients underwent diagnostic transcranial magnetic stimulation in the projection of the cortical representation of m. abductor pollicis brevis and m. tibialis anterior of both brain hemispheres. The excitability level of the motor cortex and its interhemispheric asymmetry were recorded, and correlation analysis in subgroups stratified by the degree of paresis was performed. RESULTS: No interhemispheric correlation of resting motor thresholds (rMT) was found in patients with a level of muscle strength for the “hand” segment of 0–2 points (р 0.05). In the remaining subgroups, positive interhemispheric correlations of the rMT were noted (p 0.02). A positive correlation of the rMT of the damaged brain hemisphere and interhemispheric asymmetry of the motor cortex excitability for all degrees of paresis was observed when evaluating the cortical representation of the upper limb muscles. A negative correlation between the rMT of the unaffected brain hemisphere and interhemispheric asymmetry was detected for all degrees of motor deficit of the “foot” segment (p 0.02). CONCLUSION: The study did not confirm the concept of interhemispheric competition of the studied functional activity of the brain. Three authentic variants of interhemispheric interaction were identified: unidirectional hemispheric interaction with predominant reactivity of the affected hemisphere, unidirectional hemispheric interaction with predominant reactivity of the unaffected hemisphere, and functional interhemispheric dissociation. The results indicate the need to rethink some approaches to transcranial neuromodulation strategies in the analyzed cohort.

A Clinical Case of Corticospinal Tract Reorganization of Supplementary Motor Area in a Child After Acute Hypoxic Brain Injury

We present clinical observation of a 3-year-old child during recovery after acute hypoxic brain injury (freshwater drowning). Using diagnostic transcranial magnetic stimulation and magnetic resonance tractography with reconstruction of the corticospinal tract (CST) originated from the primary motor cortex and supplementary motor area (SMA), we determined that hypoxic brain injury induced activation of CST from the SMA. The period of reorganization was associated with the development of epileptiform patterns, that confirms the transient hyperexcitability of cortical neurons. Our findings indicate no recovery of motor function after acute hypoxic brain injury when CST originated only from SMA.

Dynamics of motor and functional disorders in the early recovery period after ischemic stroke

To study the dynamics and degrees of motor and functional disorders in patients with hemiparesis during the first 6 months after ischemic stroke under the impact of medical rehabilitation, including kinesiotherapy, physiotherapy and transcranial magnetic stimulation. Motor disorders and functional limitations were assessed using validated scales (Fugl-Meyer, Medical Research Committee Scale, Modified Ashworth Scale of muscle spasticity, Modified Frenchay scale, Wolf Motor Function Test, Action Research Arm Test, Rivermead mobility index, Hauser ambulation index, Functional Independence Measurement). Diagnostic and therapeutic transcranial magnetic stimulation was performed using the «Neuro-MS/D» magnetic stimulator. The dynamics of types and degrees of motor and functional disorders were evaluated in 113 patients with hemiparesis in the first 6 months after ischemic stroke. Severe disorders of the tone and strength characteristics of paretic muscles and limitation of movement in the joints of paretic extremities have been found in 2/3 of patients. The balance function (it is difficult to maintain a vertical position of the body) was impaired in 1/2 of patients. The correlations of electrophysiological indicators (diagnostic transcranial magnetic stimulation and surface electromyography) with clinical ones (degree of paresis, tone of paretic muscles, motor abilities and motor skills of the paretic hand, independence in daily living) have been determined. Positive impact of medical rehabilitation, including kinesiotherapy, physiotherapy and transcranial magnetic stimulation, on the strength of paretic muscles of the hand and leg, mobility of patients, walking function, activity of the paretic hand (transfer by the hands, manipulation of extremities' segments and objects) has been revealed. Electrophysiological investigation has shown that the functional activity of the paretic muscles increased. Severe motor and functional disorders, most pronounced in distal segments of the extremities (lack of movements in 14-26% of cases), are prevalent in the first six months after ischemic stroke in the carotid system. The regression of motor disorders leads to an enhancement of functional abilities (use of the paretic extremities for the realization of various motor actions) under the impact of rehabilitation.

Реорганизация кортикоспинального тракта при постаноксических состояниях у детей: серия клинических наблюдений

Predicting the outcome of postanoxic conditions, particularly with respect to motor control, is an important task in rehabilitation. We describe a series of case reports of reorganization of cortical motor representations (primary motor cortex (PMC), premotor cortex (PC), supplementary motor area (SMA), and cortico-spinal tract) in children with postanoxic conditions of different origins using voxel-based morphometry, diffusion tensor imaging, and diagnostic transcranial magnetic stimulation. Our results demonstrate the ability to restore the volume of cortico-spinal motor projections in patients with less severe atrophic changes of the PMC, PC, and SMA, as well as stably reproducible motor evoked potentials of a larger area at a lower motor threshold of their registration. Patients with severe atrophic changes of the PMC had a worse prognosis for recovery, even if the pyramidal tracts were preserved and increased in volume over time. These case reports rather confirm the importance of synaptogenesis in the recovery of motor functions in patients with a formed motor act, given the variability of the density of pyramidal tracts during the reorganization of brain structures. KEYWORDS: corticospinal tract, primary motor cortex, premotor cortex, supplementary motor area, postanoxic condition, transcranial magnetic stimulation, motor-evoked potential, tractography. FOR CITATION: Kan'shina D.S., Ublinskiy M.V., Mel'nikov I.A., Valliulina S.A., Akhadov T.A., Nikitin S.S., Zykov V.P., Drozhevskaya E.E. Cortico-spinal reorganization in postanoxic conditions in children: a series of case reports. Russian Journal of Woman and Child Health. 2024;7(3):286–292 (in Russ.). DOI: 10.32364/2618-8430-2024-7-3-14.

Intermittent theta-burst stimulation combined with transcranial direct current stimulation once weekly for treatment-resistant depression: a case report

BackgroundSingle-time non-invasive brain stimulation was carried out using the two-technique approach on a patient suffering from treatment-resistant depression. Five treatment sessions given at weekly intervals resulted in a significant improvement in the Patient Health Questionnaire-9 score for up to 6 weeks. The findings of this study could pave the way for a more efficient less resource-intensive time- and budget-saving technique of employing non-invasive brain stimulation for patients with treatment-resistant depression by minimizing the number of stimulation sessions.Case presentationA 67-year-old married non-Latino white American woman suffering from treatment-resistant depression received intermittent theta-burst stimulation in combination with transcranial direct current stimulation weekly for 5 consecutive weeks. Diagnostic transcranial magnetic stimulation showed an observable electrophysiological change. The patient reported a drastic improvement in Patient Health Questionnaire-9 score up until 6-week follow-up and expressed satisfaction with the treatment.ConclusionsThis case study suggests that a streamlined protocol for using non-invasive brain stimulation could prove more effective for patients and healthcare providers in terms of safety in comparison to the present guidelines.

The potential of electromyography, diagnostic transcranial magnetic stimulation, and multiparametric magnetic resonance imaging in the combinatory assessment of facial nerve disorders: a literature review and clinical case series

Facial neuropathy (FN) is a complex multicausal problem that, with a seemingly obvious clinical picture, might be challenging to diagnose. Up to 5% of FN cases could be caused by neoplastic or otogenic processes, necessitating an interdisciplinary approach to its treatment by various specialties and in some cases a surgical intervention. In addition, in the early stages of FN, it is difficult to predict its outcomes. Therefore, beyond usual neurological exam and widely used electromyography (EMG), other additional diagnostic tools are used to ensure extended diagnosis, including cancer awareness.
 In this paper we have analyzed the principles, role and value of computed tomography, magnetic resonance imaging (MRI), diagnostic transcranial magnetic stimulation combined with EMG, and ultrasound assessment with a high-frequency linear transducer in acute FN. We present our own clinical cases of pediatric patients with FN, who were assessed with EMG and multiparametric MRI including diffusion tensor imaging. These cases illustrate both the abnormalities found in the typical course of Bell's palsy, as well as the abnormalities in neoplasm-associated FN that clinically fully mimic the Bell's palsy. Based on the world experience in multiparametric MRI, including the use of extended protocols in the Pediatric Research and Clinical Center for Infectious Diseases, in case of suspected FN, the most important are high-resolution structural submillimeter sequences based on the gradient echo (SSFP) and diffusion tensor imaging (DTI). Measurement and assessment of fractional anisotropy at the motor nuclei of the facial nerves in the pons look promising for further research. The paper is the first to describe a modified combination diagnostic approach to Bell's palsy with the use of diagnostic transcranial magnetic stimulation with round coil, supramaximal stimulation with identification of the motor evoked response threshold (minimal inducer power to register a reproducible evoked motor response of 50-100 mV in amplitude) in the occipito-parietal area of the ipsilateral muscle.

Possibilities neuroimaging and neurophysiological research methods to objectify rehabilitation potential in patients with ischemic stroke (analytical review of the literature)

Cerebral stroke (CS) remains the most important medical and social problem. According to available data, only 25% of stroke survivors return to the premorbid level of daily or work activity, most patients have residual neurological disorders of varying severity. Effective rehabilitation of patients with CS requires not only timely initiation of treatment, but also an individual choice of rehabilitation program. To optimize the rehabilitation strategy in each case, it is necessary to set goals and objectives taking into account the rehabilitation potential (RP) and the prognosis of the patient’s recovery. This paper provides a definition of RP and ways to describe it. The existing neurophysiological methods for assessing the RP of functional recovery after CS, such as electroencephalography, evoked potentials and diagnostic transcranial magnetic stimulation (TMS), are considered. Information about neuroimaging diagnostic methods – computer (CT) and magnetic resonance imaging (MRI) in the context of determining RP is presented. The possibilities of functional and diffusion-t ensor MRI of the brain for assessing RP in various periods of the disease are highlighted in detail. Other possible predictors of the restoration of impaired functions are also considered – the volume and localization of the brain lesion, the patient’s age, cognitive functions and laboratory parameters. Modern complex approaches to the formation of algorithms for the quantitative assessment of RP are described. In particular, the current algorithms for evaluating RP – PREP2 for the upper limb and TWIST for predicting the recovery of walking disorders are described. Currently, there are no generally accepted methods for determining and quantifying RP. The instruments proposed for this purpose are insufficiently sensitive and specific or are not suitable for routine clinical practice.

Navigated transcranial magnetic stimulation: Question of accuracy

In this literature review and our own data, we provide information about navigational transcranial magnetic stimulation (TMS). At present, a significant amount of knowledge has been accumulated about the use of TMS, both diagnostic and therapeutic, in real clinical practice. Diagnostic TMS has been studied and developed maximally. Nevertheless, despite the undoubted clinical effect of therapeutic TMS, the question of the need for the most accurate target designation for the greatest effectiveness of treatment remains controversial. A number of publications emphasize and justify the need for such target designation, but others report a positive clinical effect of stimulation regardless of the exact location of the inductor. This undoubtedly makes further research in this area relevant with an assessment of the comparative effectiveness of the most accurate rhythmic TMS with other protocols for its use.

Significance of diagnostic transcranial magnetic stimulation during radiotherapy

Background. Transcranial magnetic stimulation is a non-invasive, painless method that stimulates the cerebral cortex using short magnetic pulses. The information obtained as a result of the research can be further used for an objective assessment of the therapy.
 Aim. Evaluation the reliability of transcranial magnetic stimulation technique as a neurophysiological monitoring tool in patients with malignant brain tumors.
 Material and methods. There were two groups as a study objects: patients with large-focal solitary lesions of the central nervous system (glioma) who underwent radiotherapy (n=20), median age 49.55.3 (39; 60) years, and a comparison group of neurologically healthy individuals (n=16), median age 48.56.3 (43.0; 58.8) years. There were no statistically significant age differences between the studied groups. All patients underwent diagnostic transcranial magnetic stimulation before and after therapy. The MannWhitney test was used to make comparisons between the two groups. A p value 0.05 was considered statistically significant.
 Results. During transcranial magnetic stimulation in patients with malignant brain neoplasms, signs of impaired conduction along the central motor pathways were recorded in 50% of cases, and in total, signs of impaired conduction of all degrees of severity along the central motor pathway were detected in 90% of cases. Carrying out diagnostic transcranial magnetic stimulation according to a single-pulse protocol makes it possible to predict the further course of the recovery period. The use of transcranial magnetic stimulation in dynamics revealed an improvement in conduction along the central motor pathways in patients with malignant brain neoplasms. The obtained statistically significant differences allow us to conclude that transcranial magnetic stimulation can be used for an objective assessment of the state of the motor pathways in patients with neurooncological diseases.
 Conclusion. Diagnostic transcranial magnetic stimulation is applicable in large-focal solitary lesions of the central nervous system, since it allows assessing the state of the motor pathways and the functional activity of the brain at different stages of this condition.

The role of neurophysiological assessments during the combined treatment of patients with malignant brain tumors

Introduction. Dynamic monitoring and evaluation of the results of therapy of patients with malignant brain diseases is a complex and urgent problem in modern medicine. The aim of the study was to assess the reliability of the transcranial magnetic stimulation technique as a tool for neurophysiological monitoring in patients with malignant brain tumors. Material and methods. Two groups of patients were formed: adults with large focal solitary lesions of the central nervous system (glioma) (n=20), who underwent radiotherapy, and a control comparison group (n=16). All patients underwent diagnostic transcranial magnetic stimulation before and after treatment. Results. In the main group the application of transcranial magnetic stimulation in dynamics allowed to reveal reliable improvement of conduction along the central motor pathways (increase in amplitude of the evoked motor response). The obtained data of neurophysiological examination correlated with clinical improvement in the patient group. Discussion. Some parameters of the motor evoked response (MEP) changed reliably, as after the radiation treatment performed. Obtained changes (amplitude of MEP and, especially, its threshold) to the greatest extent reflect functional state of cortical motoneurons, as well as their anatomical preservation in case of organic changes. Before therapy in all cases there was a reliable tendency to a smaller amplitude and a higher threshold of cortical MEPs, which reflects a decrease in the functional activity of motor cortex neurons; a slower central motor conduction time also draws attention. These changes had a universal character and were registered in all patients. Conclusion. Diagnostic transcranial magnetic stimulation, taking into account age limitations inherent to it as a technique, is a valuable additional neurophysiological technique. It is safe, inexpensive and does not require expensive consumables, and is applicable to a wide range of diseases.

Transcranial magnetic stimulation in neurorehabilitation: experience and prospects

Diagnostic transcranial magnetic stimulation (TMS) is a valuable neurophysiological technique. The use of TMS has fundamentally changed the therapy and diagnosis of nervous diseases, introducing the possibility of direct assessment of conduction along the motor pathway in the central region, neuroplasticity, the ratio of central inhibition and excitation, and the effect on neuroplasticity and neurogenesis. The technique is safe, has a low cost and there is no need to purchase expensive consumables, it is applicable for a wide range of diseases in both adult and pediatric practice. The issues of the TMS use in CVA, depression, cerebral palsy and neurodegenerative diseases (amyotrophic lateral sclerosis, parkinsonism) have been studied to the greatest extent. When carrying out TMS in children, it should be borne in mind that signs of incomplete myelination of the motor pathways, which are normally observed, may look like pathological changes (demyelination or axonal disorders). The basic principles of TMS in both adults and children have been established and known, and the age norms have been determined, which makes it possible to widely implement this technique in applied neurophysiological practice. In the rehabilitation process, TMS can be used as a tool for personalizing and monitoring the effectiveness of rehabilitation treatment.

Diagnostic capabilities of transcranial magnetic stimulation to predict motor recovery after a stroke

Transcranial magnetic stimulation is a method of focal non-invasive brain stimulation, characterized by high spatial and temporal resolution. To date, diagnostic transcranial magnetic stimulation has been used in clinical practice primarily to assess an involvement of the upper motor neurons and to measure the velocity of the neuronal impulse propagation. However, in the last 10 years, a possible range of transcranial magnetic stimulation diagnostic applications has significantly expanded. Many transcranial magnetic stimulation approaches are coming from scientific laboratories to clinical practice due to an increased availability of transcranial magnetic stimulation equipment, in particular, magnetic resonance imaging navigation for transcranial magnetic stimulation and a combination of the transcranial magnetic stimulation with electroencephalography and also due to an increased awareness of the clinicians. The diagnostic potential of transcranial magnetic stimulation in relation to motor recovery after a stroke can be classified into 4 directions:1) assessment of the vertical tracts integrity (primarily, the cortico-spinal tract); 2) an assessment of the cortical excitation-inhibition balance;3) probing of the functional and effective connectivity among brain regions (primarily, cortical convexity and cerebellum);4) motor mapping to evaluate cortical reorganization.In this article we will present these 4 directions of the transcranial magnetic stimulation application to study motor system pathophysiology and to predict motor outcome in stroke, including both existing and developing approaches.

Features of diagnostic transcranial magnetic stimulation in dependence on personal characteristics in patients with medication-overuse headache

Features of diagnostic transcranial magnetic stimulation in dependence on personal characteristics in patients with medication-overuse headache

P76-S Therapeutic possibilities of transcranial magnetic stimulation in patients after traumatic brain injury (updated report)

Objectives The purpose of this study is to estimate the therapeutic potential of transcranial magnetic stimulation (TMS) in patients after traumatic brain injury (TBI) with impaired consciousness and motor activity. Methods Observation groups: (1)19 patients after TBI at the age of 16–50 with a prolonged (from 60 to 360 days) unconscious state in which the rhythmic TMS was performed; (2) Control group: 6 healthy men aged 22–28. 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, the dynamics of diagnostic TMS and bimodal (somatosensory and short latency auditory) EP’s were estimated. Results Therapeutic rTMS of the sagittal premotor cortex areas in both groups concurred with improvement of any attention and normalization of amplitude and latency of all ERP components, especially for P300. rTMS of the frontal lobes facilitated positive clinical dynamics, while rTMS of the parietal lobes did not prove any clear positive effects. Conclusions The obtained data proposes the availability of using rTMS for therapeutic purposes in patients with PUS. The most promising targets for stimulation at the moment seems to be the frontal and sagittal premotor areas of the brain. Further research is required to clarify the areas and parameters of stimulation. Supported by: RFFI N 16-29-08304 .

Peculiarities of motor evoked potential in healthy children of different age

Aim of the work The implementation of the database for reference values of motor evoked potentials (MEP) in healthy children of different ages. Methods 95 healthy children were enrolled. Age ranged from 1 to 204 months. Three subgroups were established: children of 1-12 months (n=31, 18 males, 13 females), 12-144 months (n=27, 14 males, 13 females) and 144-204 (n=37, 20 males, 17 females) months. All children were healthy. Diagnostic transcranial magnetic stimulation (TMS) was performed in all patients. MEP shape, threshold, latency and amplitudes were recorded for hands (m. Abductor pollicis brevis) and legs (m. Abductor Hallucis). Central motor conduction time (CMCT) was calculated. Results. Along with age there was observed the elongation of MEP latency, gain in amplitudes and shape normalization. There were significant differences in the elongation of MEP latency between children aged of 1-12 months and children from two other subgroups (12-144 and 144-204 months). Conclusions. Our normative data can be usedfor comparative studies in the broad spectrum of pediatric disorders. Age restrictions have to be taken in a consideration when performing the TMS in pediatric population.

The variability of representation and latency of the F-wave in patients at different periods of spinal cord injury

Introduction. Neurophysiological examination in patients with spinal cord injury is advisable to determine the end of the period of spinal shock. F-wave is a late electromyographic phenomenon realized by activating a pool of motor neurons of the anterior horns of the spinal cord. In the state of spinal shock, the duration of which is variable, F-waves are not recorded. The presence of F-waves from the tibial nerves indicates the completion of spinal shock and restoration of electrical excitability of motor neurons of the anterior horn of the spinal cord. The appearance of F-waves is a marker for diagnostic transcranial magnetic stimulation to assess the viability of the cortical-spinal tract in the early stages of spinal shock.Study aim. To analyze the representation of F-waves in patients in different periods of spinal shock, depending on the level, volume and duration of the lesion.Materials and methods. There were a total of 15 patients with spinal trauma in age from 19 to 29 years enrolled. All patients affected were localized in segments C4–C7. The examination included stimulation electroneuromyography: registration of motor responses, sensory responses and F-waves from the median, ulnar, fibular and tibial nerves on both sides.Results. In 5 patients: 3 in acute, 1 in early and 1 in late periods of spinal cord injury, spinal shock was clinically diagnosed: electromyographic revealed the absence of F-waves for all tested nerves. In 4 patients in the early period of spinal cord injury F-waves were registered only with n. tibialis, the first spontaneous movements in the limbs were clinically observed; in 6 patients in the intermediate and late periods of spinal cord injury f-waves were recorded from all the nerves under study with constant latency. The end of spinal shock was clinically verified, with the presence of a minimum volume of movements and restoration of sensitivity in individual segments.Conclusion. Registration of F-wave should be a mandatory component of stimulation electromyographic in the verification of spinal shock, the duration of which is not correlated with the periods of spinal cord injury. The presence of f-waves is a diagnostic marker for transcranial magnetic stimulation to assess the viability of the cortical-spinal tract.

Multimodal evoked potentials and transcranial magnetic stimulation in diagnostics of children with encephalitis, acute disseminated encephalomyelitis and multiple sclerosis

Background. The growing incidence of such central nervous system disorders as encephalitis (EP), acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) in pediatric population, similarity of their clinical manifestations at the onset, lack of universal diagnostic criteria and the risk of ADEM transformation into MS in the case of late diagnosis and inadequate treatment suggest the importance of this problem. Objective: to evaluate diagnostic and prognostic value of multimodal evoked potentials and transcranial magnetic stimulation (TCMS) in children with EP, ADEM and MS. Materials and methods. The study included 200 participants: 50 children with MS (mean age 14.0 ± 3.7 years), 50 children with ADEM (mean age 14.0 ± 3.5 years), 50 children with EP (mean age 12.0 ± 2.2 years) and 50 controls (mean age 14.0 ± 3.1 years). All patients underwent neurological examination, magnetic resonance imaging of the brain, diagnostic TCMS and assessment of visual evoked potentials, brainstem auditory evoked potentials, cognitive evoked potentials P300 to an auditory stimulus and somatosensory evoked potentials. Results. We found that the P37–N45 amplitude 124 msec) is a risk factor for ADEM transformation into MS. The P100 latency >132 msec and lack of cortical evoked motor response from the m. abductor hallucis at MS onset indicate a high risk of disease progression and further development of disability Conclusion. TCMS and assessment of multimodal evoked potentials (with estimating response amplitudes) allow determining the nature and severity of brain lesions, detecting subclinical dysfunction of the central nervous system, monitoring of the recovery processes and predicting outcomes in children with EP, ADEM and MS.

The specific features of the clinical, functional and psychological status of the patients during the early and late restorative periods of ischemic stroke

When choosing the algorithm of rehabilitative measures, the localization of the stroke, brain reserve, and neuroplasticity as well as clinical characteristics (motor, postural, speech, cognitive impairments), etc. are taken into consideration. Monitoring the health status of the patients is an integral component of and an important condition for the successful post-stroke rehabilitation. The objective of the present study was to evaluate the clinical, functional and psychological status of the patients with stroke during the early and late restorative periods. The neurological disorders were characterized based on the National Institutes of Health Stroke Scale (NIHSS), the results of hand-grip dynamometry, the Frenchay arm test, and the modified Ashworth scale of muscle spasticity in the combination with the data on the activity of everyday life and the psychological status of the patients. Sstabilograpy, encephalography, and diagnostic transcranial magnetic stimulation (TMS) were carried out. The level of health of the patients was evaluated as the integral measure representing the sum of scores of ranked characters. A total of 106 patients who had undergone ischemic stroke were available for the examination. During the early post-stroke period the gross disturbances of attention and vertical stabilization were documented. In addition, the dependence of equilibrium on the function of visual analyzer was revealed together with the large number of correlations between the clinical-psychological indicators and the functional parameters associated with neurological deficiency and disability. In the late rehabilitation period, the improvement of attention, the enhanced capability for maintaining equilibrium, and the positive influence of visual memory on the degree of dependence on the assistance of other persons were apparent in the majority of the patients even though some of them exhibited the signs of severe depression. Taking account of the aforementioned clinical, functional and psychological characteristics of the patients surviving ischemic provides a basis for the differential approach to the correction of the complex of rehabilitative measures.

Diagnostic transcranial magnetic stimulation in children with acute inflammatory demyelinating polyneuropathy

Diagnostic transcranial magnetic stimulation in children with acute inflammatory demyelinating polyneuropathy