Advertisement

Sicherheitsaspekte und Kontraindikationen

  • B.-U. Meyer

Zusammenfassung

Nach dem bisherigen Kenntnisstand ist bei Berücksichtigung von Kontraindikationen die transkranielle magnetische Kortexstimulation mit Einzelreizen als ein sicheres und nebenwirkungsfreies Untersuchungsverfahren anzusehen. Die bei der Stimulation auftretende Energieübertragung auf das Gehirn ist vernachlässigbar gering, biologische Effekte, wie z. B. die Zunahme der zerebralen Blutperfusion, liegen im physiologischen Bereich. Transiente Veränderungen höherer Hirnfunktionen können auftreten und möglicherweise genutzt werden, um z. B. die sprachdominante Hemisphäre zu identifizieren. Wegen mechanischer Effekte dürfen sich in der Nähe der Stimulatorspule weder inner-noch außerhalb des Körpers der untersuchten Probanden stark leitfähige Objekte mit einer größeren Querschnittsfläche befinden. Patienten mit Epilepsie, Anfallsbereitschaft, frischem Herzinfarkt, Herzrhythmusstörungen oder Herzschrittmacher sollten nicht untersucht werden. Mögliche Gefährdungen durch ausgelöste starke Muskelkontraktionen sollten berücksichtigt werden (z. B. Wurzelstimulation bei instabiler Wirbelsäulenfraktur). Hörgeräte sollten vor der Untersuchung entfernt werden. Für die transkranielle elektrische Hirnstimulation gelten Frakturen oder Fissuren des Schädels als zusätzliche Kontraindikationen.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Adams RD, Victor M (1986) Epilepsy and other seizure disorders. In: Adams RD and Victor M (eds) Principles of neurology, 3rd edn. Mac Graw Hill, New York, pp 233–254Google Scholar
  2. Agnew WF, McCreery DB (1987) Considerations for the safety in the use of extracranial stimulation for motor evoked potentials. Neurosurgery 20: 143–147PubMedCrossRefGoogle Scholar
  3. Ammassian VE, Maccabee PJ, Cracco RQ, Cracco JB, Rudell AP, Eberle L (1992) Identifying hemispheric asymmetry in humans by magnetic coil stimulation. J Physiol 446: 222 PGoogle Scholar
  4. Ammon K, Gandevia SC (1990) Transcranial magnetic stimulation can influence the selection of motor programmes. J Neurol Neurosurg Psychiat 53: 705–707PubMedCrossRefGoogle Scholar
  5. Barker AT (1989) Magnetic nerve stimulation — safety aspects. International motor evoked potential symposium, Chicago 1989Google Scholar
  6. Barker AT, Freeston IL, Jarrat JA, Jalinous R (1990) Magnetic stimulation of the human nervous system: an introduction and basic principles. In: Chokroverty S (ed) Magnetic stimulation in clinical neurophysiology. Butterworth, Boston 1990, pp 55–72Google Scholar
  7. Bourland JD, Nyenhuis JA, Mouchawar GA, Tacker WA, Forster KS, Jones JT, Graber GP, Geddes LA (1989) First report of ventricular ectopic beats in the dog produced by a magnetic stimulator. International motor evoked potential symposium, Chicago 1989Google Scholar
  8. Boyd SG, De Silva LVG (1986) EEG and serum prolactine studies in relation to trans-cutaneous stimulation of central motor pathways. J Neurol Neurosurg Psychiat 49: 954–956PubMedCrossRefGoogle Scholar
  9. Bridgers S, Delaney RC (1989) Transcranial magnetic stimulation: an assessment of cognitive and other cerebral side effects. Neurolgy 39: 417–419Google Scholar
  10. Cadwell J (1990) Principles of magnetoelectric stimulation. In: Chockroverty S (ed) Magnetic stimulation in clinical neurophysiology. Butterworth, Boston, pp 13–32Google Scholar
  11. Cadwell J (1989) Movement of metal objects by magnetic stimulation. International motor evoked potential symposium, Chicago 1989Google Scholar
  12. Claus D, Eichhorn KF, Sembach O, Heinrich W, Arndt B (1991) Repetitive magnetische Stimulation: erste Erfahrungen mit einer neuen Technik. Z EEG EMG 21: 121–122Google Scholar
  13. Claus D, Weis SM, Treig T, Einhorn KF, Sembach 0 (1992) Über den Einfluß repetitiver magnetischer Stimulation auf visuelle Sprachwahrnehmung. Z EEG-EMG (im Druck)Google Scholar
  14. Cohen L, Hallett M (1987) Cortical stimulation does not short term changes in the EEG. Ann Neurol 21: 512–13PubMedCrossRefGoogle Scholar
  15. Cohen L, Hallet M (1988) Non-invasive electrical stimulation of the brain does not cause short-term changes in the electroencephalogram. In: Rossini PM, Marsden CD (eds) Non-invasive stimulation of brain and spinal cord: fundamentals and clinical application. Liss, New York, pp 159–161Google Scholar
  16. Counter SA, Borg E, Lofqvist L, Engr B, Brismar T (1990) Hearing loss from the acoustic artifact of the coil used in extracranial magnetic stimulation. Neurology 40: 1159–1162PubMedGoogle Scholar
  17. Counter SA, Borg E, Lofqvist L (1991) Acoustic trauma in extracranial magnetic stimulation. Electroenceph Clin Neurophysiol 78: 173–184PubMedCrossRefGoogle Scholar
  18. Day BL, Rothwell JC, Thompson PD, Maertens de Noordhout A, Nakashima K, Shannon K, Marsden CD (1989) Delay in the execution of voluntary movement by electrical or magnetic brain stimulation in intact man. Evidence for the storage of motor programmes in the brain. Brain 112: 649–663PubMedCrossRefGoogle Scholar
  19. Dhuna A, Gates J, Pascual-Leone A (1991) Transcranial magnetic stimulation in patients with epilepsy. Neurology 41: 1067–1071PubMedGoogle Scholar
  20. Dressler D, Voth E, Feldmann M, Henze T, Felgenhauer K (1989) The development of an epileptogenic focus. A case study with 99mTc-HMPAO SPECT. J Neurol 236: 300–302PubMedCrossRefGoogle Scholar
  21. Dressler D, Voth E, Feldmann M, Benecke R (1990) Safety aspects of transcranial magnetic stimulation tested by photon emission-computed tomography. Neurosci Lett 119: 153–155PubMedCrossRefGoogle Scholar
  22. Düzel E, Hufnagel A, Helmstaedter C, Wygrala J, Sudhop T, Elger CE (1992) Keine Auswirkung der transkraniellen Magnetstimulation auf die kurzzeitige Gedächtnis-spanne von Normalpersonen. Z EEG EMG (im Druck)Google Scholar
  23. Eyre JA, Flecknell PA, Kenyon BR, Koh THHG, Miller S (1990) Acute effects of electromagnetic stimulation of the brain on cortical activity, cortical blood flow, blood pressure and heart rate in the cat: an evaluation of safety. J Neurol Neurosurg Psychiat 53: 507–513PubMedCrossRefGoogle Scholar
  24. Fauth C, Meyer B-U, Prosiegel M, Zihl J, Conrad B (1992) Seizure induction and magnetic brain stimulation. Lancet 339: 362PubMedCrossRefGoogle Scholar
  25. Ferbert A, Mussmann N, Menne A, Hartje W, Buchner H (1990) Does transcranial magnetic stimulation influence memory? Electroenceph Clin Neurophysiol 75 11: 43Google Scholar
  26. Ferbert A, Mussmann N, Menne A, Buchner H, Hartje W (1991) Short-term memory performance with magnetic stimulation of the motor cortex. Eur Arch Psychiatry Clin Neurosci 241: 135–138PubMedCrossRefGoogle Scholar
  27. Food and Drug Administration (1982) Guidelines for evaluating electromagnetic exposure risk for trials of clinical NMR systems. US Food and Drug Administration, Rockville MDGoogle Scholar
  28. Gaito J (1976) The kindling effect as a model of epilepsy. Psychol Bull 83: 1097–1109PubMedCrossRefGoogle Scholar
  29. Gallagher BB, Murvin A, Flanigin HF, King DW, Luney O (1984) Pituitary and adrenal function in epileptic patients. Epilepsia 25: 683–689PubMedCrossRefGoogle Scholar
  30. Gates JR, Dhuna A, Pascual-Leone A (1990) Lack of pathological changes in human temporal lobe after transcranial magnetic stimulation. Epilepsia 31: 646CrossRefGoogle Scholar
  31. Goddard GV, McIntyre DC, Leech CK (1969) A permanent change in brain function resulting from daily electrical stimulation. Exp Neurol 25: 295–330PubMedCrossRefGoogle Scholar
  32. Gordon B, Lesser R, Rance NE, Hart J, Webber R, Uematsu S, Fisher RS (1990). Parameters for direct cortical electrical stimulation in the human: histopathologic confirmation. Electroenceph Clin Neurophysiol 75: 371–377PubMedCrossRefGoogle Scholar
  33. Hallett M, Cohen LG, Nilsson J, Panizza M (1990) Differences between electrical and magnetic stimulation of human peripheral nerve and motor cortex. In: Chokroverty S (ed) Magnetic stimulation in clinical neurophysiology, Butterworth, Boston, pp 275–287Google Scholar
  34. Handforth A (1984) Implications of stimulus factors governing kindling seizure thresholds. Exp Neurol 86: 33–39PubMedCrossRefGoogle Scholar
  35. Hömberg V, Netz J (1989) Generalized seizures induced by transcranial magnetic stimulation of motor cortex. Lancet 2: 1223PubMedCrossRefGoogle Scholar
  36. Hufnagel A, Elger CE, Durwen HF, Boker DK, Entzian W (1990a) Activation of the epileptic focus by transcranial magnetic stimulation of the human brain. Ann Neurol 27: 49–60PubMedCrossRefGoogle Scholar
  37. Hufnagel A, Elger CE, Klingmüller D, Zierz S, Kramer R (1990b) Activation of epileptic foci by transcranial magnetic stimulation: effects on secretion of prolactin and luteinizing hormone. J Neurol 227: 242–246CrossRefGoogle Scholar
  38. Hufnagel A, Helmstaedter C, Mizel E, Wygrala J, Sudhop T, Elger CE (1992) Auswirkungen der transkraniellen Magnetstimulation auf die kurzzeitige Gedächtnisspanne von Epilepsiepatienten. Z EEG-EMG (im Druck)Google Scholar
  39. Krain L, Kimura J, Yamada T, Cadwell J, Sakamaki S (1990) Consequences of cortical magnetoelectric stimulation. In: Chokroverty S (ed) Magnetic stimulation in clinical neurophysiology, Butterworth, pp 157–163Google Scholar
  40. Laxer KG, Mullooly JP, Howell B (1985) Prolactin changes after seizures classified by EEG monitoring. Neurology 35: 31–35PubMedGoogle Scholar
  41. Lee BI, Markland ON, Wellman HN, Siddiqui AS, Worth RM, Edwards MK, Krepshaw J (1986) HIPDM-SPECT brain imaging in patients with complex partial seizures. Epilepsia 27: 603Google Scholar
  42. Levy WJ (1987) Clinical experience with motor and cerebellar evoked potential monitoring. Neurosurgery 20: 169–182PubMedGoogle Scholar
  43. Levy WJ, Oro J, Tucker D, Haghighi S (1990) Safety studies of electrical and magnetic stimulation for the production of motor evoked potentials. In: Chokroverty S (ed) Magnetic stimulation in clinical neurophysiology, Butterworth, Boston, pp 165–172Google Scholar
  44. McRobie DM, Foster MA (1985) Cardiac responses to pulsed magnetic fields with regard to safety in NMR imaging. Phys Med Biol 30: 695–702CrossRefGoogle Scholar
  45. Meyer B-U, Diehl R, Steinmetz H, Britton TC, Benecke R (1991) Magnetic stimuli applied over motor and visual cortex: influence of coil position and field polarity on motor responses, phosphenes, and eye movements. In: Levy WJ, Cracco RQ, Barker AT, Rothwell J (eds) Magnetic motor stimulation: basic principles and clinical experience. Electroenceph Clin Neurophysiol [Suppl 43]:121–134Google Scholar
  46. Mouchawar GA, Nyenhuis JA, Bourland JD, Geddes LA (1989) Guidelines for enery efficient coils: coils designed for magnetic stimulation of the heart. International motor evoked potential symposium, Chicago 1989Google Scholar
  47. National Radiological protection board (1984) Advice on acceptable limits of exposure to nuclear magnetic resonance clinical imaging. Radiograph 50: 220Google Scholar
  48. O’Dea JPK, Gould D, Hallberg M, Weiland RG (1978) Prolactin changes during electroconvulsive therapy. Am J Psychiat 135: 609–611PubMedGoogle Scholar
  49. Pascual-Leone A, Dhuna A, Roth BJ, Cohen L, Hallett M (1990) Risk of burns during rapid-rate magnetic stimulation in presence of electrodes. Lancet 336: 1195–1996PubMedCrossRefGoogle Scholar
  50. Pascual-Leone A, Gates JR, Dhuna A (1991) Induction of speech arrest and counting errors with rapid-rate transcranial magnetic stimulation. Neurology 41: 697–702PubMedGoogle Scholar
  51. Pascual-Leone A, Cohen LG, Shotland LI et al. (1992a) No evidence of hearing loss in humans due to transcranial magnetic stimulation. Neurology 42: 647–651PubMedGoogle Scholar
  52. Pascual-Leone A, Valls-Solé J, Brasil-Neto JP, Cohen LG, Hallett M (1992b) Seizure induction and transcranial magnetic stimulation. Lancet 339: 997PubMedCrossRefGoogle Scholar
  53. Pavlicek W, Gaisinger M, Castle L, Borowski GP, Meaney T, Bream BL, Gallagher JH (1983) The effects of nuclear magnetic resonance on patients with cardiac pacemakers. Radiology 147: 149–153PubMedGoogle Scholar
  54. Polson MJR, Barker AT, Gardiner S (1982) The effect of rapid rise-time magnetic fields on the ECG of the rat. Clin Phys Physiol Meas 3: 231–234PubMedCrossRefGoogle Scholar
  55. Ravnborg M, Knudson GM, Blinkenberg M (1990) No effect of pulsed magnetic stimulation on the blood brain barrier in rats. Neuroscience 38 11: 277–280PubMedCrossRefGoogle Scholar
  56. Rossini PM, Caramia R, Zarola F (1987) Mechanisms of nervous propagation along central motor pathways: noninvasive evaluation in healthy subjects and in patients with neurological disease. Neurosurg 20: 183–191CrossRefGoogle Scholar
  57. Rossini PM, Silvestrini M, Zarola F et al. (1990) Effects of non-invasive magnetic brain stimulation on transcranial doppler and computerized EEG. Electroenceph Clin Neurophysiol 75 [1]: 130CrossRefGoogle Scholar
  58. Sancesario G, Massa R, Petrillo S, Nottola SA, Giacomini P, Correr S (1988) Transcranial unifocal stimulation: problems in localizing structural alterations on rabbit brain. In: Rossini PM, Marsden CD (eds) Non-invasive stimulation of brain and spinal cord: fundamentals and clinical applications. Liss, New York, pp 163–168Google Scholar
  59. Sancesario G, Massa R, Petrillo S, Nottola SA, Correr S, Rossini PM (1989) Transcranial unifocal stimulation in rabbit: subcutaneous and meningeal changes. European Neurol 29: 93–98CrossRefGoogle Scholar
  60. Schüler P, Claus D, Stefan H (1991) Transkranielle Magnetstimulation and Hyperventilation: Zwei Methoden zur Provokation epileptischer Aktivität im Vergleich. Z EEG EMG 21: 118Google Scholar
  61. Silny J (1985) Effects of low-frequency, high intensity magnetic fields on the organism. Int Conf Mag Fields Med Biol IEE conf Publ 257: 103–107Google Scholar
  62. Tassinari CA, Michelucci R, Forti A et al. (1990) Transcranial magnetic stimulation in epileptic patients: usefulness and safety. Neurology 40: 1132–1133PubMedGoogle Scholar
  63. Tsubokawa T, Yamamoto T, Nakamura S (1989) Electrophysiological and morphological consequences of repeated magnetic stimulation of the brain and peripheral nerve. International motor evoked potential symposium, Chicago 1989Google Scholar

Copyright information

© Springer-Verlag, Berlin Heidelberg 1992

Authors and Affiliations

  • B.-U. Meyer

There are no affiliations available

Personalised recommendations