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Transkranielle magnetische Stimulation

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Evozierte Potentiale in Klinik und Praxis

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Zusammenfassung

Merton u. Morton hatten 1980 gezeigt, daß der menschliche Kortex transkraniell elektrisch gereizt werden kann [36]. Der Stimulus muß aber, um die kapazitiven Widerstände von Kalotte und Meningen zu überwinden, relativ stark sein. Deshalb wird er oft als schmerzhaft empfunden. Barker etal. stellten 1985 [3, 4] eine neue magnetische Reiztechnik vor, bei der ein sich rasch änderndes magnetisches Feld intrakraniell einen Reizstrom induziert. Dieser Strom braucht keine anderen Strukturen zu überwinden, um den Kortex zu erreichen. Bei elektrischer Stimulation verlaufen die Stromlinien zwischen den beiden extrakraniell gelegenen Reizpolen, wo sie ihre höchste Dichte haben. Der magnetisch induzierte Reizstrom hat seine höchste Dichte unter den Windungen der zirkulären Flachspule. Er wird nicht durch die Widerstände der Schädelkalotte und der Dura abgeschwächt. Das Risiko einer möglichen Fokussierung der Stromdichte im Hirngewebe durch darüberliegende Areale mit niedrigem Widerstand besteht bei magnetischer Induktion nicht [1]. Der Reiz ist schmerzlos. Von der elektrischen transkraniellen Stimulation ist bekannt, daß bipolare Elektrodenanordnung auf der Kalotte mit einer frontalen Kathode und Anode über dem Motorkortex am wirksamsten ist. Ähnliche Verhältnisse können theoretisch durch die flach aufliegende Reizspule mit über der zu reizenden Hemisphäre in frontookzipitaler Richtung fließendem Strom erreicht werden, da die intrazerebral induzierten Ströme in umgekehrter Richtung fließen (Abb. 12.1). Um den kontralateralen Motorkortex zu reizen, genügt es, die Spule mit der Oberseite nach unten zu drehen [41].

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  1. D. Claus
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Editors and Affiliations

  1. Neurol. Klinik Wuppertal, Klinikum Barmen, Heusnerstraße 8, 42283, Wuppertal, Deutschland

    Johannes Jörg

  2. Neurol. Klinik am Evangel. Krankenhaus Gelsenkirchen, Munckelstraße 27, 45805, Gelsenkirchen, Deutschland

    Horst Hielscher

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© 1993 Springer-Verlag Berlin Heidelberg

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Claus, D. (1993). Transkranielle magnetische Stimulation. In: Jörg, J., Hielscher, H. (eds) Evozierte Potentiale in Klinik und Praxis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-97462-5_12

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  • DOI: https://doi.org/10.1007/978-3-642-97462-5_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-56236-8

  • Online ISBN: 978-3-642-97462-5

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