Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector26210.17816/psaic262TechnologiesТехнологииUnknownNew step to a personalized medicine. Navigation transcranial magnetic stimulation (NBS eXimia Nexstim)Новый шаг к персонифицированной медицине. Навигационная система транскраниальной магнитной стимуляции (NBS eXimia Nexstim)ChervyakovAlexander V.ЧервяковАлександр Владимирович
Russian Federation
kremneva@neurology.ruhttps://orcid.org/0000-0002-6338-0392PiradovMichail A.ПирадовМихаил Александрович
Russian Federation

D. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Director

академик РАН, профессор, д.м.н., директор

kremneva@neurology.ruSavitskayaN. G.СавицкаяН. Г.
Russian Federation
kremneva@neurology.ruChernikovaLyudmila A.ЧерниковаЛюдмила Александровна
Russian Federation
kremneva@neurology.ruKremnevaElena I.КремневаЕлена Игоревна
Russian Federation
kremneva@neurology.ruResearch Center of NeurologyФГБНУ «Научный центр неврологии»Reseach Center of NeurologyФГБНУ «Научный центр неврологии»1009201263374602022017Copyright ©; 2012, Chervyakov A.V., Piradov M.A., Savitskaya N.G., Chernikova L.A., Kremneva E.I.Copyright ©; 2012, Chervyakov A.V., Piradov M.A., Savitskaya N.G., Chernikova L.A., Kremneva E.I.2012Chervyakov A.V., Piradov M.A., Savitskaya N.G., Chernikova L.A., Kremneva E.I.Chervyakov A.V., Piradov M.A., Savitskaya N.G., Chernikova L.A., Kremneva E.I.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/262

Navigation transcranial magnetic stimulation of the brain (nTMS) NBS eXimia Nexstim – new method based on the stimulation of neurons by an alternating magnetic field and recording responses to stimulation with electromyography. Precise guidance of the stimulus to a particular area of the cerebral cortex the patient, repeat the stimulus, somatotopical mapping of motor areas are features of this method. These characteristics are achieved by a special navigation system that compares patient’s head with the anatomical MRI image and the location of stimulating magnetic coil. This review presents the current possibilities of the navigation TMS method in the diagnosis and treatment of neurological diseases; our own local experience with the system.

Навигационная транскраниальная магнитная стимуляция мозга (нТМС) NBS eXimia Nexstim – новый метод, основанный на стимуляции нейронов головного мозга переменным магнитным полем и регистрации ответов на стимуляцию с помощью электромиографии. Особенностью данного метода является точное наведение стимула на конкретную область коры головного мозга пациента, возможность повторения стимулов, соматотопическое картирование моторных зон. Данные характеристики достигаются благодаря специальной навигационной системе, сопоставляющей голову пациента с анатомическим изображением на МРТ и расположением стимулирующей магнитной катушки. В обзоре представлены современные возможности метода нТМС в диагностике и лечении неврологических заболеваний, собственный локальный опыт применения системы.

transcranial magnetic stimulationpersonalized medicinemotor responseTMS-EEGтранскраниальная магнитная стимуляцияперсонифицированная медицинавызванный моторный ответТМС-ЭЭГБехтерева Н.П. Лечебная электрическая стимуляция мозга и нервов человека / под общ. ред. Н.П. Бехтеревой. М.: АСТ; СПб.: Сова; Владимир: ВКТ, 2008.Бехтерева Н.П., Грачев К.В., Орлова А.Н., Яцук С.Л. Использование множественных электродов, вживленных в подкорковые образования головного мозга человека для лечения гиперкинеза. Журнал неврологии и психиатрии 1963; 63 (1): 3–8.Бинги В.Н., Савин А.В. Физические проблемы действия слабых магнитных полей на биологические системы. Успехи физических наук 2003; 173 (3): 265–300.Бучаченко А.Л. Магнитные взаимодействия в химических реакциях. Физическая химия «Современные проблемы» под ред. акад. Я.М. Колотыркина. М., 1980: 7–48.Бучаченко А.Л., Кузнецов Д.А. Магнитный изотопный эффект магния – ключ к механохимии фосфорилирующих ферментов как молекулярных машин. Молекулярная биология, 2006; 40 (1): 12–19.Кандель Э.И. Паркинсонизм и его хирургическое лечение. М.: Медицина, 1965.Никитин С.С., Куренков А.Л. Магнитная стимуляция в диагностике и лечении болезней нервной системы. Руководство для врачей. М: САШКО, 2003.Чутко Л.С., Сурушкина С.Ю., Яковенко Е.А. и др. Применение транскраниальной микрополяризации в лечении синдрома дефицита внимания с гиперактивностью. Журн. Нейрохирургия и неврология детского возраста 2007; 1: 35–37.Allen E.A., Pasley B.N., Duong T., Freeman R.D. Transcranial magnetic stimulation elicits coupled neural and hemodynamic consequences. Science 2007; 317: 1918–1921.Amico L., Fazio R., Osterloh A., Vedral V. Entanglement in Many- Body Systems. Reviews of modern physics, 2008. Vol. 80; 2: 517–576.Andre-Obadia N., Peyron R., Mertens P. et al. Transcranial magnetic stimulation for pain control. Double-blind study of different frequencies against placebo, and correlation with motor cortex stimulation efficacy. Clin Neurophysiol 2006; 117: 1536–1544.Barker A.T., Jalinous R., Freeston I.L. Non-invasive magnetic stimulation of human motor cortex. Lancet 1985; 1: 1106–1107.Bender S., Basseler K., Sebastian I. et al. Electroencephalographic response to transcranial magnetic stimulation in children: Evidence for giant inhibitory potentials. 2005. Ann Neurol 58: 58–67.Boggio P.S., Fregni F., Bermpohl F. et al. Effect of repetitive TMS and fluoxetine on cognitive function in patients with Parkinson’s disease and concurrent depression. Mov Disord 2005; 20: 1178–1184.Bonnard M., Spieser L., Meziane H.B. et al. Prior intention can locally tune inhibitory processes in the primary motor cortex: direct evidence from combined TMS-EEG. Eur J Neurosci. 2009 Sep; 30 (5): 913–923.Brasil-Neto J.P., McShane L.M., Fuhr P. et al. Topographic mapping of the human motor cortex with magnetic stimulation: factors affecting accuracy and reproducibility. Electroencephalogr Clin Neurophysiol 1992; 85: 9–16.Brighina F., Piazza A., Vitello G. et al. rTMS of the prefrontal cortex in the treatment of chronic migraine: a pilot study. J Neurol Sci 2004; 227: 67–71.Brignani D., Manganotti P., Rossini P.M., Miniussi C.Modulation of cortical oscillatory activity during transcranial magnetic stimulation. 2008. Hum Brain Mapp 29: 603–612.Centonze D., Petta F., Versace V. et al. Effects of motor cortex rTMS on lower urinary tract dysfunction in multiple sclerosis. Mult Scler. 2007 Mar;13 (2): 269–271.Chen R., Cros D., Curra A. et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008; 119: 504–532.Cho S.S., Strafella A.P. rTMS of the left dorsolateral prefrontal cortex modulates dopamine release in the ipsilateral anterior cingulate cortex and orbitofrontal cortex. PLoS One. 2009 Aug 21; 4 (8).Cracco R.Q., Amassian V.E., Maccabee P.J., Cracco J.B. Comparison of human transcallosal responses evoked by magnetic coil and electrical stimulation. Electroencephalogr Clin Neurophysiol. 1989; 74: 417–424.Cykowski M.D., Coulon O., Kochunov P.V. et al. The central sulcus: an observer-independent characterization of sulcal landmarks and depth asymmetry. Cereb Cortex 2008; 18: 1999–2009.Day B.L., Dressler D., Maertens de Noordhout A. et al. Electric and magnetic stimulation of human motor cortex: surface EMG and single motor unit responses. J Physiol 1989; 412: 449–473.De Ridder D., van der Loo E., Van der Kelen K. et al. Theta, alpha and beta burst transcranial magnetic stimulation: brain modulation in tinnitus. Int J Med Sci 2007; 4: 237–241.Dell’Osso B., Mundo E., D’Urso N. et al. Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression. Bipolar Disord 2009; 11: 76–81.Di Lazzaro V., Pilato F., Profice P. et al. Motor cortex stimulation for ALS: a double blind placebo-controlled study. Neurosci Lett. 2009 Oct 16; 464 (1): 18–21.Dileone M., Profice P., Pilato F. et al. Repetitive transcranial magnetic stimulation for ALS. CNS Neurol Disord Drug Targets. 2010 Jul; 9 (3): 331–334.Elahi B., Elahi B., Chen R. Effect of transcranial magnetic stimulation on Parkinson motor function—systematic review of controlled clinical trials. Mov Disord. 2009 Feb 15; 24 (3): 357–363.Esser S.K., Huber R., Massimini M. et al. A direct demonstration of cortical LTP in humans: a combined TMS/EEG study. Brain Res Bull 2006, 69: 86–94.Forster M.T., Gasser T., Hattingen E. et al. TMS as a part of multimodal management of safe glioma resection in the motor cortex. In: DGNC, Munster. Dusseldorf: German Medical Science GMS Publishing House; 2009 [Doc MO.06–01].Forster M.T., Hattingen E., Senft C. et al. Navigated Transcranial Magnetic Stimulation and functional Magnetic Resonance Imaging – advanced adjuncts in preoperative planning for central region tumors. Neurosurgery. 2011 Jan 26.Fregni F., Boggio P.S., Mansur C.G. et al. Transcranial direct current stimulation of the unaffected hemisphere in stroke patients. Neuroreport 2005; 16: 1551–1555.Fregni F., Santos C.M., Myczkowski M.L. et al. Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004; 75: 1171–1174.Fuggetta G., Fiaschi A., Manganotti P. Modulation of cortical oscillatory activities induced by varying single-pulse transcranial magnetic stimulation intensity over the left primary motor area: a combined EEG and TMS study. 2005. Neuroimage 27:896–908.Fujiki M., Hikawa T., Abe T. et al. Navigated brain stimulation for preoperative anatomic and functional identification of impaired motor cortex in a patient with meningioma. Neurosurg Quart 2007; 17: 33–9.Green M.F., Nuechterlein K.H. Cortical oscillations and schizophrenia: timing is of the essence. 1999. Arch Gen Psychiatry 56:1007–1008.Hallett M. Transcranial magnetic stimulation: a primer. Neuron 2007, 55: 187–199.Hannula H., Ylioja S., Pertovaara A. et al. Somatotopic blocking of sensation with navigated transcranial magnetic stimulation of the primary somatosensory cortex. Hum Brain Mapp 2009; 26: 100–109.Herbsman T., Avery D., Ramsey D. et al. More lateral and anterior prefrontal coil location is associated with better repetitive transcranial magnetic stimulation antidepressant response. Biol Psychiatry 2009; 66: 509–515.Huber R., Esser S.K., Ferrarelli F. TMS-induced cortical potentiation during wakefulness locally increases slow wave activity during sleep. 2007. PLoS One 2: e276.Huber R., Määttä S., Esser S.K. et al. Measures of cortical plasticity after transcranial paired associative stimulation predict changes in electroencephalogram slow-wave activity during subsequent sleep. 2008. J Neurosci 28: 7911–7918.Huerta T.P., Volpe T.B. Transcranial magnetic stimulation, synaptic plasticity and network oscillations Journal of NeuroEngineering and Rehabilitation 2009, 6: 7.Irlbacher K., Kuhnert J., Roricht S. et al. Central and peripheral deafferent pain: therapy with repetitive transcranial magnetic stimulation. Nervenarzt 2006; 77: 1196, 1198–1203.Julkunen P., Jauhiainen A.M., Westerén-Punnonen S. et al. Navigated TMS combined with EEG in mild cognitive impairment and Alzheimer’s disease: a pilot study. J Neurosci Methods. 2008 Jul 30; 172 (2): 270–276.Keller S.S., Highley J.R., Garcia-Finana M. et al. Sulcal variability, stereological measurement and asymmetry of Broca’s area on MR images. J Anat 2007; 211: 534–555.Khedr E.M., Kotb H., Kamel N.F. et al. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry 2005; 76: 833–838.Kičic D. Probing cortical excitability with transcranial magnetic stimulation. Ph.D. Thesis. Helsinki University of Technology, Espoo 2009.Kim Y.H., You S.H., Ko M.H. et al. Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke. Stroke 2006; 37: 1471–1476.Kleinjung T., Steffens T., Londero A., Langguth B. Transcranial magnetic stimulation (TMS) for treatment of chronic tinnitus: clinical effects. Prog Brain Res 2007; 166: 359–367.Komssi S., Saolainen P., Heiskala J., Kähkönen S. Excitation threshold of the motor cortex estimated with transcranial magnetic stimulation electroencephalography. 2007. Neuroreport 18: 13–16.Langguth B., Kleinjung T., Marienhagen J. et al. Transcranial magnetic stimulation for the treatment of tinnitus: effects on cortical excitability. BMC Neurosci 2007; 8: 45.Lefaucheur J.P., Drouot X., Keravel Y., Nguyen J.P. Pain relief induced by repetitive transcranial magnetic stimulation of precentral cortex. Neuroreport 2001; 12: 2963–2965.Lefaucheur J.P., Drouot X., Menard-Lefaucheur I., Nguyen J.P. Neuropathic pain controlled for more than a year by monthly sessions of repetitive transcranial magnetic stimulation of the motor cortex. Neurophysiol Clin 2004; 34: 91–95.Lioumis P., Kičic. D., Savolainen P. et al. Reproducibility of TMSevoked EEG responses. 2009. Hum Brain Mapp 30: 1387–1396.Lomarev M.P., Kanchana S., Bara-Jimenez W. et al. Placebo-controlled study of rTMS for the treatment of Parkinson’s disease. Mov Disord 2006; 21: 325–331.Lotze M., Kaethner R.J., Erb M. et al. Comparsion of representational maps using functional magnetic resonance imaging and transcranial magnetic stimulation. Clin. Neuropysiol. 2003; 114: 306–312.Mansur C.G., Fregni F., Boggio P.S. et al. A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients. Neurology 2005; 64: 1802–1804.Machado S., Bittencourt J., Minc D. et al. Therapeutic applications of repetitive transcranial magnetic stimulation in clinical neurorehabilitation. Funct Neurol. 2008 Jul-Sep; 23 (3): 113–122.Massimini M., Ferrarelli F., Huber R. et al. Breakdown of cortical effective connectivity during sleep. 2005. Science 309: 2228–2232.Medina F.J., Túnez I. Huntington’s disease: the value of transcranial meganetic stimulation. Curr Med Chem. 2010; 17 (23): 2482–2491.Neuvonen T., Niskanen E., Hannula H. et al. Functional MRI agrees with navigated transcranial magnetic stimulation in primary motor cortex localization. In: Congress of Neurological Surgeons. 2009. New Orleans, 24–29.Pascual-Leone A., Davey N., Rothwell J. et al. Puri BK: Handbook of Transcranial Magnetic Stimulation London: Hodder Arnold; 2002.Penfield W., Jasper H. Epilepsy and the Functional Anatomy of the Human Brain. Boston, Mass: Little, Brown & Co; 1954.Pfurtscheller G., Lopes da Silva F.H. Event-related EEG/MEG synchronization and desynchronization: basic principles. 1999. Clin Neurophysiol 110: 1842–1857.Picht T., Frey D., Schmidt S. et al. Navigated transcranial magnetic stimulation for preoperative functional diagnostics in brain tumor surgery. In: Congress of Neurological Surgeons. 2009. New Orleans, October 24–29.Quartarone A., Bagnato S., Rizzo V. et al. Distinct changes in cortical and spinal excitability following highfrequency repetitive TMS to the human motor cortex. 2005. Exp Brain Res 161: 114–124.Reutens D.C., Puce A., Berkovic S.F. Cortical hyperexcitability in progressive myoclonus epilepsy: a study with transcranial magnetic stimulation. Neurology. 1993; 43: 186–192.Risto J., Ilmoniemi R.J., Dubravko, Kičić D. Methodology for Combined TMS and EEG Brain Topogr. 2010 January; 22 (4): 233–248.Rosanova M., Casali A., Bellina V. et al. Natural frequencies of human corticothalamic circuits. 2009. J Neurosci 29: 7679–7685.Ruohonen J., Ilmoniemi R.J. Modeling of the stimulating field generation in TMS. Electroencephalogr Clin Neurophysiol Suppl 1999; 51: 30–40.Ruohonen J., Karhu J. Navigated transcranial magnetic stimulation. Neurophysiologie Clinique/Clinical Neurophysiology. 2010, 40: 7–17.Sampson S.M., Rome J.D., Rummans T.A. Slow-frequency rTMS reduces fibromyalgia pain. Pain Med 2006; 7: 115–118.Siegel A., Sapru H.N. Essential neuroscience. Lippincott; 2008.Steinmetz H., Furst G., Freund H.J. Variation of perisylvian and calcarine anatomic landmarks within stereotaxic proportional coordinates. AJNR Am J Neuroradiol 1990;11: 1123–1130.Teitti S., Määttä S., Saisanen L. et al. Non-primary motor areas in the human frontal lobe are connected directly to hand muscles. Neuroimage 2008; 40: 1243–1250. Epub 2008 Jan 17.Thickbroom G.W., Byrnes M.L., Mastaglia F.L. Methodology and application of TMS mapping. EEG Clin. Neurophysiol. 1999a; 51 (Suppl.): 48–54.Trachina D., Nicholson C. A model for the polarization of neurons by extrinsically applied electric fields. Biophys J 1986; 50: 1139–1156.Valero-Cabre A., Payne B.R., Rushmore J. et al. Impact of repetitive transcranial magnetic stimulation of the parietal cortex on metabolic brain activity: a 14C-2DG tracing study in the cat. Exp Brain Res 2005, 163: 1–12.Veniero D., Bortoletto M., Miniussi C. TMS-EEG co-registration: on TMS-induced artifact. 2009 Clin Neurophysiol 120: 1392–1399.Vitikainen A.M., Lioumis P., Paetau R. et al. Combined use of noninvasive techniques for improved functional localization for a selected group of epilepsy surgery candidates. Neuroimage 2009; 45: 342–348. 82. Vedral V. Quantifying entanglement in macroscopic systems. Nature. 2008 Jun 19; 453 (7198): 1004–1007.Wagner T., Valero-Cabre A., Pascual-Leone A. Noninvasive human brain stimulation. Annu Rev Biomed Eng 2007, 9: 527–565.Williams A.J., Imamura M., Fregni F. Updates on the use of noninvasive brain stimulation in physical and rehabilitation medicine. J Rehabil Med 2009; 41: 305–311.Zorowitz R., Brainin M. Advances in brain recovery and rehabilitation 2010. Stroke. 2011; 42: 2: 294–297.