BACKGROUND:We aimed at evaluating the amplitude changes of the motor evoked potentials (MEPs) induced by of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) in10 patients with primary insomnia (PI) and in 10 age-matched healthy controls. METHODS:Median peak-to-peak MEP amplitudes were assessed in all subjects at three times: at baseline (T0), after the first train of a single rTMS session (T1), and after the whole rTMS procedure (T2). This consists of 20 trains of 1 Hz stimulation with 50 stimuli per train and an intertrain interval of 30 s. RESULTS:Resting motor threshold (RMT) and MEPs amplitude did not differ between the two groups at T0. A reduction of MEP size was observed at both T1 and T2 in all subjects, but this was significantly less pronounced in patients than in control subjects. CONCLUSIONS:The lack of MEP inhibition reflects an altered response to LF rTMS in patients with PI. These rTMS findings are indicative of an altered cortical plasticity in inhibitory circuits within M1 in PI. Subjects with PI exhibited an impairment of the LTD-like mechanisms induced by inhibitory rTMS, thus providing further support to the involvement of GABA neurotransmission in the pathophysiology of PI.

译文

摘要背景:我们旨在评估10例原发性失眠(PI)和失眠患者的原发性运动皮层(M1)上的低频(LF)重复经颅磁刺激(rTMS)诱发的运动诱发电位(MEP)的幅度变化。在10个与年龄匹配的健康对照中。
方法:对所有受试者的中值峰峰值MEP振幅进行了三次评估:在基线(T0),一次单次rTMS训练后(T1)和整个rTMS程序(T2)之后。这由20列1 Hz刺激的火车组成,每列50刺激,火车间隔为30 s。
结果:两组患者在T0时的运动阈值(RMT)和MEP幅值无差异。在所有受试者的T1和T2处均观察到MEP大小的减少,但是与对照组相比,患者的MEP明显不足。
结论:缺乏MEP抑制作用反映了PI患者对LF rTMS的反应有所改变。这些rTMS发现表明PI中M1内抑制回路的皮质可塑性发生了变化。 PI受试者表现出由抑制性rTMS诱导的LTD样机制的损伤,因此为GABA神经传递参与PI的病理生理提供了进一步的支持。

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