Utilidade diagnóstica da estimulação magnética transcraniana para doenças neurodegenerativas: uma revisão crítica

Moreno-Roco, Javier; Valle, Lucía del; Jiménez, Daniel; Acosta, Ignacio; Castillo, José Luis; Dharmadasa, Thanuja; Kiernan, Matthew C.; Matamala, José Manuel

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Dementia & Neuropsychologia

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View and Review • Dement. neuropsychol. 17 • 2023 • https://doi.org/10.1590/1980-5764-DN-2023-0048 copiar

Utilidade diagnóstica da estimulação magnética transcraniana para doenças neurodegenerativas: uma revisão crítica

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO.

As doenças neurodegenerativas representam desafio significativo por seu impacto na estrutura cerebral, função e cognição. À medida que a expectativa de vida aumenta, a prevalência dessas doenças cresce rapidamente, resultando em substanciais encargos pessoais, familiares e sociais. Esforços têm sido feitos para otimizar os processos diagnósticos e terapêuticos, com foco principal na caracterização clínica, cognitiva e de imagem. No entanto, o surgimento de técnicas de estimulação cerebral não invasivas, especificamente a estimulação magnética transcraniana (EMT), oferece compreensão funcional e potencial diagnóstico únicos. A TMS permite a avaliação direta da função cerebral, fornecendo informações valiosas inacessíveis por outros métodos. Esta revisão teve como objetivo resumir a utilidade diagnóstica atual e potencial da EMT na investigação de doenças neurodegenerativas, destacando sua relevância para o campo da neurociência cognitiva. As conclusões aqui apresentadas contribuem para o crescente corpo de investigação centrado na melhoria da nossa compreensão e gestão dessas condições debilitantes, particularmente em regiões com recursos limitados e necessidade premente de abordagens inovadoras.

Palavras-chave:
Estimulação Magnética Transcraniana; Neurofisiologia; Biomarcadores; Doenças Neurodegenerativas; Esclerose Amiotrófica Lateral

Protocols		Proposed physiological mechanisms	Neurotransmitters involved
Single-Pulse TMS	MEP	Summation of corticospinal volleys of direct and indirect waves onto corticospinal neurons. Global excitability	Mainly glutamatergic synapses through corticomotoneuronal system
	RMT	Density of corticomotoneuronal projections and their global excitability	Mainly glutamatergic synapses through corticomotoneuronal system
	CSP	Cortico-subcortical and spinal excitability	Mainly GABA_B-type receptors
	ISP	Evaluate transcallosal inhibition	Glutamatergic and GABAergic synapses
	CMCT	Excitability of the fastest conducting corticomotoneuronal projections	Mainly glutamatergic synapses through corticomotoneuronal system
Paired-Pulse TMS	SICI	Inhibitory short-interval intracortical circuits	GABA_A-type receptors mediated
	ICF	Facilitatory short-interval intracortical circuits	Glutamatergic excitatory postsynaptic potentials (NMDA receptor)
	SICF	Facilitatory short-interval intracortical circuits	Facilitatory activity from interneuronal activation resulting in summation of I-waves on corticospinal neurons
	LICI	Inhibitory long-interval intracortical circuits	Mediated in part by GABA_B-type receptors
	SAI	Motor cortex inhibition induced by short-latency peripheral afferents stimulus	Cholinergic thalamocortical projections on GABA_A cortical networks
	LAI	Motor cortex inhibition induced by long-latency peripheral afferents stimulus	Inhibitory interneurons that are shared by LICI
	CBI	Inhibitory dento-thalamo-cortical pathway	GABA_A receptors at the end of cerebellothalamocortical pathway
Neuro-plasticity TMS	iTBS	Corticospinal or corticocortical excitability that may reflect LTP-like synaptic effects	Glutamatergic NMDA receptors mediating LTP-like synaptic effects
	cTBS	As iTBS, but may reflect LTD-like synaptic effects	May mediate LTD-like synaptic effects by GABAergic transmission
	HF rTMS	LTP-like synaptic effects	May mediate LTD-like effects through slow increase in ionic calcium concentration
	LF rTMS	LTD-like synaptic effects	May mediate reduce cortical excitability generating later I-waves
	PAS	LTP-like effects through Hebbian STDP	Mainly glutamatergic NMDA receptors mediating LTP-like effects

Protocol	Single- pulse protocols					Paired pulse protocols							Neuroplasticity protocols
Disease	MEP	RMT	CSP	ISP	CMCT	SICI	ICF	SICF	LICI	SAI	LAI	CBI	iTBS	cTBS	HF TMS	LF TMS	PAS
ALS	↑	↓	↓		↑	↓	^* * controversial results in the literature; blank cell, no data available in the literature to date.	↑		↓	↓						↓
AD	↑	↓	↓	↑	=	↓	=		↓	↓							↓
FTD	↓	↑	↓		↑	↓	↓		↓	^* * controversial results in the literature; blank cell, no data available in the literature to date.			^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.			↓
PD	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	↓	↓	↓				^* * controversial results in the literature; blank cell, no data available in the literature to date.

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: José Manuel Matamala; Email: jm_matamala@med.uchile.cl.