Post R M, Kimbrell T A, McCann U D, Dunn R T, Osuch E A, Speer A M, Weiss S R
Biological Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA.
J ECT. 1999 Mar;15(1):39-59.
Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising therapeutic intervention in the treatment of affective disorders. The differences in the type of electrical stimulation required for therapeutic efficacy by rTMS and electroconvulsive therapy (ECT) are discussed. In contrast to ECT, rTMS would not appear to require the generation of a major motor seizure to achieve therapeutic efficacy. Accordingly, it carries the potentially important clinical advantages of not requiring anesthesia and of avoiding side effects such as transient memory loss. Preclinical studies on long-term potentiation (LTP) and long-term depression (LTD) in hippocampal and amygdala slices, as well as clinical data from neuroimaging studies, have provided encouraging clues for potential frequency-dependent effects of rTMS. Preliminary evidence from position emission tomography (PET) scans suggests that higher frequency (20 Hz) stimulation may increase brain glucose metabolism in a transsynaptic fashion, whereas lower frequency (1 Hz) stimulation may decrease it. Therefore, the ability of rTMS to control the frequency as well as the location of stimulation, in addition to its other advantages, has opened up new possibilities for clinical explorations and treatments of neuropsychiatric conditions.
重复经颅磁刺激（rTMS）已成为治疗情感障碍的一种有前景的治疗干预手段。文中讨论了rTMS与电休克疗法（ECT）在治疗效果所需电刺激类型上的差异。与ECT不同，rTMS似乎不需要引发大的运动性癫痫发作就能达到治疗效果。因此，它具有无需麻醉以及避免诸如短暂性记忆丧失等副作用等潜在的重要临床优势。对海马体和杏仁核切片中长时程增强（LTP）和长时程抑制（LTD）的临床前研究，以及神经影像学研究的临床数据，为rTMS潜在的频率依赖性效应提供了令人鼓舞的线索。正电子发射断层扫描（PET）的初步证据表明，高频（20Hz）刺激可能以跨突触方式增加脑葡萄糖代谢，而低频（1Hz）刺激可能降低脑葡萄糖代谢。因此，rTMS除了其他优势外，还能够控制刺激频率和位置，这为神经精神疾病的临床探索和治疗开辟了新的可能性。
