Kimbrell Timothy A, Dunn Robert T, George Mark S, Danielson Aimee L, Willis Mark W, Repella Jennifer D, Benson Brenda E, Herscovitch Peter, Post Robert M, Wassermann Eric M
Biological Psychiatry Branch, NIMH, NIH, Bethesda, MD 20892, USA.
Psychiatry Res. 2002 Oct 1;115(3):101-13. doi: 10.1016/s0925-4927(02)00041-0.
Repetitive transcranial magnetic stimulation (rTMS) holds promise as a probe into the pathophysiology and possible treatment of neuropsychiatric disorders. To explore its regional effects, we combined rTMS with positron emission tomography (PET). Fourteen healthy volunteers participated in a baseline 18-fluorodeoxyglucose (FDG) PET scan. During a second FDG infusion on the same day, seven subjects received 30 min of 1 Hz rTMS at 80% of motor threshold to left prefrontal cortex, and seven other subjects received sham rTMS under identical conditions. Global and normalized regional cerebral glucose metabolic rates (rCMRglu) from the active and sham conditions were compared to baseline and then to each other. Sham, but not active 1 Hz rTMS, was associated with significantly increased global CMRglu. Compared to baseline, active rTMS induced normalized decreases in rCMRglu in right prefrontal cortex, bilateral anterior cingulate, basal ganglia (L>R), hypothalamus, midbrain, and cerebellum. Increases in rCMRglu were seen in bilateral posterior temporal and occipital cortices. Sham rTMS compared to baseline resulted in isolated normalized decreases in rCMRglu in left dorsal anterior cingulate and left basal ganglia, and increases in posterior association and occiptal regions. Differences between the 1 Hz active versus sham changes from baseline revealed that active rTMS induced relative decrements in rCMRglu in the left superior frontal gyrus and increases in the cuneus (L>R). One Hertz rTMS at 80% motor threshold over the left prefrontal cortex in healthy subjects compared to sham rTMS in another group (each compared to baseline) induced an area of decreased normalized left prefrontal rCMRglu not directly under the stimulation site, as well as increases in occipital cortex. While these results are in the predicted direction, further studies using other designs and higher intensities and frequencies of rTMS are indicated to better describe the local and distant changes induced by rTMS.
重复经颅磁刺激（rTMS）有望成为探究神经精神疾病病理生理学及可能治疗方法的一种手段。为探究其区域效应，我们将rTMS与正电子发射断层扫描（PET）相结合。14名健康志愿者参与了一次基线18氟脱氧葡萄糖（FDG）PET扫描。在同一天的第二次FDG注入过程中，7名受试者接受了30分钟频率为1赫兹、强度为运动阈值80%的rTMS，刺激左侧前额叶皮质，另外7名受试者在相同条件下接受伪刺激rTMS。将主动刺激和伪刺激条件下的全脑及标准化区域脑葡萄糖代谢率（rCMRglu）与基线进行比较，然后相互比较。伪刺激（而非主动1赫兹rTMS）与全脑CMRglu显著增加相关。与基线相比，主动rTMS导致右侧前额叶皮质、双侧前扣带回、基底神经节（左侧>右侧）、下丘脑、中脑和小脑的rCMRglu标准化降低。双侧颞后皮质和枕叶皮质的rCMRglu增加。与基线相比，伪刺激rTMS导致左侧背侧前扣带回和左侧基底神经节的rCMRglu单独标准化降低，以及后联合区和枕叶区域增加。1赫兹主动刺激与伪刺激相对于基线变化的差异表明，主动rTMS导致左侧额上回的rCMRglu相对降低，楔叶增加（左侧>右侧）。与另一组的伪刺激rTMS相比（每组均与基线相比），健康受试者在左侧前额叶皮质以运动阈值80%进行的1赫兹rTMS在未直接受刺激部位诱导了左侧前额叶rCMRglu标准化降低区域，以及枕叶皮质增加。虽然这些结果符合预期方向，但仍需使用其他设计以及更高强度和频率的rTMS进行进一步研究，以更好地描述rTMS诱导的局部和远处变化。
