Lisanby Sarah H
Department of Biological Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York 10032, USA.
J ECT. 2002 Dec;18(4):182-8. doi: 10.1097/00124509-200212000-00003.
Magnetic seizure therapy (MST) refers to the use of transcranial magnetic stimulation to induce a seizure for therapeutic purposes. MST is under investigation as a means of improving the safety profile of electroconvulsive therapy (ECT). Although both MST and ECT induce seizures through electrical stimulation of the brain, the electric field induced by MST is more focal and limited than that induced by ECT. Because magnetic fields pass through tissue unimpeded, there is greater control over the site and extent of stimulation with MST than can be achieved with ECT. This enhanced control represents a means of focusing the treatment on target cortical structures thought to be essential to antidepressant response and of reducing spread to medial temporal regions implicated in the cognitive side effects of ECT. MST is currently at an early stage of development. This article reviews the experience with MST in animal models and initial human investigations. Preliminary results have demonstrated the feasibility of performing MST in the clinical setting, and there are suggestions that MST may have advantages over ECT in terms of subjective side effects and some measures of acute cognitive functioning. The antidepressant efficacy of MST is not yet known, but studies designed to address that critical issue are underway. As with all attempts to refine convulsive therapy techniques (such as modifications in stimulation parameter configurations and electrode placement), the ultimate clinical value of MST will need to be established through controlled clinical trials.
磁休克疗法（MST）是指为治疗目的而使用经颅磁刺激来诱发癫痫发作。目前正在研究将磁休克疗法作为一种改善电休克疗法（ECT）安全性的手段。虽然磁休克疗法和电休克疗法都是通过对大脑进行电刺激来诱发癫痫发作，但磁休克疗法所诱发的电场比电休克疗法诱发的电场更具局灶性且范围更有限。由于磁场可不受阻碍地穿过组织，因此与电休克疗法相比，磁休克疗法对刺激的部位和范围具有更强的控制能力。这种更强的控制能力意味着可以将治疗集中在被认为对抗抑郁反应至关重要的目标皮质结构上，并减少扩散到与电休克疗法认知副作用相关的内侧颞叶区域。磁休克疗法目前正处于发展的早期阶段。本文回顾了磁休克疗法在动物模型和初步人体研究中的经验。初步结果已证明在临床环境中进行磁休克疗法的可行性，并且有迹象表明，在主观副作用和一些急性认知功能指标方面，磁休克疗法可能比电休克疗法更具优势。磁休克疗法的抗抑郁疗效尚不清楚，但旨在解决这一关键问题的研究正在进行中。与所有改进惊厥疗法技术的尝试（如刺激参数配置和电极放置的改变）一样，磁休克疗法的最终临床价值需要通过对照临床试验来确定。
