Lisanby Sarah H, Morales Oscar, Payne Nancy, Kwon Edward, Fitzsimons Linda, Luber Bruce, Nobler Mitchell S, Sackeim Harold A
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, USA.
CNS Spectr. 2003 Jul;8(7):529-36. doi: 10.1017/s1092852900019003.
New findings regarding the mechanisms of action of electro-convulsive therapy (ECT) have led to novel developments in treatment technique to further improve this highly effective treatment for major depression. These new approaches include novel placements, optimization of electrical stimulus parameters, and new methods for inducing more targeted seizures(eg, magnetic seizure therapy [MST]). MST is the use of transcranial magnetic stimulation to induce a seizure. Magnetic fields pass through tissue unimpeded, providing more control over the site and extent of stimulation 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 reducing spread to medial temporal regions implicated in the cognitive side effects of ECT. MST is at an early stage of development. Preliminary results suggest that MST may have some advantages over ECT in terms of subjective side effects and acute cognitive functioning. Studies designed to address the antidepressant efficacy of MST are underway. As with all attempts to improve convulsive therapy technique, the clinical value of MST will need to be established through controlled clinical trials. This article reviews the experience to date with MST, and places this work in the broader context of other means of optimizing convulsive therapy in the treatment of depression.
关于电休克治疗（ECT）作用机制的新发现促使治疗技术取得了新进展，以进一步改善这种对重度抑郁症非常有效的治疗方法。这些新方法包括新的电极放置方式、电刺激参数的优化以及诱导更具靶向性癫痫发作的新方法（如磁休克治疗[MST]）。MST是利用经颅磁刺激来诱发癫痫发作。磁场可不受阻碍地穿过组织，与ECT相比，能对刺激的部位和范围进行更好的控制。这种增强的控制代表了一种将治疗聚焦于被认为对抗抑郁反应至关重要的目标皮质结构，并减少扩散至与ECT认知副作用相关的内侧颞叶区域的方法。MST尚处于发展初期。初步结果表明，MST在主观副作用和急性认知功能方面可能比ECT具有一些优势。旨在探讨MST抗抑郁疗效的研究正在进行中。与所有改善惊厥治疗技术的尝试一样，MST的临床价值需要通过对照临床试验来确定。本文回顾了迄今为止MST的经验，并将这项工作置于优化抑郁症惊厥治疗的其他方法这一更广泛的背景下。
