Fregni Felipe, Pascual-Leone Alvaro
Harvard Medical School and the Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Nat Clin Pract Neurol. 2007 Jul;3(7):383-93. doi: 10.1038/ncpneuro0530.
In neurology, as in all branches of medicine, symptoms of disease and the resulting burden of illness and disability are not simply the consequence of the injury, inflammation or dysfunction of a given organ; they also reflect the consequences of the nervous system's attempt to adapt to the insult. This plastic response includes compensatory changes that prove adaptive for the individual, as well as changes that contribute to functional disability and are, therefore, maladaptive. In this context, brain stimulation techniques tailored to modulate individual plastic changes associated with neurological diseases might enhance clinical benefits and minimize adverse effects. In this Review, we discuss the use of two noninvasive brain stimulation techniques--repetitive transcranial magnetic stimulation and transcranial direct current stimulation--to modulate activity in the targeted cortex or in a dysfunctional network, to restore an adaptive equilibrium in a disrupted network for best behavioral outcome, and to suppress plastic changes for functional advantage. We review randomized controlled studies, in focal epilepsy, Parkinson's disease, recovery from stroke, and chronic pain, to illustrate these principles, and we present evidence for the clinical effects of these two techniques.
在神经病学领域，与医学的所有分支一样，疾病症状以及由此产生的疾病负担和残疾并非仅仅是特定器官损伤、炎症或功能障碍的结果；它们还反映了神经系统试图适应损伤的后果。这种可塑性反应包括对个体具有适应性的代偿性变化，以及导致功能残疾因而具有 maladaptive 的变化。在此背景下，针对调节与神经系统疾病相关的个体可塑性变化而量身定制的脑刺激技术，可能会增强临床疗效并将不良反应降至最低。在本综述中，我们讨论了两种非侵入性脑刺激技术——重复经颅磁刺激和经颅直流电刺激——的应用，以调节目标皮层或功能失调网络中的活动，在紊乱的网络中恢复适应性平衡以实现最佳行为结果，并为获得功能优势而抑制可塑性变化。我们回顾了针对局灶性癫痫、帕金森病、中风康复和慢性疼痛的随机对照研究，以阐明这些原理，并展示这两种技术临床效果的证据。
