Wu Allan D, Fregni Felipe, Simon David K, Deblieck Choi, Pascual-Leone Alvaro
Department of Neurology, University of California, Los Angeles, California 90095, USA.
Neurotherapeutics. 2008 Apr;5(2):345-61. doi: 10.1016/j.nurt.2008.02.002.
Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are promising noninvasive cortical stimulation methods for adjunctive treatment of movement disorders. They avoid surgical risks and provide theoretical advantages of specific neural circuit neuromodulation. Neuromodulatory effects depend on extrinsic stimulation factors (cortical target, frequency, intensity, duration, number of sessions), intrinsic patient factors (disease process, individual variability and symptoms, state of medication treatment), and outcome measures. Most studies to date have shown beneficial effects of rTMS or tDCS on clinical symptoms in Parkinson's disease (PD) and support the notion of spatial specificity to the effects on motor and nonmotor symptoms. Stimulation parameters have varied widely, however, and some studies are poorly controlled. Studies of rTMS or tDCS in dystonia have provided abundant data on physiology, but few on clinical effects. Multiple mechanisms likely contribute to the clinical effects of rTMS and tDCS in movement disorders, including normalization of cortical excitability, rebalancing of distributed neural network activity, and induction of dopamine release. It remains unclear how to individually adjust rTMS or tDCS factors for the most beneficial effects on symptoms of PD or dystonia. Nonetheless, the noninvasive nature, minimal side effects, positive effects in preliminary clinical studies, and increasing evidence for rational mechanisms make rTMS and tDCS attractive for ongoing investigation.
重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）是用于运动障碍辅助治疗的很有前景的非侵入性皮层刺激方法。它们避免了手术风险，并提供了特定神经回路神经调节的理论优势。神经调节作用取决于外在刺激因素（皮层靶点、频率、强度、持续时间、疗程次数）、内在患者因素（疾病进程、个体变异性和症状、药物治疗状态）以及结果测量指标。迄今为止，大多数研究表明rTMS或tDCS对帕金森病（PD）的临床症状有有益影响，并支持其对运动和非运动症状的影响具有空间特异性的观点。然而，刺激参数差异很大，一些研究的控制也很差。rTMS或tDCS在肌张力障碍方面的研究提供了丰富的生理学数据，但临床效果的数据很少。多种机制可能导致rTMS和tDCS在运动障碍中的临床效果，包括皮层兴奋性的正常化、分布式神经网络活动的重新平衡以及多巴胺释放的诱导。目前尚不清楚如何针对PD或肌张力障碍的症状最有益地单独调整rTMS或tDCS因素。尽管如此，非侵入性的性质、最小的副作用、初步临床研究中的积极效果以及越来越多的合理机制证据，使得rTMS和tDCS对正在进行的研究具有吸引力。
