Williams Julie A, Imamura Marta, Fregni Felipe
Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
J Rehabil Med. 2009 Apr;41(5):305-11. doi: 10.2340/16501977-0356.
Brain stimulation for the treatment of neuropsychiatric diseases has been used for more than 50 years. Although its development has been slow, current advances in the techniques of brain stimulation have improved its clinical efficacy. The use of non-invasive brain stimulation has significant advantages, such as not involving surgical procedures and having relatively mild adverse effects. In this paper we briefly review the use of 2 non-invasive brain stimulation techniques, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), as therapeutic approaches in physical and rehabilitation medicine. We also compare the effects of non-invasive central nervous system stimulation with techniques of non-invasive peripheral electrical stimulation, in order to provide new insights for future developments. Although the outcomes of these initial trials include some conflicting results, the evidence supports that rTMS and tDCS might have a therapeutic value in different neurological conditions. Studies published within the last year have examined new approaches of stimulation, such as longer intensities of stimulation, new electrode sizes for tDCS, novel coils for stimulation of deeper areas, and new frequencies of stimulation for rTMS. These new approaches need to be tested in larger clinical trials in order to determine whether they offer significant clinical effects.
脑刺激用于治疗神经精神疾病已有50多年历史。尽管其发展缓慢,但目前脑刺激技术的进步提高了其临床疗效。非侵入性脑刺激的应用具有显著优势,如无需手术且不良反应相对较轻。本文简要综述了两种非侵入性脑刺激技术,即重复经颅磁刺激(rTMS)和经颅直流电刺激(tDCS),在物理医学与康复医学中的治疗应用。我们还比较了非侵入性中枢神经系统刺激与非侵入性外周电刺激技术的效果,以便为未来发展提供新的见解。尽管这些初步试验的结果存在一些相互矛盾的结论,但有证据支持rTMS和tDCS在不同神经疾病中可能具有治疗价值。去年发表的研究探讨了新的刺激方法,如更长的刺激强度、tDCS的新电极尺寸、用于刺激更深区域的新型线圈以及rTMS的新刺激频率。这些新方法需要在更大规模的临床试验中进行测试,以确定它们是否具有显著的临床效果。
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