Lefaucheur J-P, André-Obadia N, Poulet E, Devanne H, Haffen E, Londero A, Cretin B, Leroi A-M, Radtchenko A, Saba G, Thai-Van H, Litré C-F, Vercueil L, Bouhassira D, Ayache S-S, Farhat W-H, Zouari H-G, Mylius V, Nicolier M, Garcia-Larrea L
EA 4391, faculté de médecine, université Paris-Est-Créteil, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Neurophysiol Clin. 2011 Dec;41(5-6):221-95. doi: 10.1016/j.neucli.2011.10.062. Epub 2011 Nov 10.
During the past decade, a large amount of work on transcranial magnetic stimulation (TMS) has been performed, including the development of new paradigms of stimulation, the integration of imaging data, and the coupling of TMS techniques with electroencephalography or neuroimaging. These accumulating data being difficult to synthesize, several French scientific societies commissioned a group of experts to conduct a comprehensive review of the literature on TMS. This text contains all the consensual findings of the expert group on the mechanisms of action, safety rules and indications of TMS, including repetitive TMS (rTMS). TMS sessions have been conducted in thousands of healthy subjects or patients with various neurological or psychiatric diseases, allowing a better assessment of risks associated with this technique. The number of reported side effects is extremely low, the most serious complication being the occurrence of seizures. In most reported seizures, the stimulation parameters did not follow the previously published recommendations (Wassermann, 1998) [430] and rTMS was associated to medication that could lower the seizure threshold. Recommendations on the safe use of TMS / rTMS were recently updated (Rossi et al., 2009) [348], establishing new limits for stimulation parameters and fixing the contraindications. The recommendations we propose regarding safety are largely based on this previous report with some modifications. By contrast, the issue of therapeutic indications of rTMS has never been addressed before, the present work being the first attempt of a synthesis and expert consensus on this topic. The use of TMS/rTMS is discussed in the context of chronic pain, movement disorders, stroke, epilepsy, tinnitus and psychiatric disorders. There is already a sufficient level of evidence of published data to retain a therapeutic indication of rTMS in clinical practice (grade A) in chronic neuropathic pain, major depressive episodes, and auditory hallucinations. The number of therapeutic indications of rTMS is expected to increase in coming years, in parallel with the optimisation of stimulation parameters.
在过去十年中，人们对经颅磁刺激（TMS）开展了大量研究工作，包括开发新的刺激模式、整合成像数据以及将TMS技术与脑电图或神经成像技术相结合。由于这些积累的数据难以综合分析，几个法国科学学会委托一组专家对TMS相关文献进行全面综述。本文包含了专家组关于TMS（包括重复经颅磁刺激（rTMS））作用机制、安全规则和适应症的所有共识性发现。TMS治疗已在数千名健康受试者或患有各种神经或精神疾病的患者中进行，从而能更好地评估该技术相关的风险。报告的副作用数量极低，最严重的并发症是癫痫发作。在大多数报告的癫痫发作案例中，刺激参数未遵循先前发表的建议（瓦瑟曼，1998年）[430]，且rTMS与可能降低癫痫阈值的药物有关。最近更新了关于安全使用TMS/rTMS的建议（罗西等人，2009年）[348]，确定了刺激参数的新限制并明确了禁忌症。我们提出的关于安全性的建议在很大程度上基于这份先前的报告，并做了一些修改。相比之下，rTMS的治疗适应症问题此前从未得到解决，本研究是对该主题进行综合和专家共识的首次尝试。在慢性疼痛、运动障碍、中风、癫痫、耳鸣和精神疾病的背景下讨论了TMS/rTMS的使用。已有足够的已发表数据证据支持在临床实践中（A级）将rTMS用于慢性神经性疼痛、重度抑郁发作和幻听的治疗适应症。随着刺激参数的优化，预计未来几年rTMS的治疗适应症数量将会增加。
