Holtzheimer Paul E, Kosel Markus, Schlaepfer Thomas
Department of Psychiatry and Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Handb Clin Neurol. 2012;106:681-95. doi: 10.1016/B978-0-444-52002-9.00041-3.
ECT is a well-established, effective, and safe treatment for many neuropsychiatric conditions, especially major depression. However, ECT is also associated with a high relapse rate, notable side-effects, and significant social stigma. Additionally, ECT is ineffective in a sizable minority of patients. Based on this, several other brain stimulation therapies are currently under active investigation. VNS is approved in many countries for the treatment of treatment-resistant epilepsy and TRD. The available data suggest long-term VNS may have clinically significant antidepressant effects, though more data are needed to clarify how VNS might optimally be used in the treatment of neuropsychiatric disease.TMS offers a noninvasive technique for modulating neural function, and preliminary studies support acute efficacy in the treatment of depression and several other neuropsychiatric illnesses; results from more definitive studies are pending. Although early in development,MST may develop as a form of convulsive therapy that minimizes characteristic side-effects of ECT while achieving similar efficacy; clearly, more data from larger, controlled trials are needed, tDCS is in the early stages of development, but may prove to be an effective, noninvasive alternative for treatment-resistant patients with psychiatric disorders. DBS is the most invasive of these brain stimulation therapies, but may become an effective intervention for patients who have failed other available treatments (including ECT). Very preliminary data support the efficacy of DBS for specific neuropsychiatric conditions, and more definitive data are eagerly awaited. Beyond their potential efficacy for neuropsychiatric conditions, these various brain stimulation therapies may help improve our understand-ing of the neurobiology of neuropsychiatric disease.
电休克疗法（ECT）是一种成熟、有效且安全的治疗多种神经精神疾病的方法，尤其是重度抑郁症。然而，ECT也与高复发率、显著的副作用以及严重的社会污名化相关。此外，ECT对相当一部分患者无效。基于此，目前正在积极研究其他几种脑刺激疗法。迷走神经刺激（VNS）在许多国家被批准用于治疗难治性癫痫和难治性抑郁症（TRD）。现有数据表明，长期VNS可能具有临床上显著的抗抑郁作用，不过还需要更多数据来阐明VNS在神经精神疾病治疗中如何能得到最佳应用。重复经颅磁刺激（TMS）提供了一种调节神经功能的非侵入性技术，初步研究支持其在治疗抑郁症和其他几种神经精神疾病方面的急性疗效；更确切研究的结果尚待揭晓。虽然磁休克疗法（MST）尚处于研发早期，但可能会发展成为一种惊厥疗法，在达到类似疗效的同时将ECT的典型副作用降至最低；显然，需要来自更大规模对照试验的更多数据。经颅直流电刺激（tDCS）正处于研发早期，但可能被证明是治疗难治性精神疾病患者的一种有效、非侵入性替代方法。脑深部电刺激（DBS）是这些脑刺激疗法中侵入性最强的，但对于其他可用治疗方法（包括ECT）均无效的患者可能会成为一种有效的干预手段。非常初步的数据支持DBS对特定神经精神疾病的疗效，人们急切期待更确切的数据。除了对神经精神疾病的潜在疗效外，这些各种脑刺激疗法可能有助于增进我们对神经精神疾病神经生物学的理解。
