Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.
Eur J Psychotraumatol. 2011;2. doi: 10.3402/ejpt.v2i0.5609. Epub 2011 Oct 17.
Posttraumatic stress disorder (PTSD) is a complex, heterogeneous disorder that develops following trauma and often includes perceptual, cognitive, affective, physiological, and psychological features. PTSD is characterized by hyperarousal, intrusive thoughts, exaggerated startle response, flashbacks, nightmares, sleep disturbances, emotional numbness, and persistent avoidance of trauma-associated stimuli. The efficacy of available treatments for PTSD may result in part from relief of associated depressive and anxiety-related symptoms in addition to treatment of core symptoms that derive from reexperiencing, numbing, and hyperarousal. Diverse, heterogeneous mechanisms of action and the ability to act broadly or very locally may enable brain stimulation devices to address PTSD core symptoms in more targeted ways. To achieve this goal, specific theoretical bases derived from novel, well-designed research protocols will be necessary. Brain stimulation devices include both long-used and new electrical and magnetic devices. Electroconvulsive therapy (ECT) and Cranial electrotherapy stimulation (CES) have both been in use for decades; transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), deep brain stimulation (DBS), transcranial Direct Current Stimulation (tDCS), and vagus nerve stimulation (VNS) have been developed recently, over approximately the past twenty years. The efficacy of brain stimulation has been demonstrated as a treatment for psychiatric and neurological disorders such as anxiety (CES), depression (ECT, CES, rTMS, VNS, DBS), obsessive-compulsive disorder (OCD) (DBS), essential tremor, dystonia (DBS), epilepsy (DBS, VNS), Parkinson Disease (DBS), pain (CES), and insomnia (CES). To date, limited data on brain stimulation for PTSD offer only modest guidance. ECT has shown some efficacy in reducing comorbid depression in PTSD patients but has not been demonstrated to improve most core PTSD symptoms. CES and VNS have shown some efficacy in reducing anxiety, findings that may suggest possible utility in relieving PTSD-associated anxiety. Treatment of animal models of PTSD with DBS suggests potential human benefit. Additional research and novel treatment options for PTSD are urgently needed. The potential usefulness of brain stimulation in treating PTSD deserves further exploration.
创伤后应激障碍（PTSD）是一种复杂的异质障碍，在创伤后发展，通常包括知觉、认知、情感、生理和心理特征。PTSD 的特征是过度警觉、侵入性思维、夸张的惊吓反应、闪回、噩梦、睡眠障碍、情感麻木和持续避免与创伤相关的刺激。现有的 PTSD 治疗方法的疗效可能部分归因于除了治疗源于再体验、麻木和过度警觉的核心症状外，还缓解了相关的抑郁和焦虑相关症状。不同的、异质的作用机制以及广泛或非常局部作用的能力，可能使脑刺激设备能够以更有针对性的方式解决 PTSD 的核心症状。为了实现这一目标，需要从新颖的、精心设计的研究方案中得出具体的理论依据。脑刺激设备包括长期使用的和新的电和磁设备。电惊厥疗法（ECT）和颅电刺激（CES）已经使用了几十年；经颅磁刺激（TMS）、磁惊厥治疗（MST）、深部脑刺激（DBS）、经颅直流电刺激（tDCS）和迷走神经刺激（VNS）最近开发出来，大约在过去二十年。脑刺激的疗效已被证明是治疗焦虑症（CES）、抑郁症（ECT、CES、rTMS、VNS、DBS）、强迫症（DBS）、原发性震颤、肌张力障碍（DBS）、癫痫（DBS、VNS）、帕金森病（DBS）、疼痛（CES）和失眠（CES）等精神和神经疾病的一种治疗方法。迄今为止，关于 PTSD 脑刺激的有限数据仅提供了一些适度的指导。ECT 已显示出在减轻 PTSD 患者共病性抑郁方面的一些疗效，但尚未证明能改善大多数 PTSD 的核心症状。CES 和 VNS 已显示出在减轻焦虑方面的一些疗效，这些发现可能表明在缓解 PTSD 相关焦虑方面具有潜在的效用。DBS 治疗 PTSD 动物模型表明可能对人类有益。迫切需要进一步研究和新的 PTSD 治疗方法。脑刺激在治疗 PTSD 方面的潜在用途值得进一步探索。
