Beuzon G, Timour Q, Saoud M
Pharmacologie médicale, EA 4312 neurocardiologie, physiopathologie des troubles du rythme cardiaque, hôpital Louis-Pradel, unité 50, 28, avenue du Doyen-Lépine, 69677 Bron, France.
Pharmacologie médicale, EA 4612 neurocardiologie, physiopathologie des troubles du rythme cardiaque hôpital Louis-Pradel, unité 50, 28, avenue du Doyen-Lépine, 69677 Bron, France.
Encephale. 2017 Feb;43(1):3-9. doi: 10.1016/j.encep.2016.11.002. Epub 2016 Dec 26.
Repetitive transcranial magnetic stimulation (rTMS), based on the principle of electromagnetic induction, consists of applying series of magnetic impulses to the cerebral cortex so as to modulate neurone activity in a target zone. This technique, still experimental, could prove promising in the field of psychiatry, in particular for the treatment of major depressive disorder. It is important for the clinician to be able to assess the response potential of a given patient to rTMS, and this among other things requires relevant predictive factors to be available. This review of the literature aims to determine and analyse reported predictive factors for therapeutic response to rTMS treatment in major depressive disorder. Different parameters are studied, in particular age, the severity of the depressive episode, psychological dimensions, genetic factors, cerebral blood flows via cerebral imagery, and neuronavigation. The factors found to be associated with better therapeutic response were young age, low level of severity of the depressive episode, motor threshold intensity over 100%, more than 1000 stimulations per session, more than 10 days treatment, L/L genotype on the 5-HTTLPR transporter gene, C/C homozygosity on the promotor regions of the 5-HT1A receptor gene, Val/Val homozygosity on the BDNF gene, cordance analyses by EEG, and finally the accurate localisation provided by neuronavigation. The authors conclude that investigations in larger patient samples are required in the future, and that the work already achieved should provide lines of approach for the coming experimental studies.
重复经颅磁刺激（rTMS）基于电磁感应原理，通过对大脑皮层施加一系列磁脉冲来调节目标区域的神经元活动。这项技术仍处于实验阶段，但在精神病学领域可能具有广阔前景，尤其是在治疗重度抑郁症方面。对于临床医生来说，能够评估特定患者对rTMS的反应潜力非常重要，而这尤其需要有相关的预测因素。这篇文献综述旨在确定和分析已报道的重度抑郁症患者对rTMS治疗反应的预测因素。研究了不同参数，特别是年龄、抑郁发作的严重程度、心理维度、遗传因素通过脑成像的脑血流量以及神经导航。发现与更好治疗反应相关的因素包括年轻、抑郁发作严重程度低、运动阈值强度超过100%、每次治疗超过1000次刺激、治疗超过10天、5 - HTTLPR转运体基因上的L/L基因型、5 - HT1A受体基因启动子区域的C/C纯合性、BDNF基因上的Val/Val纯合性、脑电图的一致性分析，以及最后神经导航提供的确切定位。作者得出结论，未来需要对更大的患者样本进行研究，并且已经取得的工作成果应为即将开展的实验研究提供思路。
