Prevention Neuroscience Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada N2L 3G1.
Prevention Neuroscience Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada N2L 3G1.
Neuropsychologia. 2018 Mar;111:344-359. doi: 10.1016/j.neuropsychologia.2018.02.004. Epub 2018 Feb 10.
Theta burst stimulation (TBS) is a highly efficient repetitive transcranial magnetic stimulation (rTMS) variant employed in experimental and clinical treatment paradigms. Despite widespread usage of TBS targeting the prefrontal cortex (PFC), there has been no systematic review of the evidence linking TBS protocols to changes in task performance on common measures of prefrontal function in general, and executive functions specifically. A systematic review of the literature was conducted using PsycINFO, PubMed, Web of Science and Scopus databases to identify articles examining the effects of TBS targeting the PFC on executive function task performance. Both the up-regulating (intermittent theta burst stimulation; iTBS) and down-regulating (continuous theta burst stimulation; cTBS) variants of TBS were considered. 32 (29 cTBS; 8 iTBS) studies met the inclusion criteria. Participants (n = 759; 51.41% female) were primarily young adults (M = 26), with one study examining the effects of cTBS and iTBS in older adults. Results from individual studies were converted to Hedge's g and random-effects models were used to estimate the overall effect size for each protocol. Age, biological sex, and control methodology were examined as potential moderators of the cTBS effect on executive function test performance. Findings indicated a- reliable attentuating effect of cTBS on executive function task performance (g = -.244, Z = -5.920, p < .001); this effect was relatively uniform across included studies (Q= 24.178, p = .838, I = 0). Although no significant moderators of the cTBS effect were identified, laterality sub analyses indicated that the magnitude of the effect was significantly higher (M = .213, Z = 2.546, p = .011) for left-sided (g = -.358, Z = -5.816, p < .001) relative to right-sided (g = -.145, Z = -2.552, p = .011) PFC stimulation. A systematic review of iTBS studies revealed variability in reliability of effects though most were in the theorized direction. TBS protocols appear to be effective in modulating prefrontal cortical excitability in previously theorized directions.
theta 爆发刺激（TBS）是一种高效的重复经颅磁刺激（rTMS）变体，用于实验和临床治疗模式。尽管 TBS 靶向前额叶皮层（PFC）的应用已经很广泛，但尚未有系统的综述来证明 TBS 方案与常见的前额叶功能任务表现的变化之间存在联系，尤其是执行功能。我们使用 PsycINFO、PubMed、Web of Science 和 Scopus 数据库进行了文献系统综述，以确定检查 TBS 靶向 PFC 对执行功能任务表现影响的文章。我们考虑了 TBS 的上调（间歇性 theta 爆发刺激；iTBS）和下调（连续 theta 爆发刺激；cTBS）两种变体。符合纳入标准的 32 项研究（29 项 cTBS；8 项 iTBS）。参与者（n=759；51.41%为女性）主要为年轻人（M=26），其中一项研究检查了 cTBS 和 iTBS 在老年人中的影响。来自个别研究的结果被转换为 Hedge 的 g，并使用随机效应模型来估计每个方案的总体效应大小。年龄、生物性别和对照方法被视为 cTBS 对执行功能测试表现影响的潜在调节因素。研究结果表明，cTBS 对执行功能任务表现有可靠的减弱作用（g=-.244，Z=-5.920，p<.001）；这种效应在纳入的研究中相对一致（Q=24.178，p=.838，I=0）。虽然没有发现 cTBS 效应的显著调节因素，但侧脑室分析表明，效应的幅度显著更高（M=.213，Z=2.546，p=.011），左侧（g=-.358，Z=-5.816，p<.001）相对于右侧（g=-.145，Z=-2.552，p=.011）PFC 刺激。对 iTBS 研究的系统综述显示，效应的可靠性存在差异，但大多数都在理论上的方向。TBS 方案似乎能够有效地调节前额叶皮质兴奋性，朝着之前理论上的方向发展。
