Department of Psychiatry and Psychotherapy, University Hospital Muenster, Muenster, Germany.
Institute for Biomagnetism and Biosignal Analysis and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2018 Apr;3(4):329-336. doi: 10.1016/j.bpsc.2017.12.007. Epub 2017 Dec 29.
Excitatory repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (dlPFC) is approved by the U.S. Food and Drug Administration for the treatment of adult patients with treatment-resistant major depressive disorder (MDD). This stimulation is supposed to restore excitability of prefrontal cortex regions that exhibit diminished regulation of emotion-generative systems in MDD. Based on the valence lateralization hypothesis, inhibitory rTMS of the right dlPFC has also been applied in MDD. This approach has proved to be effective, although meta-analyses of emotional perception and affective regulation in healthy control subjects and patients with depression do not support functional asymmetries within dlPFC regions.
To shed more light on this discrepancy, the effects of excitatory and inhibitory rTMS of the right dlPFC on visual emotional perception were compared in two groups of 41 healthy participants overall. Before and after rTMS stimulation, participants viewed fearful and neutral faces while whole-head magnetoencephalography was recorded and supplemented by behavioral tests.
Visual sensory processing of fearful facial expressions, relative to neutral facial expressions, was reduced after excitatory stimulation and was increased after inhibitory stimulation within right occipital and right temporal regions. Correspondingly, after excitatory rTMS compared with inhibitory rTMS, participants displayed relatively reduced reaction times in an emotion discrimination task and showed reduced emotional arousal.
These results support the hypothesis that excitatory rTMS compared with inhibitory rTMS of the right dlPFC strengthens top-down control of aversive stimuli in healthy control subjects, which should encourage more research on mechanisms of excitatory/inhibitory dlPFC-rTMS protocols in general and on neuromodulatory treatment of MDD.
美国食品和药物管理局批准左背外侧前额叶皮层（dlPFC）的兴奋性重复经颅磁刺激（rTMS）用于治疗成人难治性重度抑郁症（MDD）。这种刺激旨在恢复前额叶皮层区域的兴奋性，这些区域在 MDD 中表现出情绪产生系统的调节减弱。基于效价侧化假说，右 dlPFC 的抑制性 rTMS 也已应用于 MDD。尽管对健康对照组和抑郁症患者的情绪感知和情感调节进行的荟萃分析不支持 dlPFC 区域内的功能不对称，但这种方法已被证明是有效的。
为了更清楚地了解这种差异，我们在两组共 41 名健康参与者中比较了右 dlPFC 的兴奋性和抑制性 rTMS 对视觉情绪感知的影响。在 rTMS 刺激前后，参与者观看了恐惧和中性面孔，同时记录了全头磁脑电图，并辅以行为测试。
与中性面孔相比，恐惧面部表情的视觉感觉处理在右枕叶和右颞叶区域的兴奋性刺激后减少，在抑制性刺激后增加。相应地，与抑制性 rTMS 相比，在兴奋性 rTMS 后，参与者在情绪辨别任务中的反应时间相对较短，表现出较低的情绪唤醒。
这些结果支持了这样的假设，即与右 dlPFC 的抑制性 rTMS 相比，兴奋性 rTMS 增强了健康对照组对厌恶刺激的自上而下的控制，这应该鼓励更多地研究兴奋性/抑制性 dlPFC-rTMS 方案的机制以及 MDD 的神经调节治疗。
