Stagg Charlotte J, Antal Andrea, Nitsche Michael A
Department of Clinical Neurophysiology, University Medical Center Göttingen, University of Göttingen, Göttingen.
J ECT. 2018 Sep;34(3):144-152. doi: 10.1097/YCT.0000000000000510.
Direct current stimulation is a neuromodulatory noninvasive brain stimulation tool, which was first introduced in animal and human experiments in the 1950s, and added to the standard arsenal of methods to alter brain physiology as well as psychological, motor, and behavioral processes and clinical symptoms in neurological and psychiatric diseases about 20 years ago. In contrast to other noninvasive brain stimulation tools, such as transcranial magnetic stimulation, it does not directly induce cerebral activity, but rather alters spontaneous brain activity and excitability by subthreshold modulation of neuronal membranes. Beyond acute effects on brain functions, specific protocols are suited to induce long-lasting alterations of cortical excitability and activity, which share features with long-term potentiation and depression. These neuroplastic processes are important foundations for various cognitive functions such as learning and memory formation and are pathologically altered in numerous neurological and psychiatric diseases. This explains the increasing interest to investigate transcranial direct current stimulation (tDCS) as a therapeutic tool. However, for tDCS to be used effectively, it is crucial to be informed about physiological mechanisms of action. These have been increasingly elucidated during the last years. This review gives an overview of the current knowledge available regarding physiological mechanisms of tDCS, spanning from acute regional effects, over neuroplastic effects to its impact on cerebral networks. Although knowledge about the physiological effects of tDCS is still not complete, this might help to guide applications on a scientifically sound foundation.
直流电刺激是一种神经调节性非侵入性脑刺激工具，它于20世纪50年代首次引入动物和人体实验，并在约20年前被纳入改变脑生理学以及神经和精神疾病中的心理、运动和行为过程及临床症状的标准方法库。与其他非侵入性脑刺激工具（如经颅磁刺激）不同，它并不直接诱发大脑活动，而是通过对神经元膜的阈下调制来改变自发脑活动和兴奋性。除了对脑功能的急性影响外，特定方案适合诱导皮层兴奋性和活动的持久改变，这些改变与长时程增强和抑制具有共同特征。这些神经可塑性过程是学习和记忆形成等各种认知功能的重要基础，并且在众多神经和精神疾病中发生病理改变。这解释了人们越来越有兴趣研究经颅直流电刺激（tDCS）作为一种治疗工具。然而，为了有效使用tDCS，了解其生理作用机制至关重要。在过去几年中，这些机制已越来越多地得到阐明。本综述概述了关于tDCS生理机制的现有知识，涵盖从急性局部效应、神经可塑性效应到其对脑网络的影响。尽管关于tDCS生理效应的知识仍不完整，但这可能有助于在科学合理的基础上指导其应用。
