Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A.
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
J Clin Neurophysiol. 2020 Mar;37(2):118-130. doi: 10.1097/WNP.0000000000000573.
Neurostimulation in epilepsy is a long standing established concept, and through experimental and clinical uses, our understanding of neurostimulation and neuromodulation has grown substantially. Noninvasive brain stimulation techniques use electromagnetic principles to noninvasively modulate brain activity in a spatiotemporally targeted manner. This review focused on the two predominant forms of noninvasive neurostimulation: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation, and their current applications in the diagnosis and management of epilepsy. A number of small randomized sham-controlled studies suggest that both TMS and transcranial direct current stimulation may have a beneficial effect in decreasing seizure frequency in patients with medically refractory epilepsy, without significant side effects. Small pilot studies also suggest that TMS in combination with EEG may be used to develop quantitative biomarkers of cortical hyperexcitability in patients with epilepsy. Furthermore, TMS is already Food and Drug Administration-cleared for presurgical mapping of eloquent cortex, and preliminary studies suggest that navigated TMS represents a highly valuable clinical supplement for preoperative functional planning. Transcranial magnetic stimulation and transcranial direct current stimulation have shown great potential benefit for patients with epilepsy; however, further large multicenter randomized sham-controlled studies are needed to better optimize stimulation settings and protocols, define mechanisms of action, assess long-term effects, and clearly define roles and determine efficacy.
神经刺激在癫痫中的应用是一个由来已久的概念，通过实验和临床应用，我们对神经刺激和神经调节的理解有了很大的提高。非侵入性脑刺激技术利用电磁原理以时空靶向的方式非侵入性地调节大脑活动。本综述重点介绍了两种主要的非侵入性神经刺激形式：经颅磁刺激（TMS）和经颅直流电刺激，以及它们在癫痫的诊断和管理中的当前应用。一些小型随机假对照研究表明，TMS 和经颅直流电刺激都可能对药物难治性癫痫患者的癫痫发作频率有有益的影响，且没有明显的副作用。小型试点研究还表明，TMS 与脑电图结合使用可能用于开发癫痫患者皮质过度兴奋的定量生物标志物。此外，TMS 已经获得美国食品和药物管理局（FDA）的批准，用于语言区皮质的术前定位，初步研究表明，导航 TMS 代表了术前功能规划的一种非常有价值的临床补充手段。TMS 和经颅直流电刺激对癫痫患者显示出了巨大的潜在益处；然而，还需要进一步进行大型多中心随机假对照研究，以更好地优化刺激设置和方案，确定作用机制，评估长期效果，并明确作用和疗效。
