经颅磁刺激治疗重性抑郁障碍：反应调节与状态依存性。
Transcranial magnetic stimulation in major depressive disorder: Response modulation and state dependency.
机构信息
Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
出版信息
J Affect Disord. 2020 Apr 1;266:793-801. doi: 10.1016/j.jad.2020.02.006. Epub 2020 Feb 4.
BACKGROUND
Transcranial Magnetic Stimulation (TMS) has emerged as a valid therapeutic option in the treatment of depression, especially in cases of inadequate response to antidepressant agents. Despite the recognized efficacy of this technique, its mechanisms of action are still debated and optimal protocols have not yet been established.
METHODS
The present review focuses on TMS protocols that either engage the targeted brain circuits or synchronize the stimulation frequency to individual neuronal oscillations to increase the antidepressant efficacy.
RESULTS
TMS efficacy was found to be enhanced by preliminary or concomitant modulation of the functional state of the targeted brain networks. Conversely, there is not enough evidence of higher efficacy of TMS protocols with individual selection of the stimulation frequency compared to standard ones.
LIMITATIONS
Most studies included small patient samples.
CONCLUSIONS
Our results suggest that a good option to enhance rTMS efficacy might be to follow synaptic potentiation and depression rules.
背景
经颅磁刺激（TMS）已成为治疗抑郁症的有效治疗选择，尤其是在抗抑郁药物反应不足的情况下。尽管该技术已被认可具有疗效，但其作用机制仍存在争议，并且尚未确定最佳方案。
方法
本综述重点介绍了那些能够作用于靶向脑回路或使刺激频率与个体神经元振荡同步以提高抗抑郁疗效的 TMS 方案。
结果
发现通过对靶向脑网络的功能状态进行初步或同时调节，可以增强 TMS 的疗效。相反，与标准方案相比，针对刺激频率进行个体化选择的 TMS 方案是否具有更高的疗效，目前还没有足够的证据。
局限性
大多数研究纳入的患者样本量较小。
结论
我们的结果表明，增强 rTMS 疗效的一个好方法可能是遵循突触增强和抑制的规则。
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