Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy.
Brain Res Bull. 2020 Jun;159:44-52. doi: 10.1016/j.brainresbull.2020.03.016. Epub 2020 Apr 3.
We provide here the first systematic review on the studies dealing with repetitive transcranial magnetic stimulation (rTMS) for traumatic brain injury (TBI) in animals and humans. Several experimental studies in animal models have explored with promising results the use of rTMS to enhance neuroprotection and recovery after TBI. However, there are surprisingly few studies that have obtained substantial evidence regarding effects of rTMS in humans with TBI, many of them are case reports investigating the heterogeneous conditions linked to TBI. The most studies have investigated the effects of rTMS in subjects with post-traumatic depression and variable effects have been observed. rTMS has been proposed as an experimental approach for the treatment of disorders of consciousness (DOC), but in subjects with TBI therapeutic effects on DOC have also been variously documented. Beneficial effects have been reported in subjects with cognitive/emotional disturbances and auditory dysfunction (tinnitus and hallucinations), although the results are somewhat conflicting. rTMS applied over the left prefrontal cortex may relieve, at least transiently, post-traumatic headache. Isolated rTMS studies have been performed in TBI patients with motor impairment, chronic dizziness or pain. Especially whether provided in combination, rTMS and neurorehabilitation may be synergistic in the potential to translate experimental findings in the clinical practice. In order to reach definitive conclusions, well-designed randomized controlled studies with larger patient samples, improved design and optimized rTMS setup, are warranted to verify and corroborate the initial promising findings.
我们在此提供了关于重复性经颅磁刺激（rTMS）在动物和人类创伤性脑损伤（TBI）研究的首次系统综述。 几项动物模型的实验研究已经探索了 rTMS 在增强 TBI 后神经保护和恢复方面的应用，并取得了有希望的结果。 然而，令人惊讶的是，关于 rTMS 在 TBI 人类中的效果，仅有少数研究获得了实质性证据，其中许多是调查与 TBI 相关的异质情况的病例报告。 大多数研究都调查了 rTMS 在创伤后抑郁患者中的效果，观察到了不同的效果。 rTMS 已被提议作为治疗意识障碍（DOC）的实验方法，但在 TBI 患者中，DOC 的治疗效果也有不同的记录。 在认知/情感障碍和听觉功能障碍（耳鸣和幻觉）患者中，已经报道了有益的效果，尽管结果有些矛盾。 rTMS 施加于左前额皮质可能会至少暂时缓解创伤后头痛。 在运动障碍、慢性头晕或疼痛的 TBI 患者中已经进行了单独的 rTMS 研究。 特别是 rTMS 和神经康复相结合，可能会在将实验发现转化为临床实践方面具有协同作用。 为了得出明确的结论，需要进行设计良好的随机对照研究，以增加患者样本量、改进设计并优化 rTMS 设置，以验证和证实最初有希望的发现。
