Marder Katharine G, Barbour Tracy, Ferber Stephen, Idowu Olanike, Itzkoff Amanda
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (Marder); Division of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Barbour, Ferber); Curated Mental Health, New York City (Idowu, Itzkoff); Yale Stress Center, New Haven, Connecticut (Idowu); Department of Psychiatry, Mount Sinai Hospital, New York City (Itzkoff).
Focus (Am Psychiatr Publ). 2022 Jan;20(1):8-18. doi: 10.1176/appi.focus.20210021. Epub 2022 Jan 25.
Transcranial magnetic stimulation (TMS) is an increasingly popular noninvasive brain stimulation modality. In TMS, a pulsed magnetic field is used to noninvasively stimulate a targeted brain region. Repeated stimulation produces lasting changes in brain activity via mechanisms of synaptic plasticity similar to long-term potentiation. Local application of TMS alters activity in distant, functionally connected brain regions, indicating that TMS modulates activity of cortical networks. TMS has been approved by the U.S. Food and Drug Administration for the treatment of major depressive disorder, obsessive-compulsive disorder, and smoking cessation, and a growing evidence base supports its efficacy in the treatment of other neuropsychiatric conditions. TMS is rapidly becoming part of the standard of care for treatment-resistant depression, where it yields response rates of 40%-60%. TMS is generally safe and well tolerated; its most serious risk is seizure, which occurs very rarely. This review aims to familiarize practicing psychiatrists with basic principles of TMS, including target localization, commonly used treatment protocols and their outcomes, and safety and tolerability. Practical considerations, including evaluation and monitoring of patients undergoing TMS, device selection, treatment setting, and insurance reimbursement, are also reviewed.
经颅磁刺激（TMS）是一种越来越受欢迎的非侵入性脑刺激方式。在TMS中，脉冲磁场被用于非侵入性地刺激目标脑区。重复刺激通过类似于长时程增强的突触可塑性机制，使脑活动产生持久变化。局部应用TMS会改变远处功能连接脑区的活动，这表明TMS可调节皮质网络的活动。TMS已被美国食品药品监督管理局批准用于治疗重度抑郁症、强迫症和戒烟，并且越来越多的证据支持其在治疗其他神经精神疾病方面的疗效。TMS正迅速成为难治性抑郁症标准治疗的一部分，其有效率为40%-60%。TMS一般安全且耐受性良好；其最严重的风险是癫痫发作，这种情况非常罕见。本综述旨在使执业精神科医生熟悉TMS的基本原理，包括靶点定位、常用治疗方案及其结果，以及安全性和耐受性。还对实际考虑因素进行了综述，包括对接受TMS治疗患者的评估和监测、设备选择、治疗环境和保险报销。
