加速经颅磁刺激的安全性、有效性和参数空间的跨诊断综述。
A transdiagnostic review of safety, efficacy, and parameter space in accelerated transcranial magnetic stimulation.
机构信息
Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Department of Psychology, University of Georgia, Athens, GA, USA.
出版信息
J Psychiatr Res. 2022 Aug;152:384-396. doi: 10.1016/j.jpsychires.2022.06.038. Epub 2022 Jun 28.
BACKGROUND
Accelerated transcranial magnetic stimulation (aTMS) is an emerging delivery schedule of repetitive TMS (rTMS). TMS is "accelerated" by applying two or more stimulation sessions within a day. This three-part review comprehensively reports the safety/tolerability, efficacy, and stimulation parameters affecting response across disorders.
METHODS
We used the PubMed database to identify studies administering aTMS, which we defined as applying at least two rTMS sessions within one day.
RESULTS
Our targeted literature search identified 85 aTMS studies across 18 diagnostic and healthy control groups published from July 2001 to June 2022. Excluding overlapping populations, 63 studies delivered 43,873 aTMS sessions using low frequency, high frequency, and theta burst stimulation in 1543 participants. Regarding safety, aTMS studies had similar seizure and side effect incidence rates to those reported for once daily rTMS. One seizure was reported from aTMS (0.0023% of aTMS sessions, compared with 0.0075% in once daily rTMS). The most common side effects were acute headache (28.4%), fatigue (8.6%), and scalp discomfort (8.3%), with all others under 5%. We evaluated aTMS efficacy in 23 depression studies (the condition with the most studies), finding an average response rate of 42.4% and remission rate of 28.4% (range = 0-90.5% for both). Regarding parameters, aTMS studies ranged from 2 to 10 sessions per day over 2-30 treatment days, 10-640 min between sessions, and a total of 9-104 total accelerated TMS sessions per participant (including tapering sessions). Qualitatively, response rate tends to be higher with an increasing number of sessions per day, total sessions, and total pulses.
DISCUSSION
The literature to date suggests that aTMS is safe and well-tolerated across conditions. Taken together, these early studies suggest potential effectiveness even in highly treatment refractory conditions with the added potential to reduce patient burden while also expediting response time. Future studies are warranted to systematically investigate how key aTMS parameters affect treatment outcome and durability.
背景
经颅磁刺激（TMS）是一种新兴的重复 TMS（rTMS）传递方案。TMS 通过每天进行两次或更多次刺激来实现“加速”。本综述共三部分，全面报告了安全性/耐受性、疗效以及影响各种疾病反应的刺激参数。
方法
我们使用 PubMed 数据库来确定应用 aTMS 的研究，我们将其定义为在一天内至少进行两次 rTMS 治疗。
结果
我们的目标文献检索确定了 2001 年 7 月至 2022 年 6 月期间在 18 个诊断和健康对照组中发表的 85 项 aTMS 研究。排除重叠人群后，有 63 项研究在 1543 名参与者中使用低频、高频和 theta 爆发刺激共进行了 43873 次 aTMS 治疗。关于安全性，aTMS 研究的癫痫发作和副作用发生率与每日一次 rTMS 报告的发生率相似。aTMS 治疗后报告了一例癫痫（占 aTMS 治疗次数的 0.0023%，而每日一次 rTMS 为 0.0075%）。最常见的副作用是急性头痛（28.4%）、疲劳（8.6%）和头皮不适（8.3%），其他所有副作用均低于 5%。我们评估了 23 项抑郁症研究中的 aTMS 疗效，发现平均反应率为 42.4%，缓解率为 28.4%（两者范围为 0-90.5%）。关于参数，aTMS 研究的每日治疗次数为 2 到 10 次，治疗天数为 2 到 30 天，两次治疗之间的间隔为 10 到 640 分钟，每位参与者总共接受 9 到 104 次加速 TMS 治疗（包括逐渐减少治疗的次数）。从定性角度来看，随着每日治疗次数、总治疗次数和总脉冲数的增加，反应率也会随之提高。
讨论
迄今为止的文献表明，aTMS 在各种情况下都是安全且耐受良好的。这些早期研究表明，即使在治疗高度难治性疾病时，aTMS 也具有潜在的有效性，同时还可能减轻患者负担，同时加快反应时间。未来需要进行系统研究，以调查关键的 aTMS 参数如何影响治疗效果和持久性。
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