Cotovio Gonçalo, Ventura Fabiana, Rodrigues da Silva Daniel, Pereira Patrícia, Oliveira-Maia Albino J
Champalimaud Research and Clinical Centre, Champalimaud Foundation, 1400-038 Lisbon, Portugal.
NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal.
Brain Sci. 2023 Jul 5;13(7):1029. doi: 10.3390/brainsci13071029.
Non-invasive brain stimulation techniques (NIBS) have been widely used in both clinical and research contexts in neuropsychiatry. They are safe and well-tolerated, making NIBS an interesting option for application in different settings. Transcranial magnetic stimulation (TMS) is one of these strategies. It uses electromagnetic pulses for focal modulate ion of neuronal activity in brain cortical regions. When pulses are applied repeatedly (repetitive transcranial magnetic stimulation-rTMS), they are thought to induce long-lasting neuroplastic effects, proposed to be a therapeutic mechanism for rTMS, with efficacy and safety initially demonstrated for treatment-resistant depression (TRD). Since then, many rTMS treatment protocols emerged for other difficult to treat psychiatric conditions. Moreover, multiple clinical studies, including large multi-center trials and several meta-analyses, have confirmed its clinical efficacy in different neuropsychiatric disorders, resulting in evidence-based guidelines and recommendations. Currently, rTMS is cleared by multiple regulatory agencies for the treatment of TRD, depression with comorbid anxiety disorders, obsessive compulsive disorder, and substance use disorders, such as smoking cessation. Importantly, current research supports the potential future use of rTMS for other psychiatric syndromes, including the negative symptoms of schizophrenia and post-traumatic stress disorder. More precise knowledge of formal indications for rTMS therapeutic use in psychiatry is critical to enhance clinical decision making in this area.
非侵入性脑刺激技术（NIBS）已在神经精神病学的临床和研究环境中广泛应用。它们安全且耐受性良好，这使得NIBS成为在不同环境中应用的一个有趣选择。经颅磁刺激（TMS）就是这些策略之一。它利用电磁脉冲对大脑皮质区域的神经元活动进行局部调节。当脉冲重复施加时（重复经颅磁刺激 - rTMS），人们认为它们会诱导持久的神经可塑性效应，这被认为是rTMS的一种治疗机制，其疗效和安全性最初在难治性抑郁症（TRD）的治疗中得到证实。从那时起，针对其他难治性精神疾病出现了许多rTMS治疗方案。此外，多项临床研究，包括大型多中心试验和几项荟萃分析，已经证实了其在不同神经精神疾病中的临床疗效，从而产生了基于证据的指南和建议。目前，多个监管机构批准rTMS用于治疗TRD、伴有共病焦虑症的抑郁症、强迫症以及物质使用障碍，如戒烟。重要的是，当前的研究支持rTMS未来可能用于其他精神综合征，包括精神分裂症的阴性症状和创伤后应激障碍。更精确地了解rTMS在精神病学治疗应用中的正式适应症对于加强该领域的临床决策至关重要。
