Zhou Xiao-Li, Li Yan, Xia Wan, Zheng Ying-Ying, Wu Ai-Ping
Department of Rehabilitation, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China.
Department of Neurology, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China.
World J Psychiatry. 2025 Sep 19;15(9):108497. doi: 10.5498/wjp.v15.i9.108497.
Parkinson's disease patients, in addition to typical motor symptoms, often experience various psychological symptoms, including depression, anxiety, cognitive impairment, impulse control disorders, and psychotic symptoms. These symptoms severely affect patients' quality of life and may even cause a greater disease burden than motor symptoms. This review focuses on the application progress of transcranial magnetic stimulation (TMS) as a non-invasive neuromodulation technique in the treatment of psychological symptoms in Parkinson's disease. Studies have shown that repetitive TMS (rTMS) has significant improvement effects on Parkinson's disease-related depressive symptoms, with mechanisms possibly related to the regulation of the prefrontal-striatal dopamine pathway and the promotion of neuroplasticity. For anxiety symptoms, continuous theta burst stimulation has shown potential in indirect regulation of the amygdala and hippocampal regions. For cognitive impairment, high-frequency rTMS applied to the dorsolateral prefrontal cortex can improve executive function deficits, while bilateral coordinated stimulation protocols help enhance attention and memory functions. For impulse control disorders in Parkinson's disease patients, inhibitory stimulation applied to the orbitofrontal cortex can alleviate pathological gambling and compulsive behaviors. In terms of sleep disorders, TMS has also shown potential efficacy in regulating circadian rhythms and improving rapid eye movement sleep behavior disorder. However, current research still has limitations such as small sample sizes, non-standardized stimulation protocols, and insufficient evaluation of long-term efficacy. Future research directions should focus on optimizing stimulation parameters, exploring individualized treatment protocols, integrating multimodal imaging assessments, and conducting large-sample randomized controlled trials to clarify the clinical application value of TMS in the rehabilitation of psychological symptoms in Parkinson's disease, providing new approaches for the comprehensive management of this common neurodegenerative disease.
帕金森病患者除了有典型的运动症状外，还常出现各种心理症状，包括抑郁、焦虑、认知障碍、冲动控制障碍和精神病性症状。这些症状严重影响患者的生活质量，甚至可能导致比运动症状更大的疾病负担。本综述聚焦于经颅磁刺激（TMS）作为一种非侵入性神经调节技术在帕金森病心理症状治疗中的应用进展。研究表明，重复经颅磁刺激（rTMS）对帕金森病相关的抑郁症状有显著改善作用，其机制可能与调节前额叶-纹状体多巴胺通路以及促进神经可塑性有关。对于焦虑症状，连续theta爆发刺激已显示出在间接调节杏仁核和海马区方面的潜力。对于认知障碍，应用于背外侧前额叶皮质的高频rTMS可改善执行功能缺陷，而双侧协同刺激方案有助于增强注意力和记忆功能。对于帕金森病患者的冲动控制障碍，应用于眶额皮质的抑制性刺激可减轻病理性赌博和强迫行为。在睡眠障碍方面，TMS在调节昼夜节律和改善快速眼动睡眠行为障碍方面也显示出潜在疗效。然而，目前的研究仍存在样本量小、刺激方案不规范以及长期疗效评估不足等局限性。未来的研究方向应集中在优化刺激参数、探索个性化治疗方案、整合多模态成像评估以及开展大样本随机对照试验，以阐明TMS在帕金森病心理症状康复中的临床应用价值，为这种常见神经退行性疾病的综合管理提供新方法。
