A real electro-magnetic placebo (REMP) device for sham transcranial magnetic stimulation (TMS
A real electro-magnetic placebo (REMP) device for sham transcranial magnetic stimulation (TMS
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DOI：
10.1016/j.clinph.2006.11.005
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发表时间：
2007-03-01
影响因子：
4.7
通讯作者：
Passero, Stefano
中科院分区：
文献类型：
--
作者：
Rossi, Simone;Ferro, Marisa;Passero, Stefano
目的：神经精神病学对重复经颅磁刺激（rTMS）作为神经调节治疗的兴趣越来越大。然而，将rTMS效应解释为大脑生理变化的真实结果或安慰剂介导的非特异性效应存在局限性，这在精神病患者中可能特别强烈。这是由于现有的假rTMS程序不是最理想的。本文介绍了一种新的安慰剂工具——真实电磁安慰剂（real electro-magnetic placebo， REMP）装置，它可以模拟真实经颅磁刺激引起的头皮感觉，同时保持真实经颅磁刺激的视觉冲击和听觉感觉不变。方法：分别在经颅磁刺激专家和新手中测试单相和双相单脉冲经颅磁刺激和双相1 Hz和20 Hz rTMS程序（不同强度）的生理、神经生理和行为变量。将真实经颅磁刺激的结果与REMP装置和其他两种目前使用的假手术进行比较，即市售的Magstim假线圈和将真实线圈倾斜90度。结果：REMP装置除了产生与真正的经颅磁刺激相似的头皮感觉外，还将经颅磁刺激引起的电场（通过偶极子探针测量）减弱到生物无活性水平。从行为上看，专家和幼稚的TMS受试者都没有将“90度线圈”或“Magstim假线圈”识别为真正的TMS干预，而幼稚的受试者更有可能将remp减弱的TMS识别为真实的。结论：REMP装置的“假性好”通过物理、神经生理和行为结果得到证明。意义：在首次接受经颅磁刺激的受试者（如接受临床rTMS试验的患者）中，这种安慰剂性经颅磁刺激优于现有的假手术。(c) 2006年国际临床神经生理学联合会。爱思唯尔爱尔兰有限公司出版。版权所有。
Objective: There is growing interest in neuropsychiatry for repetitive transcranial magnetic stimulation (rTMS) as a neuromodulatory treatment. However, there are limitations in interpreting rTMS effects as a real consequence of physiological brain changes or as placebo-mediated unspecific effects, which may be particularly strong in psychiatric patients. This is due to the fact that existing sham rTMS procedures are less than optimal. A new placebo tool is introduced here, called real electro-magnetic placebo (REMP) device, which can simulate the scalp sensation induced by the real TMS, while leaving both the visual impact and acoustic sensation of real TMS unaltered.Methods: Physical, neurophysiological and behavioural variables of monophasic and biphasic single-pulse TMS and biphasic 1 Hz and 20 Hz rTMS procedures (at different intensities) were tested in subjects who were expert or naive of TMS. Results of the real TMS were compared with those induced by the REMP device and with two other currently used sham procedures, namely the commercially available Magstim sham coil and tilting the real coil by 90 degrees.Results: The REMP device, besides producing scalp sensations similar to the real TMS, attenuated the TMS-induced electric field (as measured by a dipole probe) to a biologically inactive level. Behaviourally, neither expert nor naive TMS subjects identified the "coil at 90 degrees" or the "Magstim sham coil" as a real TMS intervention, whilst naive subjects were significantly more likely to identify the REMP-attenuated TMS as real.Conclusions: The "goodness of sham" of the REMP device is demonstrated by physical, neurophysiological, and behavioural results.Significance: Such placebo TMS is superior to the available sham procedures when applied on subjects naive to TMS, as in case of patients undergoing a clinical rTMS trial. (c) 2006 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.