Neuroimaging Mechanisms of Therapeutic Transcranial Magnetic Stimulation for Major Depressive Disorder.
Neuroimaging Mechanisms of Therapeutic Transcranial Magnetic Stimulation for Major Depressive Disorder.
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DOI：
10.1016/j.bpsc.2017.10.007
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Carpenter LL
中科院分区：
文献类型：
--
作者：
Philip NS;Barredo J;Aiken E;Carpenter LL
过去十年，针对重度抑郁症治疗性经颅磁刺激（TMS）的研究急剧增加。了解 TMS 的作用机制对于提高疗效和开发下一代治疗刺激至关重要。早期的影像学研究提供了初步数据，支持了人们普遍持有的关于刺激的抑制性或兴奋性后果的假设。早期研究还表明，虽然 TMS 调节刺激部位下的大脑活动，但对更深区域（尤其是膝下前扣带皮层）的影响与临床改善相关。与早期发现一致，功能连接研究还表明，临床改善与刺激部位远端而不是近端的变化有关。此外，最近的研究表明，TMS 可以调节并潜在地规范神经网络之间的功能关系。本次综述得出的一个重要观察结果是，无论 TMS 参数如何，在各个研究中都观察到类似的连接变化模式。尽管前景广阔，但我们强调，鉴于广泛依赖适度的样本量且很少实施统计验证，必须谨慎评估这些成像结果。其他限制包括在 TMS 疗程前后使用成像，这无法深入了解刺激期间可能发生的变化。此外，由于迄今为止的研究主要集中在抑郁症上，尚不清楚观察结果是否与 TMS 对抑郁症的作用机制有关，或者代表了与临床改善相关的更广泛的大脑功能变化模式。
Research into therapeutic transcranial magnetic stimulation (TMS) for major depression has dramatically increased in the last decade. Understanding the mechanism of action of TMS is crucial to improve efficacy and develop the next generation of therapeutic stimulation. Early imaging research provided initial data supportive of widely held assumptions about hypothesized inhibitory or excitatory consequences of stimulation. Early work also indicated that while TMS modulated brain activity under the stimulation site, effects at deeper regions, and in particular the subgenual anterior cingulate cortex, were associated with clinical improvement. Concordant with earlier findings, functional connectivity studies also demonstrated that clinical improvements were related to changes distal, rather than proximal, to the site of stimulation. Moreover, recent work suggests that TMS modulates and potentially normalizes functional relationships between neural networks. An important observation that emerged from this review is that similar patterns of connectivity changes are observed across studies regardless of TMS parameters. Though promising, we stress that these imaging findings must be evaluated cautiously given the widespread reliance on modest sample sizes and little implementation of statistical validation. Additional limitations include use of imaging before and after a course of TMS, which provides little insight into changes that might occur during the weeks of stimulation. Furthermore, as studies to date have focused on depression, it is unclear whether observations are related to mechanisms of action of TMS for depression, or represent broader patterns of functional brain changes associated with clinical improvement.
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DOI：
10.1073/pnas.0504136102
发表时间：
2005-07-05
影响因子：
11.1
作者：
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影响因子：
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作者：
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通讯作者：
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