经颅交流电刺激干预神经精神疾病的研究进展

经颅交流电刺激是一种无创的电刺激疗法,有望成为干预大脑相关疾病的一种新的神经调控方法。本文中简要介绍与经颅交流电刺激干预疗效的相关因素、可能的治疗机制、临床应用及其发展前景。     

诊断性经颅磁刺激研究进展

经颅磁刺激是一种无创性神经电生理学技术,经颅磁刺激运动诱发电位已广泛应用于运动皮质兴奋性与皮质延髓束、皮质脊髓束传导功能的评价。近年随着对磁刺激原理的深入了解和刺激线圈、刺激模式的不断多样化,经颅磁刺激在神经病学临床诊断中的应用不断拓展,逐渐形成更加科学和标准化的运动诱发电位操作流程。本文拟对诊断性经颅磁刺激常规刺激模式研究进展、特殊模式刺激方案,以及经颅磁刺激与脑电图、f MRI的联合应用进行综述。     

经颅直流电刺激治疗难治性癫痫研究进展

经颅直流电刺激（tDCS）作为一种新兴的非侵入性神经调控技术,安全性较高,为无手术适应证或无法手术获益的难治性癫痫患者提供了选择,其中,阴极经颅直流电刺激通过抑制皮质兴奋性,恢复脑功能网络平衡,减少痫样放电和癫痫发作频率。但是由于各项研究之间存在异质性,其在癫痫治疗中的应用有待进一步探索。本文综述经颅直流电刺激原理及其治疗癫痫的潜在机制,以及近3年在癫痫临床应用中的进展,为经颅直流电刺激应用于难治性癫痫临床治疗的潜力和安全性提供依据。     

经颅直流电刺激的研究进展

正经颅直流电刺激(transcranial direct current stimulation,tDCS)是一种通过阳性和阴性电极在头皮特定位点施加微弱电流(1~2 mA)调节大脑皮质兴奋性的非侵袭性技术。t DCS具有兴奋性刺激、抑制性刺激和伪刺激3种刺激模式,其刺激参数包括刺激位点、电流强度、刺激持续时间、     

高精度经颅直流电刺激治疗脑高级功能障碍的研究进展

中枢神经系统病变或损伤后常合并脑高级功能障碍，部分患者单药物治疗效果不佳，因此迫切需要新的治疗方式辅助药物治疗。高精度经颅直流电刺激作为一种新型的神经康复技术，通过特别设计的高精度电极以低强度的电流作用于特定的脑区，调节大脑皮层神经活动。目前，高精度经颅直流电刺激对于卒中后失语、意识障碍、抑郁症、癫痫后认知障碍等脑高级功能障碍疾病有不同程度的改善。本文从作用原理及机制为切入点，结合国内外研究成果，概述高精度经颅直流电刺激相关研究及其在脑高级功能障碍中的临床应用，旨在对未来的发展提供依据。     

经颅直流电刺激治疗心境障碍的研究进展

心境障碍以心境或情感改变为基础,常表现为情绪低落或情感高涨,大多数症状多继发于心境改变.此类疾病发作时常常与应激事件等因素有关,易复发,且疾病经济负担重.心境障碍的治疗以药物治疗为主,接受药物治疗后部分患者症状可以完全缓解,而部分患者单药治疗的疗效不佳,因此迫切需要新的治疗方式辅助药物治疗.经颅直流电刺激作为一种无创性...     

深部经颅磁刺激在精神疾病中的研究进展

深部经颅磁刺激（DTMS）是基于经颅磁刺激技术发展而来的新型无创物理治疗技术，具有 刺激部位深及作用范围广等优点，在精神疾病治疗及机制探索中有着突出优势。现主要介绍DTMS在 精神疾病中的临床研究进展     

经颅磁刺激治疗抑郁症的研究进展

经颅磁刺激是利用一定的时变磁场在脑内诱发电场,产生感应电流,影响脑内诸多代谢及电活动的无痛无创的检测和治疗技术.现就经颅磁刺激基本物理学原理、抗抑郁治疗及机制作一综述.     

经颅磁刺激在强迫症治疗中的研究进展

尽管经颅磁刺激已被广泛应用于强迫症的治疗,如何选择最佳刺激靶点、频率等治疗参 数仍有待进一步研究。现从线圈、刺激频率及刺激靶点 3 个参数入手,对经颅磁刺激治疗强迫症的效果 进行综述,认为仍需要更多的随机对照试验证实经颅磁刺激治疗强迫症的疗效及患者耐受性,未来应 着重关注个体化刺激方案的选择和优化。     

经颅直流电刺激对不同人群抑郁症疗效的研究进展

经颅直流电刺激作为一种非侵入性神经刺激技术,具有经济、便携等特点,诸多学者认为它可能是治疗抑郁症有潜力的新方式。目前关于其治疗一般人群抑郁症的研究主要聚焦于优化治疗方案,不同方案疗效的结果尚不一致。其治疗特殊人群抑郁症的研究尚处于起步阶段,但已取得了一些初步结果。现就近年来经颅直流电刺激对不同人群抑郁症疗效的研究进展进行综述,以期提供一些循证证据。     

Electrode-distance dependent after-effects of transcranial direct and random noise stimulation with extracephalic reference electrodes

Objective

To evaluate the importance of the distance between stimulation electrodes, in various montages, on the ability to induce sustained cortical excitability changes using transcranial direct and random noise stimulation.

Methods

Twelve healthy subjects participated in four different experimental conditions. The stimulation electrode was always placed over the primary motor cortex; the reference electrode was placed at the contralateral orbit or at the ipsilateral/contralateral arm. MEPs were recorded in order to measure changes in cortical excitability over time.

Results

The distance between the two electrodes correlates negatively with the duration and magnitude of induced after-effects.

Conclusions

In particular when using extracephalic reference electrodes with transcranial electric stimulation techniques, the stimulation intensity has to be adapted to account for interelectrode distance.

Significance

Electrode distance plays a critical role in the induction for stimulation after-effects in tDCS and tRNS studies, and must be taken into account in future studies and also when making comparisons with the published literature.     

Improving working memory: Exploring the effect of transcranial random noise stimulation and transcranial direct current stimulation on the dorsolateral prefrontal cortex

Objective

The aim of this study was to determine if working memory (WM) performance is significantly improved after the delivery of transcranial random noise stimulation (tRNS) to the left dorsolateral prefrontal cortex (DLPFC), compared to an active comparator or sham.

Methods

Ten participants undertook three experimental sessions in which they received 10 min of anodal tDCS (active comparator), tRNS or sham tDCS whilst performing the Sternberg WM task. Intra-stimulation engagement in a WM task was undertaken as this has been previously shown to enhance the effects of tDCS. Experimental sessions were separated by a minimum of 1 week. Immediately prior to and after each stimulation session the participants were measured on speed and accuracy of performance on an n-back task.

Results

There was significant improvement in speed of performance following anodal tDCS on the 2-back WM task; this was the only significant finding.

Conclusions

The results do not provide support for the hypothesis that tRNS improves WM. However, the study does provide confirmation of previous findings that anodal tDCS enhances some aspects of DLPFC functioning. Methodological limitations that may have contributed to the lack of significant findings following tRNS are discussed.

Significance

Anodal tDCS may have significant implications for WM remediation in psychiatric conditions, particularly schizophrenia.     

重复经颅磁刺激治疗阿尔茨海默病的刺激参数及作用机制研究进展

阿尔茨海默病（AD）是最常见的痴呆类型，其发病率逐年增加，但缺乏特效治疗药物，给患 者家庭和社会带来了沉重的负担。重复经颅磁剌激（rTMS）是一种成熟的非侵入性神经调节技术，其被 广泛应用于多种神经精神疾病的临床辅助治疗。目前，rTMS 在 AD 的治疗中取得了一定的成效，但如何 选择最佳刺激靶点、频率等治疗参数仍有待进一步研究。本文从优化与治疗 AD 相关的 rTMS 刺激参数 的角度，对 rTMS 治疗 AD 的效果及其可能的作用机制进行综述，以期为 rTMS 应用于治疗 AD 提供指导。     

重复经颅磁刺激对精神障碍患者听力功能的影响

目的 评价重复经颅磁刺激（rTMS）治疗精神分裂症幻听及双相情感障碍抑郁发作时对患者听力功能的影响.方法 30例精神分裂症和30例双相情感障碍抑郁发作（以下简称双相抑郁）患者均给予rTMS治疗,精神分裂症幻听组的刺激选择部位为左侧颞顶叶皮质（1 Hz,80％MT）,双相抑郁发作患者选择左侧前额叶背外侧皮质（10 Hz,80％ MT）;在治疗前和治疗后均采用纯音听力测试分别测试患者左右耳气导听力,纯音频率在125～8 000 Hz之间选择8个点进行测试,强度＜30dB视为正常.结果 60例患者治疗后听力阈值强度下降,与治疗前比较差异有统计学意义[（18.22±12.24）比（16.41±12.25）,t=2.71,P＜0.01],表明rTMS对听力有一定的改善作用;在60例患者中有听力功能障碍者23例,其中精神分裂症患者13例,双相抑郁患者10例;23例中在6 000 Hz,8 000 Hz两个频率段存在异常者13例,占听力异常总人数的56.5％;虽然刺激部位及治疗强度均不相同,但rTMS对精神分裂症患者及双相抑郁患者的听力功能均有改善作用,两组之间差异无统计学意义（t=0.3,P＞0.05）;rTMS治疗后精神分裂症患者幻听症状减轻或消失,双相抑郁发作者的情绪改善.结论 rTMS在改善精神障碍患者临床症状的同时对听力功能有一定改善作用.     

重复经颅磁刺激治疗缺血性脑卒中后认知障碍的研究进展

重复经颅磁刺激（rTMS）是一种安全无创的非侵入性干预技术,在各种神经和精神疾病中已得到广泛应用。目前,rTMS在改善缺血性脑卒中后认知障碍（PISCI）方面也取得一定疗效。本文从rTMS的基本原理、治疗PISCI的作用机制、在PISCI中的应用、安全性等方面进行综述,以期为rTMS在PISCI中的应用提供理论依据。     

The effects of high-frequency transcranial random noise stimulation (hf-tRNS) on global motion processing: An equivalent noise approach

Background

High frequency transcranial random noise stimulation (hf-tRNS) facilitates performance in several perceptual and cognitive tasks, however, little is known about the underlying modulatory mechanisms.

Repetitive transcranial magnetic stimulation as treatment for anxiety disorders

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and generally well-tolerated method of focally stimulating brain regions. It has been shown to be efficacious in the treatment for depression, but only to a limited degree. It has also been investigated for the treatment of some anxiety disorders, particularly obsessive-compulsive disorder, post-traumatic stress disorder and panic disorder. While anecdotal reports and open studies have suggested a therapeutic role for rTMS in anxiety disorders, controlled studies, which have varied greatly in terms of rTMS administration, have not shown it to be superior to placebo. Furthermore, reports in animal models of anxiety have not been consistent. Therefore, to date, there is no convincing evidence for the clinical role of rTMS in anxiety disorders. Further research is needed, drawing on advances in our understanding of pathological neurocircuitry in anxiety disorders and the mechanisms of action by which rTMS may alter that neurocircuitry. With advances in neuroimaging technology, this understanding is likely to be more accessible than it has been in the past.