重复经颅磁刺激治疗儿童孤独症的个案分析

目的:通过个案研究探讨重复经颅磁刺激对儿童孤独症的治疗效果。方法:对1例孤独症患儿使用重复经颅磁刺激,共治疗65次,20min/次,每分钟连续刺激4s,间歇56s。结果:孤独症患儿在经过65次经颅磁刺激后,在行为、语言、社会交往障碍等方面与治疗前相比有明显改善。结论:初步提示经颅磁刺激可以改善孤独症患儿的部分核心症状。     

经颅刺激对脑功能的调节作用

文章分析经颅刺激技术的发展趋势,为研究者及相关仪器开发者提供参考。首先对3种刺激技术(经颅磁刺激、经颅直流电刺激、经颅超声刺激)在物理指标及生物作用特性等方面进行了横向分析、比较;然后以经颅磁刺激为例,从文献计量学的角度分析了其在神经、精神疾病的应用范围及发展趋势。经颅刺激技术已经被应用于30多种疾病的临床治疗或研究,相关的临床研究文献数量也以稳定的速度持续增长。经颅超声刺激具有更加精确的空间分辨率、与功能性磁共振成像技术兼容性良好等优势,有望成为和经颅磁刺激相媲美的脑功能调节技术。     

经颅磁刺激电场分析研究进展

经颅磁刺激是一种利用通电线圈在脑部的诱发电场来调节皮质兴奋性的技术,广泛应用于神经病学、康复学等领域。经颅磁刺激诱发电场分析与安全性、刺激效果密切相关,在优化刺激方案、线圈设计方面具有重要意义,成为相关领域的研究重点。首先介绍经颅磁刺激3种常见的临床副作用,然后阐述经颅磁刺激现有研究中的常规电场分析方法,包括解析法和数值分析法及其应用场景,并讨论与电场分析密切相关的生物模型建模方法。此外,由于磁刺激线圈与组织中电场分布的密切相关性,介绍常规的刺激线圈结构类型,并结合磁刺激线圈的7种典型设计,分析基于有限元分析的球模型下的电场分布特征。最后,展望经颅磁刺激电场分析研究未来的发展趋势。     

重复经颅磁刺激对腕手功能重建的临床分析

目的 应用重复经颅磁刺激,作用于肌肉运动点,帮助中风后患者腕手功能的重建,观察重复经颅磁刺激对中风后腕手功能的治疗效果.方法 选择病程在2周-2个月的、手腕部Lovett肌力分级法肌力在0～2级的中风患者37例,随机分为2组,治疗组(经颅磁刺激组+电刺激组)及对照组(电刺激组),于治疗前后用Fugl-Meyer运动功能、Barthel ADL指数评价表评价各组治疗前后腕手运动功能.结果 治疗后各组腕手功能均有恢复.治疗组腕手部各项分值提高较为明显(P＜0.05).结论 重复经颅磁刺激对中风偏瘫患者的日常生活能力及认知能力的恢复有一定的促进作用,且临床应用中具有无痛、无创、操作简单等特点.     

重复经颅磁刺激治疗认知功能障碍的研究新进展

本文综述了重复经颅磁刺激(rTMS)治疗认知功能障碍的研究进展,对rTMS改善认知功能的生物学机制,rTMS改善认知发展的临床作用以及rTMS改善认知功能和安全性等进行了全面阐述。     

经颅磁刺激治疗阿尔茨海默病研究进展

经颅磁刺激作为一种无创的神经刺激方法,因其具有相对安全、无创的特点而成为目前治疗阿尔茨海默病的研究热点。该文首先介绍了经颅磁刺激原理;然后分别介绍了经颅磁刺激对阿尔茨海默病整体认知功能及不同认知域的治疗效果;接着分别分析了不同参数对整体认知功能治疗效果的影响;最后总结了经颅磁刺激的治疗机制,并探讨了可能的治疗方案。     

经颅磁刺激的多尺度建模仿真研究

经颅磁刺激是一种无创无痛的电磁刺激手段，被广泛应用于神经调控，在临床上对多种精神疾病和神经类疾病有明显的治疗效果。本文从电磁场建模仿真，细胞跨膜电位建模仿真，以及神经元响应建模仿真3个方面对经颅磁刺激多尺度建模仿真研究进行了详细的综述，并提出现阶段存在的问题以及对未来的展望。经颅磁刺激的多尺度建模仿真对磁刺激仪的设计开发具有指导意义，对磁刺激的导航系统提供重要的理论基础，有助于我们更好的理解电磁刺激的神经调控机制。     

基于经颅电、磁刺激神经调控方法的卒中康复研究进展

肢体运动功能障碍作为卒中后的常见病症,急需有效的康复治疗手段以助其运动功能改善。近年来,诸如经颅电磁刺激等新型神经调控技术通过可逆性地调控神经系统活性,达到改善患者肢体运动功能障碍、增强康复效果的目的。本文在阐述经颅直流电刺激(transcranial direct current stimulation,tDCS)和重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)两种方法的作用机制基础上,对tDCS及rTMS分别在卒中后肢体运动功能康复中的神经可塑性机制、肢体运动功能康复刺激参数的研究、康复手段融合研究进行了回顾与总结,发现tDCS和rTMS均可促进患者大脑运动功能神经重组,与传统、现代技术治疗手段结合均可在运动功能康复方面发挥有效作用。而后归纳了影响二者临床应用的诸如刺激部位、tDCS最佳电流强度和rTMS最优频率等刺激参数设置不一致等问题。最后针对两种调控手段融合方式的探索性研究,展望了未来新型调控方法在临床的应用模式,为今后临床康复中面向肢体运动功能障碍的神经调控技术研究方法的设计、制定与优化提供新的技术思路。     

重复经颅磁刺激治疗抑郁症的刺激参数的研究进展

重复经颅磁刺激是在经颅磁刺激基础上发展起来的新的神经电生理技术,它利用磁场作用于大脑皮质产生感应电流来改变皮质神经细胞的动作电位,从而影响脑内代谢和神经电活动。本文简单综述了重复经颅磁刺激治疗抑郁症的部分刺激参数。     

CT定位下经颅磁刺激对卒中后运动功能障碍的治疗效果

目的:观察CT定位下经颅磁刺激对卒中后运动功能障碍患者的治疗效果。方法:150例缺血型脑卒中患者按入院时间分为观察组（n=75）和对照组（n=75）,两组患者一般资料无显著性差异。观察组患者给予CT定位下经颅磁刺激治疗,对照组患者给予常规经颅磁刺激治疗。于治疗前和治疗8周后评估患者下肢肌力、上下肢运动能力评分、平衡能力、生活能力以及治疗有效性。结果:观察组患者治疗后下肢肌力、上下肢运动能力评分、平衡能力、生活能力显著高于对照组（P<0.05）;观察组治疗有效率显著高于对照组（84.00% vs 68.00%, P<0.05）。结论:CT定位下经颅磁刺激治疗对卒中后运动功能障碍患者疗效显著,其具体机制有待于神经生物学基础研究进一步揭示。     

Transcranial direct current stimulation and repetitive transcranial magnetic stimulation in consultation-liaison psychiatry

Patients with clinical diseases often present psychiatric conditions whose pharmacological treatment is hampered due to hazardous interactions with the clinical treatment and/or disease. This is particularly relevant for major depressive disorder, the most common psychiatric disorder in the general hospital. In this context, nonpharmacological interventions could be useful therapies; and, among those, noninvasive brain stimulation (NIBS) might be an interesting option. The main methods of NIBS are repetitive transcranial magnetic stimulation (rTMS), which was recently approved as a nonresearch treatment for some psychiatric conditions, and transcranial direct current stimulation (tDCS), a technique that is currently limited to research scenarios but has shown promising results. Therefore, our aim was to review the main medical conditions associated with high depression rates, the main obstacles for depression treatment, and whether these therapies could be a useful intervention for such conditions. We found that depression is an important and prevalent comorbidity in a variety of diseases such as epilepsy, stroke, Parkinson''s disease, myocardial infarction, cancer, and in other conditions such as pregnancy and in patients without enteral access. We found that treatment of depression is often suboptimal within the above contexts and that rTMS and tDCS therapies have been insufficiently appraised. We discuss whether rTMS and tDCS could have a significant impact in treating depression that develops within a clinical context, considering its unique characteristics such as the absence of pharmacological interactions, the use of a nonenteral route, and as an augmentation therapy for antidepressants.     

重复经颅磁刺激合并帕罗西汀治疗 难治性强迫症的临床观察

目的 观察重复经颅磁刺激合并帕罗西汀治疗难治性强迫症的临床疗效。方法 回顾分析2016年10月~2017年10月在我院治疗的140例难治性强迫症患者临床资料,将其随机分为对照组和观察组,每组70例。对照组采用帕罗西汀治疗,观察组在对照组治疗基础上联合重复经颅磁刺激治疗。观察两组患者的临床效果,治疗前后的Yale-Bocs评分、生存质量评分以及不良反应发生情况。结果 观察组治疗总有效率为94.29%,高于对照组的71.43%,差异有统计学意义（P＜0.05）;治疗后观察组Yale-Bocs评分为（25.21±5.60）分,低于对照组的（32.44±5.40）分,差异有统计学意义（P＜0.05）;治疗后观察组生存质量评分为（15.87±1.82）分,高于对照组的（10.53±1.95）分,差异有统计学意义（P＜0.05）;观察组患者不良反应发生率与对照组对比,差异无统计学意义（P＞0.05）。结论 重复经颅磁刺激合并帕罗西汀治疗难治性强迫症效果显著,可显著降低患者强迫症评分,改善患者生存质量,且无严重不良反应,值得临床推广和应用。     

Muscarinic receptor blockade has differential effects on the excitability of intracortical circuits in the human motor cortex

The aim of the present study was to investigate whether muscarinic receptor blockade with scopolamine modifies the excitability of specific cortical networks of the human motor cortex as tested with transcranial magnetic stimulation. The effects of scopolamine on the excitability of human motor cortex were investigated in four healthy subjects using transcranial magnetic stimulation before and after an intravenous dose of scopolamine (0.006 mg/kg). We measured the threshold for motor responses, amplitude of motor responses, the duration of the cortical silent period, intracortical inhibition and facilitation, and short-latency inhibition produced by somatosensory input from the hand. In addition, we evaluated the amplitude of motor responses evoked by electrical anodal stimulation, since these responses originate from direct activation of corticospinal axons in the white matter and are not sensitive to changes in cortical excitability. Scopolamine decreased the threshold to magnetic stimuli and increased the amplitude of motor responses evoked by magnetic stimulation. In contrast, motor responses evoked by electrical stimulation were unaffected by administration of scopolamine. Scopolamine also led to a highly significant reduction in the amount of short-latency inhibition produced by somatosensory input from the hand. In contrast, short-latency intracortical inhibition and facilitation were not modified by scopolamine. The differential effect of scopolamine on motor responses evoked by magnetic and electrical stimulation of the motor cortex and the selective effect on somatosensory inhibition demonstrate that muscarinic blockade modifies the excitability of specific cortical networks in the human motor cortex.     

经颅磁刺激帕金森病模型小鼠体内神经干细胞的增殖

背景：神经毒素1-甲基-4-苯基-1、2、3、6-四氢吡啶能够诱导类似于在原发性帕金森病所观察到的临床、生化和病理的特征。 目的：观察重复经颅磁刺激对帕金森病模型小鼠侧脑室室管膜下区内源性神经干细胞增殖的影响及对情绪障碍的影响。 方法：选用雄性C57BL/6J小鼠72只,随机分为 4 组。帕金森病模型组和磁刺激组采用背部皮下注射1-甲基-4-苯基-1、2、3、6-四氢吡啶注射4次制备急性帕金森病模型,末次注射24 h后,对磁刺激组小鼠进行重复经颅磁刺激干预,刺激频率为1 Hz,刺激强度为阈上20%,刺激5个序列,每个序列刺激25次,分别治疗1,3,7 d;假磁刺激组不暴露于磁场下;帕金森病模型组不给予任何处理;盐水对照组皮下注射与帕金森病模型组等量的生理盐水。对重复经颅磁刺激干预前后进行高架十字迷宫实验,以评价其情绪障碍。利用免疫组织化学染色的方法检测室管膜下区巢蛋白阳性细胞数。 结果与结论：①高架十字迷宫试验：各组内及各组间在不同时间点,小鼠的开放臂停留时间比例(OT%)差异无显著性意义,但重复经颅磁刺激干预后的小鼠OT%有较明显的下降。②巢蛋白免疫组织化学染色结果：帕金森病模型组较盐水对照组巢蛋白的阳性细胞数于第3天和第7天时明显增高,较假磁刺激组无统计学意义。②磁刺激组较假磁刺激组及帕金森病模型组巢蛋白的阳性细胞数明显增高。③巢蛋白的阳性细胞数随时间的延长而增加,内源性神经干细胞沿一定的路径逐渐往外迁移,第3天时有一部分迁移到胼胝体,到第7天时有一部分能迁移到大脑皮质。说明重复经颅磁刺激能促进内源性神经干细胞增殖,内源性神经干细胞增殖具有时间依赖性。     

硬膜外植入式皮质刺激脑卒中患者提高神经网络功能

背景：硬膜外植入式皮质刺激兼顾了经颅磁刺激、经颅直流电刺激、硬膜下皮质刺激和深部脑刺激的优点,可显著改善脑卒中后的肢体运动与语言功能。 目的：综述近年来有关硬膜外植入式皮质刺激在脑卒中康复中的研究及其临床应用。 方法：由第一作者应用计算机检索1995年1月至2014年4月PubMed 数据库及中国期刊全文数据库文献,检索关键词为“cortical stimulation,extradural motor cortex stimulation,extradural cortical implants,extradural cortical stimulation,stroke,rehabilitation;皮质刺激,硬膜外电刺激,硬膜外皮质植入,硬膜外皮质刺激,脑卒中,康复”。纳入有关硬膜外植入式皮质刺激在脑卒中后运动与言语障碍中应用的文章。 结果与结论：硬膜外皮质刺激是植入式皮质刺激,其优势是侵入性小、高度精确性和经硬膜与大脑密切接触,对缺乏有效治疗的脑卒中慢性期运动和语言障碍患者来说,这有可能是一种新的治疗方法。硬膜外皮质刺激通过促进神经可塑性、促进病灶周围结构与功能改变、提高神经网络功能、促进大脑半球间功能平衡及增加感觉输入来改善脑卒中后的肢体运动功能与语言功能。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

A propriospinal-like contribution to electromyographic responses evoked in wrist extensor muscles by transcranial stimulation of the motor cortex in man

We tested the hypothesis that some of the electromyographic (EMG) responses elicited in preactivated forearm muscles by transcranial stimulation of the human motor cortex are produced by activity in a disynaptic corticospinal linkage involving propriospinal-like interneurones with cell bodies in the spinal C3–4 segments. The experimental design incorporated a previous observation that stimulation of afferents in the superficial radial nerve inhibits propriospinal-like neurones projecting to the extensor carpi radialis (ECR) muscle. Surface EMG responses were recorded from the active ECR muscle after transcranial electrical or magnetic stimulation over the motor cortex. In random trials, single conditioning stimuli at twice perceptual threshold were given to the superficial radial nerve at the wrist at different times before a cortical shock. When the cortex was stimulated electrically, the conditioning stimulus suppressed the EMG responses when the interval between the shocks was 11 ms or more. This was about 3.5 ms longer than the minimum time calculated for a possible direct cutaneous effect on spinal motoneurones. The time course of suppression began earlier and was more complex during magnetic stimulation of the cortex. It is argued that this difference is due to the repetitive I waves generated by the magnetic shock. Whether electrical or magnetic stimulation was used, the first 1–3 ms of the EMG response was relatively unaffected by superficial radial nerve stimulation at any interstimulus interval, whereas clear suppression was seen in the later portion of the response. In contrast, if the EMG response in ECR was suppressed by a conditioning stimulus to the median nerve at the elbow, then all portions of the EMG response were inhibited including the first 1–3 ms. The median nerve effect is thought to be due to direct reciprocal inhibition of the extensor motoneurones. Thus sparing of the initial part of the cortically evoked response with superficial radial stimulation suggests that the latter type of inhibition occurs at a premotoneuronal level. The timing of the effect is compatible with the explanation that corticospinal excitation is produced in ECR motoneurones through both monosynaptic and disynaptic (including propriospinal premotoneuronal) pathways, with superficial radial nerve inhibition being exerted at the propriospinal level.     

重复磁刺激右侧大脑中动脉闭塞模型大鼠脑梗死区微环境及神经功能的变化

背景：国内外大量研究表明重复经颅磁刺激可使皮质兴奋性产生较刺激时间更加持久的改变,为磁刺激应用于脑梗死后康复治疗提供了一个新的研究方向,但其远期临床疗效与安全性尚需进一步研究。 目的：观察重复经颅磁刺激脑梗死大鼠对神经再生微环境及功能恢复的影响。 方法：将大鼠随机分为模型组、假刺激组及重复经颅磁刺激组(80%运动阈值(MT)组、100%MT组和120%MT组),采用线栓法制备大鼠右侧大脑中动脉闭塞模型。制模24 h后各重复经颅磁刺激亚组给予20 Hz相应强度磁刺激,假刺激组则给予假磁刺激,模型组制模后未给予特殊处理。 结果与结论：造模后7 d,重复经颅磁刺激组的脑梗死体积显著小于模型组及假刺激组(P < 0.05)。RT-PCR、Western blot检测显示,造模后72 h,重复经颅磁刺激组水通道蛋白4/9基因和蛋白表达均较模型组显著增高(P < 0.05)。与造模后第1天比较,造模后第15天重复经颅磁刺激组(100%MT)神经功能缺损评分得到明显改善(P < 0.05)。免疫组织化学检测结果显示,各重复经颅磁刺激亚组缺血半暗带区胶质纤维酸性蛋白表达与模型组比较均显著减少(P < 0.05)。结果证实,重复经颅磁刺激可减轻脑梗死模型大鼠神经功能缺损程度,通过诱导脑缺血耐受、减少神经细胞凋亡和降低水通道蛋白4/9基因和蛋白的表达,改善神经再生微环境。中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程     

Cortical excitability in adult patients with attention-deficit/hyperactivity disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is more and more focused on, and the awareness of adult patients with ADHD increases. Deficits in inhibitory processes in cortical brain areas are discussed as possible causes for ADHD. An easy measurement of these processes is provided by transcranial magnetic stimulation (TMS). We applied single- and double-pulse TMS to the left motor cortex while an electromyogram (EMG) was taken at the abductor pollicis brevis muscle (APB) of the right hand. Intracortical inhibition (SICI) and facilitation (ICF) were measured in ten adult ADHD patients and ten healthy participants using inter-pulse intervals of 2 and 3ms (SICI), and 8 and 15ms (ICF). Furthermore, resting motor threshold (RMT) and latency of the motor evoked potential (MEP) following magnetic stimulation were compared. t-Tests were calculated for statistical analysis. TMS measurements resulted in impaired inhibition in ADHD patients, whereas there were no differences in facilitation, RMT and MEP-latency between groups. Large variability in the patient group was found. This study expands the findings of deficits in inhibition described in earlier studies in children to an adult population, which could be a hint for similar neurophysiological mechanisms underlying ADHD symptomatology in children and adults.     

低频重复经颅磁刺激治疗左右利手精神分裂症幻听对照研究

目的:探讨低频重复经颅磁刺激治疗左、右利手精神分裂症幻听的疗效及安全性。方法:95例精神分裂症幻听按左、右利手分为两组,右利手组(72例)和左利手组(23例),均在原来抗精神病药治疗的基础上给予低频重复经颅磁刺激治疗共4周。治疗前及治疗后2、4周末分别用幻听评定量表(AHRS)评定幻听治疗效果,用阳性和阴性症状量表(PANSS)评定临床疗效,用副反应量表(TESS)评定不良反应。结果:治疗中左、右利手组各有1例脱落。4周末右利手组与左利手组AHRS比较有显著性差异(t=2.12,P0.05),右利手组减分高于左利手组。PANSS评分两组比较有显著性差异(t=2.30,P0.05)。不良反应两组间比较无显著性差异。结论:低频重复经颅磁刺激治疗右利手精神分裂症幻听好于左利手者。     

低频经颅磁治疗抑郁症的Meta分析

目的:系统评价低频经颅磁治疗抑郁症的有效性。方法:计算机检索Google Scholar,Pubmed,The Cochrane Library,CBM,EBSCO,SinoMed,CNKI,VIP和WanFang Data数据库,查找有关经颅磁治疗抑郁症的临床对照实验,检索时限为建库到2017年1月。由两名研究者按照纳入标准与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,用RevMan 5.3软件进行Meta分析。结果:共纳入22项研究,包括1418例患者。Meta分析结果显示,与对照组相比,在治疗1周[OR=4.36,95%CI(6.31,2.41),P0.0001],2周[OR=4.36,95%CI(6.31,2.41),P0.0001],4周[OR=0.64,95%CI(0.77,0.51),P0.00001]后,低频经颅磁治疗对抑郁症患者的HAMD评分都能显著改善,差异有统计学意义。结论:当前证据显示,低频经颅磁治疗抑郁症有一定的优势。受纳入研究的质量限制,上述结论仍需大样本和更高质量的研究进一步验证。