重複性經顱磁刺激對神經可塑性的調控在神經及精神疾病的應用

Neuromodulation and Clinical Applications of Transcranial Magnetic Stimulation in Neurology and Psychiatry

林皇利(Huang-Li Lin) ； 黃英儒(Ying-Zu Huang)

《物理治療》 39卷1期 (2014/03) Pp. 10-17

https://doi.org/10.6215/JFPT.PTS1382345945

摘要

經顱磁刺激（transcranial magnetic stimulation）的技術，是一種非侵入性、安全性高且極少造成病人不適的神經刺激術。它藉由快速改變的磁場引發電流，進而有效的刺激大腦皮質或周邊神經。經顱磁刺激可以以單一刺激、成對刺激及重複刺激等方式進行。單一刺激及成對刺激主要是用來檢測腦部的生理現象，而連續刺激則可以改變神經迴路達到神經可塑性（plasticity）的調控。雖然詳細的系統性機轉及生理現象仍有許多值得研究的地方，但是在臨床治療應用上面已經有所發展。例如在憂鬱症的治療上面已經獲得美國藥物及食品衛生管理局（FDA）的適應症許可。另外在帕金森氏症、阿滋海默症、肌張力不全、偏癱、神經復健、偏頭痛、慢性疼痛及耳鳴，或者是精神疾病包含：精神分裂症和焦慮症等都已取得一些適度可信的臨床證據。

關鍵字

經顱磁刺激 ； 神經可塑性 ； 神經醫學 ； 精神疾病學

並列摘要

Transcranial magnetic stimulation (TMS) is a relatively safe non-invasive technique with minimal discomfort for stimulating the nervous system. TMS induces weak electric currents through a rapidly changing magnetic field to stimulate the brain cortex or peripheral nerve. TMS may be given in different modes, including single pulse TMS, paired pulse TMS, repetitive TMS (rTMS) and so on. Single and paired pulse TMS are mainly used to test the cortical physiology, while rTMS is capable of modulating the cortical excitability through neuroplasticity-like mechanisms. Despite some fundamental mechanisms of TMS remain unclear, there have been several lines of evidence suggesting the therapeutic potential of rTMS. One of the most successful examples is that Food and Drug Administration (US) has approved a rTMS device for treating depression. Moreover, the therapeutic effect has also been reported on Parkinson disease, Alzheimer's disease, neurorehabilitation, migraine, chronic pain, schizophrenic hallucinations, tinnitus, anxiety and so on.

並列關鍵字

Transcranial magnetic stimulation ； Plasticity ； Neurology ； Psychiatry

參考文獻

Pascual-Leone A, Davey N, Rothwell J, Wasserman E, Puri BK. Handbook of Transcranial Magnetic Stimulation. London: Arnold; 2002.

Bickford RG, Fremming BD. Neural stimulation by pulsed magnetic fields in animals and man. Digest of the 6th International Conference Medical Electronics and Biological Engineering; 1965; Tokyo, Japan. Tokyo: Japan Society of Medical Electronics and Biological Engineering; 1965.

Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet 1985;1:1106-7.

Di Lazzaro V, Oliviero A, Pilato F, Saturno E, Dileone M, Mazzone P, et al. The physiological basis of transcranial motor cortex stimulation in conscious humans. Clin Neurophysiol 2004;115:255-66.

Huang YZ, Chen RS, Rothwell JC, Wen HY. The after-effect of human theta burst stimulation is NMDA receptor dependent. Clin Neurophysiol 2007;118:1028-32.