应用无创脑刺激技术治疗精神障碍的策略  

Strategies for applying noninvasive brain stimulation techniques to treat psychiatric disorders

作　　者：王红星[1] 刘晓蕾 Wang Hongxing;Liu Xiaolei(Department of Neurology,Xuanwu Hospital,Capital Medical University,National Center for Neurological Disorders,National Clinical Research Center for Geriatric Disorders,Beijing Psychosomatic Disease Consultation Center,Beijing 100053,China;Department of Neurology,the First Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]首都医科大学宣武医院神经内科,国家神经疾病医学中心,国家老年疾病临床医学研究中心,北京市心身疾病会诊中心,北京100053 [2]昆明医科大学第一附属医院神经内科,昆明650000

出　　处：《中华医学杂志》2024年第41期3785-3791,共7页National Medical Journal of China

基　　金：国家自然科学基金(82371490);国家重点研发计划(2022YFC2503901,2022YFC2503900);北京卫生高层次领军人才(2022-02-10);北京市登峰计划(2024-05-10)。

摘　　要：随着科技、医疗和生物工程技术的不断发展,精神障碍领域各种电、磁、声、光等神经调控技术不断涌现。针对不同的精神障碍及其临床特点选择何种无创脑刺激技术是临床应用中的现实问题。本文通过阐述精神障碍复杂的发病机制和现有治疗方法的局限性,结合不同神经调控技术的特征,提出了组合式无创脑刺激技术干预精神障碍的新策略:利用强能量刺激能够调控全脑且不引起癫痫大发作的特征将其作为精神障碍的基础治疗,针对残留症状和(或)单一症状应用弱电流或弱能量的无创脑刺激调控特定靶点/脑区,对于难治性和急重症精神障碍首选电痉挛疗法/改良电休克治疗(ECT/MECT)以快速控制症状;不同的无创脑刺激技术与药物治疗、心理治疗相结合,为该领域的未来发展提供新思路。With the continuous development of science and technology,medical science,and bioengineering technology,various neuromodulation techniques,such as electrical,magnetic,acoustic,and optical modalities,are rapidly emerging in the therapeutic regime of psychiatric disorders.How to choose the appropriate noninvasive brain stimulation techniques for different psychiatric disorders and their clinical features is becoming a practical dilemma in clinical setting.In this paper,by describing the complex pathogenesis of psychiatric disorders and the limitations of existing therapeutic approaches on psychiatric disorders,combining with the characteristics of different neuromodulation techniques,we propose a new strategy of combined noninvasive brain stimulation to intervene in psychiatric disorders:high-intensity stimulation modulating the whole brain without inducing epilepsy should be as the basic treatment of psychiatric disorders,applying low-intensity stimulation with the advantage of specific targets/brain regions to modulate the residual symptoms or/and single symptom,and for refractory and acute psychiatric disorders,ECT/MECT is preferred for rapid symptom control;different noninvasive brain stimulation techniques can be combined with pharmacological and psychotherapeutic treatments,which will provide a new idea for the future development of this field.

关 键 词：精神障碍 无创脑刺激 神经调控 电休克治疗 神经环路 策略 

分 类 号：R749[医药卫生—神经病学与精神病学]