Abstract：
Extinction of traumatic memory, a primary treatment approach (termed exposure therapy) in post-traumatic stress disorder (PTSD), occurs through relearning and may be subserved at the molecular level by long-term potentiation (LTP) of relevant circuits. In parallel, repetitive transcranial magnetic stimulation (rTMS) is thought to work through LTP-like mechanisms and may provide a novel, safe, and effective treatment for PTSD. Our recent failed randomized controlled trial (1) emphasizes the necessity of correctly identifying cortical targets, directionality of TMS protocol, and role of memory activation. Here we provide a systematic review of TMS for PTSD to further identify how, where, and when TMS treatment should be delivered to alleviate PTSD symptoms. We conducted a systematic review of the literature searching for rTMS clinical trials involving PTSD patients and outcomes. We searched MEDLINE through October 25th, 2023 for \"TMS and PTSD\" and \"transcranial magnetic stimulation and posttraumatic stress disorder.\" Thirty-one publications met our inclusion criteria (k=17 randomized controlled trials (RCTs), k=14 open label). RCT protocols were varied in TMS protocols, cortical TMS targets, and memory activation protocols. There was no clear superiority across protocols of low-frequency (k=5) vs. high-frequency protocols (k=6), or by stimulation location. Memory provocation or exposure protocols (k=7) appear to enhance response. Overall, TMS appears to be effective in treating PTSD symptoms across a variety of TMS frequencies, hemispheric target differences, and exposure protocols. Disparate protocols may be conceptually harmonized when viewed as potentiating proposed anxiolytic networks or suppressing anxiogenic networks.
摘要：
创伤记忆的灭绝，创伤后应激障碍（PTSD）的主要治疗方法（称为暴露疗法），通过重新学习发生，并且可能通过相关电路的长期增强（LTP）在分子水平上被保留。并行,重复经颅磁刺激（rTMS）被认为是通过LTP-like机制工作的，安全,和创伤后应激障碍的有效治疗。我们最近失败的随机对照试验（1）强调正确识别皮质目标的必要性，TMS协议的方向性，和记忆激活的作用。在这里，我们提供了对创伤后应激障碍的系统评价，以进一步确定如何，where,以及何时应进行TMS治疗以缓解PTSD症状。我们对涉及PTSD患者和结局的rTMS临床试验的文献进行了系统回顾。我们搜索了MEDLINE直到10月25日,2023年用于“TMS和PTSD”和“经颅磁刺激和创伤后应激障碍”。“31篇出版物符合我们的纳入标准(k=17项随机对照试验(RCT)，k=14开放标签)。RCT协议在TMS协议中有所不同，皮层TMS目标，和内存激活协议。在低频方案中没有明显的优势(k=5)与高频协议(k=6)，或通过刺激位置。记忆激发或暴露方案（k=7）似乎可以增强反应。总的来说,TMS似乎可以有效治疗各种TMS频率的PTSD症状，半球目标差异，和暴露协议。当被视为增强提出的抗焦虑网络或抑制抗焦虑网络时，不同的协议在概念上可能是统一的。
