重复经颅磁刺激(rTMS)是FDA批准的重度抑郁症(MDD)治疗方法。然而,神经机制有助于rTMS对抑郁症状的影响,认知,和行为不清楚。质子磁共振波谱(MRS),一种非侵入性神经成像技术,测量体内大脑中生化化合物的浓度,可以提供机械论的见解。
本系统综述总结了已发表的rTMS治疗试验的MRS发现,以探讨其抗抑郁作用的潜在神经代谢机制。使用PubMed,谷歌学者,WebofScience,还有JSTOR,我们确定了12项实证研究,这些研究评估了受试者体内MRS代谢物的变化,前vs.MDD患者rTMS治疗后的设计。
rTMS协议的持续时间从4天到8周,在大多数研究中以高频率应用于左背外侧前额叶皮质(DLPFC),并在13至70岁的患者中进行。大多数研究在双侧前扣带皮质和DLPFC的3特斯拉处利用MRS点分辨光谱采集。症状改善与rTMS相关的谷氨酸能化合物浓度增加相关(谷氨酸,Glu,还有谷氨酰胺,Gln),GABA,和N-乙酰化化合物(NAA),有一些结果趋势水平。
这是第一次深入系统评价rTMS在MDD患者中的代谢作用。现有文献表明,rTMS刺激不会产生独立于临床反应的神经代谢物的变化;额叶谷氨酸能化合物的增加,高频左DLPFCrTMS治疗后的N-乙酰化化合物和GABA通常与临床改善相关。Glu,Gln,GABA,NAA可能通过细胞内机制介导rTMS治疗对MDD症状学的影响。
Repetitive Transcranial magnetic stimulation (rTMS) is an FDA approved treatment for major depressive disorder (MDD). However, neural mechanisms contributing to rTMS effects on depressive symptoms, cognition, and behavior are unclear. Proton magnetic resonance spectroscopy (MRS), a noninvasive neuroimaging technique measuring concentrations of biochemical compounds within the brain in vivo, may provide mechanistic insights.
This systematic
review summarized published MRS findings from rTMS treatment trials to address potential neurometabolic mechanisms of its antidepressant action. Using PubMed, Google Scholar, Web of Science, and JSTOR, we identified twelve empirical studies that evaluated changes in MRS metabolites in a within-subjects, pre- vs. post-rTMS treatment design in patients with MDD.
rTMS protocols ranged from four days to eight weeks duration, were applied at high frequency to the left dorsolateral prefrontal cortex (DLPFC) in most studies, and were conducted in patients aged 13-to-70. Most studies utilized MRS point resolved spectroscopy acquisitions at 3 Tesla in the bilateral anterior cingulate cortex and DLPFC. Symptom improvements were correlated with rTMS-related increases in the concentration of glutamatergic compounds (glutamate, Glu, and glutamine, Gln), GABA, and N-acetylated compounds (NAA), with some results trend-level.
This is the first in-depth systematic
review of metabolic effects of rTMS in individuals with MDD. The extant literature suggests rTMS stimulation does not produce changes in neurometabolites independent of clinical response; increases in frontal lobe glutamatergic compounds, N-acetylated compounds and GABA following high frequency left DLPFC rTMS therapy were generally associated with clinical improvement. Glu, Gln, GABA, and NAA may mediate rTMS treatment effects on MDD symptomatology through intracellular mechanisms.