重复经颅磁刺激治疗强迫症的研究进展

The research progress of repetitive transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder

强迫症(OCD)是一种严重的慢性致残性疾病.尽管有多种方法可以用以治疗强迫症,但仍有10%的患者难以治愈.对于这种具有抗药性的强迫症患者,重复经颅磁刺激(rTMS)是近阶段兴起的一种新的治疗方法.近年来,很多学者尝试使用rTMS治疗不同症状的强迫症病人,但其各研究的样本大小、患者因素、刺激部位和刺激参数的差异对疗效造成不同程度的影响.本文旨在从刺激部位入手,探讨经颅磁刺激的基本原理和强迫症的病理生理学基础,对rTMS刺激不同脑区治疗强迫症的有效性进行综述.

Obsessive-compulsive disorder（OCD）is a chronic,often severe and disabling disease. About ten percent of the patients remain treatment-refractory despite of several treatments.For these se-vere,treatment-refractory patients,repetitive transcranial magnetic stimulation（rTMS）has been suggested as a new treatment.In recent years,many scholars have tried to use rTMS to cure OCD patients with dif-ferent symptoms,but,the results were affected by their small sample sizes,heterogeneity in terms of de-mographic and clinical variables,the choice of stimulation sites,and treatment parameters such as treat-ment duration and intensity of stimulation.Also,these study designs ranged from open label to a few of randomized sham-controlled trials,which did not have enough statistical power to differentiate the treat-ment outcomes between the test and sham groups.This paper aims to review the efficacy of rTMS for the treatment of most severe resistant OCD.Firstly the basic principle of transcranial magnetic stimulation and the pathophysiology of OCD were discussed,followed by the efficacy of rTMS treatment at various brain targets,and finally the future of the treatment techniques.