rTMS靶向刺激对帕金森病运动症改善作用的研究进展

Research Progress on Potential Brain Stimulation Targets of rTMS for Alleviating Motor Symptoms in Parkinson's Disease

重复经颅磁刺激技术(rTMS)已广泛应用于精神类和神经类疾病的临床辅助治疗,有改善帕金森病(PD)运动症状的作用,是实现PD精准治疗策略的重要手段。基底神经节环路特异性病变导致PD临床分型复杂多样,针对不同运动症状明确rTMS在神经环路关键靶区调控作用对提高改善效果有重要意义。首先从突触可塑性、神经环路角度分析了rTMS对改善PD的作用,然后分别从初级运动皮层(M1)、背外侧前额叶(DLPFC)、辅助运动皮层(SMA)以及小脑,就不同刺激模式在特定脑区的调控作用以及不同刺激靶区对不同运动症状的改善作用进行了探讨,最后指出现阶段研究中存在的主要问题,并从多靶区刺激、最佳干预期以及与脑成像技术相结合多方面探讨其未来的研究趋势。

Repetitive transcranial magnetic stimulation(rTMS)is widely used in the clinical treatment of psychiatry and neurology,which can improve the motor symptoms of Parkinson's disease(PD),and is an important approach to realize the precision treatment strategy of PD.The pathological changes in basal ganglia circuit lead to diverse clinical types of PD.To understand the modulatory effects of rTMS in key target areas according to different motor symptoms is significant to improve the therapeutic effect.At the beginning of this paper,the effect of rTMS on PD from the perspective of synaptic plasticity and neural circuits was analyzed.Then,the potential stimulation targets of primary motor cortex(M1),dorsolateral prefrontal cortex(DLPFC),supplementary motor cortex(SMA)and cerebellum were reviewed to discuss the modulatory effects of different stimulation parameters in specific brain regions and the effects of different stimulation target areas on different motor symptoms.At last,the main problems in the current research were pointed out,and the future research trends were discussed from the aspects of multi-target stimulation,optimal intervention period,and combination with brain imaging technology.