Kích thích não không xâm lấn cho bệnh Parkinson và chứng loạn động

Elsevier BV - Tập 5 - Trang 345-361 - 2008
Allan D. Wu1,2, Felipe Fregni3,4, David K. Simon3,4, Choi Deblieck1,2, Alvaro Pascual-Leone3,4,5
1Department of Neurology, University of California, Los Angeles
2Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles
3Department of Neurology, Beth Israel Deaconess Medical Center, Boston
4Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston
5Institut Guttmann for Neurorehabilitation, Universitat Autònoma, Barcelona, Spain

Tóm tắt

Kích thích từ trường xuyên sọ lặp lại (rTMS) và kích thích dòng điện trực tiếp xuyên sọ (tDCS) là những phương pháp kích thích vỏ não không xâm lấn hứa hẹn cho việc điều trị kết hợp các rối loạn vận động. Chúng tránh được các rủi ro phẫu thuật và cung cấp các lợi thế lý thuyết về việc điều chỉnh các mạch thần kinh cụ thể. Các tác động điều chỉnh thần kinh phụ thuộc vào các yếu tố kích thích bên ngoài (mục tiêu vỏ não, tần suất, cường độ, thời gian, số lượng buổi), các yếu tố nội tại của bệnh nhân (quá trình bệnh, sự thay đổi cá nhân và triệu chứng, trạng thái điều trị bằng thuốc), và các biện pháp kết quả. Hầu hết các nghiên cứu cho đến nay đã chỉ ra các tác động có lợi của rTMS hoặc tDCS đối với triệu chứng lâm sàng ở bệnh Parkinson (PD) và ủng hộ quan điểm về tính đặc thù không gian đối với các tác động lên triệu chứng vận động và không vận động. Tuy nhiên, các thông số kích thích đã rất đa dạng và một số nghiên cứu có kiểm soát kém. Các nghiên cứu về rTMS hoặc tDCS trong chứng loạn động đã cung cấp dữ liệu phong phú về sinh lý học, nhưng rất ít về các tác động lâm sàng. Nhiều cơ chế có thể góp phần vào các tác động lâm sàng của rTMS và tDCS trong các rối loạn vận động, bao gồm việc chuẩn hóa tính dễ bị kích thích của vỏ não, cân bằng lại hoạt động của các mạng lưới thần kinh phân tán, và kích thích phóng thích dopamine. Vẫn chưa rõ làm thế nào để điều chỉnh các yếu tố rTMS hoặc tDCS cho từng cá nhân nhằm mang lại các tác động có lợi nhất cho triệu chứng của PD hoặc chứng loạn động. Tuy nhiên, tính chất không xâm lấn, tác dụng phụ tối thiểu, tác động tích cực trong các nghiên cứu lâm sàng sơ bộ, và bằng chứng ngày càng tăng cho các cơ chế hợp lý khiến cho rTMS và tDCS trở thành đối tượng nghiên cứu hấp dẫn cho các nghiên cứu tiếp theo.

Từ khóa

#Kích thích não #rTMS #tDCS #bệnh Parkinson #chứng loạn động

Tài liệu tham khảo

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