摘要
卒中后抑郁(PSD)是脑卒中后常见的非运动功能并发症,以明显情感障碍为特征,严重阻碍患者康复进程。重复经颅磁刺激(rTMS)作为一种无创神经调控技术,通过调节大脑皮质兴奋性改善抑郁症状。其治疗PSD的机制尚未完全明确,可能与脑源性神经营养因子水平增加、神经免疫炎症反应调节、大脑皮质的葡萄糖代谢加速、神经可塑性调节有关,且这些因素间存在相互作用。高频rTMS常选择左侧背外侧前额叶皮质(DLPFC)区域,低频rTMS则多作用于右侧DLPFC区域;单用或两者联用均对PSD具有临床疗效。此外,rTMS联合其他疗法亦可改善抑郁症状。未来需进一步探究rTMS的参数组合及刺激频率对PSD患者临床疗效的影响,以实现PSD的精准化治疗。
Post-stroke depression(PSD)is a common non-motor complication following stroke,characterized by significant emotional disturbances,severely hindering the patient′s rehabilitation process.Repetitive transcranial magnetic stimulation(rTMS),a non-invasive neuromodulation technique,improves depressive symptoms by modulating cortical excitability.The precise mechanisms underlying its therapeutic effect on PSD remain incompletely elucidated,which may involve increased levels of brain-derived neurotrophic factor,modulation of neuroimmune inflammatory responses,enhanced glucose metabolism in the cerebral cortex,and regulation of neuroplasticity,with potential interactions existing among these factors.High-frequency rTMS is typically applied to the left dorsolateral prefrontal cortex(DLPFC),while low-frequency rTMS is often applied to the right DLPFC.Both monotherapy and combined application of these approaches demonstrate clinical efficacy for PSD.Furthermore,rTMS combined with other therapeutic modalities can also ameliorate depressive symptoms.In the future,it is necessary to further explore the effects of rTMS parameter combination and stimulation frequency on the clinical efficacy of PSD patients,so as to achieve accurate treatment of PSD.
作者
徐辉
谢晶军
XU Hui;XIE Jingjun(Department of Rehabilitation Medicine,the First Affiliated Hospital of Huzhou Normal University,Huzhou 313000,China;Huzhou Normal University,Huzhou 313000,China)
出处
《医学综述》
2025年第15期1836-1840,共5页
Medical Recapitulate
基金
浙江省中医药科技计划项目(2024ZL1027)
湖州市科技计划项目(2022GY16)。
关键词
卒中后抑郁
重复经颅磁刺激
高频刺激
低频刺激
Post-stroke depression
Repetitive transcranial magnetic stimulation
High-frequency stimulation
Low-frequency stimulation
