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中华卫生应急电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 166 -171. doi: 10.3877/cma.j.issn.2095-9133.2020.03.007

所属专题: 文献 指南共识

综述

rTMS临床治疗指南与2019-nCoV相关神经精神疾病治疗推荐
孙志辉1, 张妍2, 郑重3,(), 王朴4, 潘桂花5, 廖皓磊6   
  1. 1. 215129 江苏苏州,苏州高新区人民医院国际医学部
    2. 430074 湖北武汉,华中科技大学教育科学研究院
    3. 610041 四川成都,四川大学华西医院
    4. 518000 广东深圳,中山大学附属第七医院康复医学科
    5. 200030 上海,上海市精神卫生中心精神医学部
    6. 430072 湖北武汉,武汉大学全球健康研究中心
  • 收稿日期:2020-03-04 出版日期:2020-06-18
  • 通信作者: 郑重
  • 基金资助:
    国家自然科学基金(81873354)

Guidelines of rTMS clinical treatment and recommendations for COVID-19 related neuropsychiatric diseases

Zhihui Sun1, Yan Zhang2, Zhong Zheng3()   

  • Received:2020-03-04 Published:2020-06-18
  • Corresponding author: Zhong Zheng
引用本文:

孙志辉, 张妍, 郑重, 王朴, 潘桂花, 廖皓磊. rTMS临床治疗指南与2019-nCoV相关神经精神疾病治疗推荐[J]. 中华卫生应急电子杂志, 2020, 06(03): 166-171.

Zhihui Sun, Yan Zhang, Zhong Zheng. Guidelines of rTMS clinical treatment and recommendations for COVID-19 related neuropsychiatric diseases[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2020, 06(03): 166-171.

图1 磁刺激作用原理
表1 基于循证的rTMS临床治疗指南(2014年至2018年更新)
推荐级别 适应证 方案 证据等级
A级推荐 抑郁症 左侧DLPFC高频 Ⅰ、Ⅱ、Ⅲ
(疗效确切) 神经病理性疼痛 疼痛对侧半球M1区高频
  亚急性脑卒中(改善手运动功能) 健侧半球M1区低频 Ⅰ、Ⅱ、Ⅲ
B级推荐 帕金森病 改善抑郁症状 左侧DLPFC高频
(疗效可信)   改善运动功能 双侧半球M1区高频
  创伤后应激障碍 右侧DLPFC高频刺激 Ⅱ、Ⅲ
  亚急性脑卒中(改善运动功能) 患侧半球M1区高频或iTBS
  慢性脑卒中(改善非流利性失语) 右侧额下回低频 Ⅱ、Ⅲ
  抑郁症 右侧DLPFC低频(或cTBS)联合左侧DLPFC高频(或iTBS) Ⅱ、Ⅲ
  肌纤维痛 改善生活质量 高频剌激左侧M1区 Ⅱ、Ⅲ
  改善疼痛 高频刺激左侧DLPFC Ⅱ、Ⅲ
  多发性硬化(下肢痉挛) iTBS剌激下肢运动区
C级推荐 复杂区域疼痛综合征I型 疼痛对侧半球M1区高频
(疗效可能) 强迫症 右侧DLPFC低频 Ⅱ、Ⅲ
  物质成瘾(戒烟) 左侧DLPFC高频 Ⅱ、Ⅲ
  早期阿尔茨海默症(轻度认知障碍) 多靶区高频 Ⅱ、Ⅲ
  慢性耳鸣 低频剌激左颞顶叶 Ⅰ、Ⅱ、Ⅲ
  癫痫 癫痫病灶区低频
  亚急性脑卒中偏侧忽视 健侧后顶叶cTBS Ⅱ、Ⅲ
  精神分裂症 改善幻听 左颞顶叶低频 Ⅱ、Ⅲ
  改善阴性症状 左侧DLPFC高频 Ⅱ、Ⅲ
  慢性脑卒中(改善手运动功能) 健侧M1区低频 Ⅱ、Ⅲ
可期待 意识障碍 左或/和右DLPFC或M1区高频  
  运动性失语 高频剌激左额下  
  肌张力障碍 cTBS剌激小脑  
  慢性脑卒中(改善运动功能) 低频剌激小脑  
图2 半球间功能非对称性与胼胝体的关系
图3 脑卒中运动功能障碍和偏侧忽视症rTMS治疗模式
图4 慢性疼痛的构成及rTMS治疗方式
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