Current applications and perspectives of neurologic and psychiatric disorderstherapy with repetitive transcranial magnetic stimulation

Przezczaszkowa stymulacja magnetyczna serią bodźców (repetitive transcranial magnetic stimulation, rtMs) jest modyfikacją tradycyjnej TMS. W odróżnieniu od TMS, w której pojedyncze lub podwójne bodźce pola magnetycznego używane są w celu diagnostyki funkcjonalnej układu nerwowego, rTMS stosuje serie bodźców magnetycznych w celu modyfikacji pobudliwości korowej. W zależności od częstotliwości bodźców można uzyskać wzrost lub spadek pobudliwości, określane mianem odpowiednio długotrwałej depresji i długotrwałej potencjacji. W obu przypadkach dochodzi do zmian w przekaźnictwie nerwowym, co z kolei może przełożyć się na zmianę funkcji poznawczych, motorycznych i innych. Zmiany te mogą być indukowane celem osiągnięcia pozytywnych efektów w wielu chorobach układu nerwowego. Artykuł prezentuje zasadę działania, zasady bezpieczeństwa i zastosowania rTMS w chorobach, w których skuteczność terapeutyczna jest wystarczająco udokumentowana. Najszerzej omówione zostaną choroby, w których skuteczność terapeutyczną rTMS można uznać za pewną, czyli choroba afektywna jednobiegunowa i ból neuropatyczny, a także te, w których skuteczność jest prawdopodobna, czyli negatywne objawy schizofrenii oraz niedowład po udarze mózgu. Ponadto w artykule wspomniane są potencjalne zastosowania rTMS, wymagające jeszcze badań klinicznych, np. szumy uszne, migrena, a także nowoczesne paradygmaty stymulacji, jak stymulacja theta burst. W artykule omówiono także, zyskujące ostatnio na znaczeniu, merytoryczne i etyczne kwestie stymulacji rTMS osób zdrowych w celu podniesienia wydajności funkcji poznawczych. Słowa kluczowe: rTMS, depresja, długofalowa potencjacja, długofalowa depresja, ból neuropatyczny.

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