張俊鴻醫師: 治療憂鬱症哪種經顱磁刺激 (TMS)設定(protocol)效果最好?

治療憂鬱症哪種經顱磁刺激 (TMS)設定(protocol)效果最好?

先講結論: 大原則是促進左側大腦DLPFC皮質活性或抑制右側大腦DLPFC皮質。和憂鬱藥物一樣，沒有最好的抗憂鬱藥物，須依據病人狀況調整最適合的設定。

根據Jean-Pascal Lefaucheur教授團隊2020年的TMS回顧文獻，針對憂鬱症，目前治療的主要機轉原則是either HF-rTMS of the left DLPFC (aimed at correcting an alleged hypoactivity) or LF-rTMS of the right DLPFC (aimed at reducing an alleged hyperactivity) (De Raedt et al., 2015).

設定有HF-rTMS of the left DLPFC ，LF-rTMS of the right DLPFC，Deep HF-rTMS over the left DLPFC，iTBS over the left DLPFC or cTBS over the right DLPFC， Accelerated protocols ，Miscellaneous . . . .

比較安慰劑(sham) 顯著有效的設定為bilateral prefrontal rTMS or iTBS, LF-rTMS of the right DLPFC, and HF-rTMS of the left DLPFC。[A recent network meta-analysis showed a higher response to real vs. sham stimulation condition for bilateral prefrontal rTMS or iTBS, LF-rTMS of the right DLPFC, and HF-rTMS of the left DLPFC (Mutz et al., 2019).]

參考文獻

Jean-Pascal Lefaucheur et al., Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018)Clin Neurophysiol . 2020 Feb;131(2):474-528.