Neuromodulation最新文献_第4页

Shape of the Pulse: Pulse Width and Current Direction Effects on Motor Evoked Potentials Using a Cobot-assisted Controllable Transcranial Magnetic Stimulation Device 脉冲形状：脉冲宽度和电流方向对协同机器人辅助可控经颅磁刺激装置运动诱发电位的影响。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-11-07 DOI: 10.1016/j.neurom.2025.08.418

Mirja Osnabruegge MSc , Florian Schwitzgebel PhD , Carolina Kanig MSc , Hannah Franke , Katharina Kerkel MSc , Andreas Reissmann PhD , Berthold Langguth MD , Wolfgang Mack PhD , Martin Schecklmann PhD , Stefan Schoisswohl PhD

Background

Transcranial magnetic stimulation (TMS) is a noninvasive technique for stimulating the cerebral cortex. The purpose of the study is to investigate the effect of current direction and pulse width on motor evoked potentials (MEPs), using a controllable TMS (cTMS) stimulator in combination with cobot-assisted neuronavigation. The setup allows a modulation of pulse width and current direction within one TMS system while precise and reliable coil placement motor cortex is ensured.

Materials and Methods

In 30 healthy participants, MEPs were recorded from the first dorsal interosseous muscle. Biphasic pulses with different initial phase durations (280 and 160 μs) and current directions (posterior-anterior [PA] and anterior-posterior [AP] in second phase) were used both for determining resting motor threshold (RMT) and MEPs. To assess MEPs, 100 pulses were applied with an intensity of 110% RMT in three conditions (PA_280μs, AP_280μs, PA_160μs).

Results

Stimulation with the cTMS device was well tolerated, with no serious adverse events or uncommon side effects. The RMT differed significantly among pulse widths, indicating an inversely proportional relationship of pulse width and stimulation intensity. Differences in RMT and MEP readout show sensitivity of the motor cortex and indicate AP-PA currents as more effective than PA-AP currents when adjusted to threshold. For pulse width, no differences were found for electromyography readout, indicating shorter pulses as more efficient given they produce the same level of electrophysiologic response but with less energy loss.

Discussion

This study emphasizes that TMS outcomes depend on the current direction and pulse width of stimulation parameters. The finding that shorter pulses achieve equivalent responses with lower energy use suggests more efficient stimulation protocols, whereas the sensitivity to current direction underlines the need for parameter optimization to improve reliability and comparability across studies and devices. These insights support the improvement of TMS protocols in both research and clinical applications.

背景：经颅磁刺激（TMS）是一种刺激大脑皮层的无创技术。本研究采用可控TMS （cTMS）刺激器结合协作机器人辅助神经导航，研究电流方向和脉宽对运动诱发电位（MEPs）的影响。该设置允许在一个TMS系统内调制脉冲宽度和电流方向，同时确保精确可靠的线圈放置运动皮层。材料和方法：在30名健康参与者中，记录了第一背骨间肌的mep。采用不同初始相持续时间（280 μs和160 μs）和电流方向（后-前[PA]和第二相前后[AP]）的双相脉冲测定静息运动阈值（RMT）和MEPs。为了评估MEPs，在3种条件（PA280μs、AP280μs、PA160μs）下，以110% RMT强度施加100个脉冲。结果：cTMS装置的刺激耐受性良好，无严重不良事件或罕见的副作用。不同脉冲宽度的RMT差异显著，表明脉冲宽度与刺激强度成反比关系。RMT和MEP读数的差异显示了运动皮层的敏感性，并表明AP-PA电流在调整到阈值时比PA-AP电流更有效。对于脉冲宽度，肌电图读数没有发现差异，表明短脉冲更有效，因为它们产生相同水平的电生理反应，但能量损失更少。讨论：本研究强调TMS结果取决于刺激参数的电流方向和脉冲宽度。研究发现，更短的脉冲可以在更低的能量消耗下获得等效的响应，这表明更有效的刺激方案，而对电流方向的敏感性强调了参数优化的必要性，以提高研究和设备之间的可靠性和可比性。这些见解支持在研究和临床应用中改进经颅磁刺激方案。

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引用次数: 0

Repetitive Transcranial Magnetic Stimulation for Refractory and Super-refractory Status Epilepticus: A Systematic Review 反复经颅磁刺激治疗难治性和超难治性癫痫持续状态：系统综述。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-03-28 DOI: 10.1016/j.neurom.2025.02.001

Chloé Algoet MD , Kato Van Rooy MD , Paul Boon MD, PhD , Evelien Carrette PhD , Sofie Carrette MD , Mathieu Sprengers MD, PhD , Robrecht Raedt PhD , Ann Mertens MD, PhD , Alfred Meurs MD, PhD , Kristl Vonck MD, PhD

Rationale

Off-label treatments are often considered to treat refractory status epilepticus (RSE) and superrefractory status epilepticus (SRSE). To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) as a treatment for (S)RSE, we performed a systematic review.

Materials and Methods

Cessation of (S)RSE after rTMS was extracted as the primary end point from manuscripts describing patients with (S)RSE treated with rTMS. Data relevant to epilepsy history, (S)RSE type and etiology, prior treatment for (S)RSE, prior duration of (S)RSE, rTMS parameters, number of treatment sessions, duration of rTMS protocols, latency to (S)RSE cessation, recurrence rate, adverse events, and long-term outcome were collected as secondary end points.

Results

We identified 33 patients; 17 of 33 had epilepsia partialis continua; 7 of 33 had new onset RSE. Data were incomplete in 3 of 33 regarding classification and etiology; 18 of 30 had focal motor status epilepticus (SE), 9 of 30 nonconvulsive SE, and 3 of 30 convulsive SE. The most frequent etiologies were cortical malformation (8/31), stroke (5/31), and genetic mutations (5/31). Median duration of (S)RSE before rTMS was 70 days (range: two–7300, interquartile range = 148, Q1 = 32, Q3 = 180). In 25 of 33 patients (75.8%), rTMS caused cessation of (S)RSE after zero to four days. (S)RSE recurred in eight of 17 patients (47%), for whom follow-up was available. Three deaths occurred from the underlying disease.

Conclusion

rTMS caused cessation in 75.8% of patients with (S)RSE within four days, with recurrence in 47%. To determine the therapeutic potential of rTMS for patients with (S)RSE, further studies are required given the present findings stem from level IV studies and may have reporting bias.

理由：说明书外治疗通常被认为是治疗难治性癫痫持续状态（RSE）和超难治性癫痫持续状态（SRSE）。为了研究重复经颅磁刺激（rTMS）治疗(S)型RSE的疗效，我们进行了一项系统综述。材料和方法：从描述经rTMS治疗的(S)RSE患者的文献中提取rTMS后(S)RSE停止作为主要终点。收集与癫痫史、(S)RSE类型和病因、(S)RSE既往治疗、(S)RSE既往持续时间、rTMS参数、治疗次数、rTMS方案持续时间、(S)RSE停止延迟、复发率、不良事件和长期结局相关的数据作为次要终点。结果：我们确定了33例患者；局部持续性癫痫17例；其中7例为新发RSE。33例中有3例关于分类和病因的数据不完整；30例有局灶性运动癫痫持续状态（SE） 18例，非惊厥性SE 9例，惊厥性SE 3例。最常见的病因是皮质畸形（8/31）、中风（5/31）和基因突变（5/31）。rTMS前RSE的中位持续时间为70天（范围：2 ~ 7300天，四分位数间距= 148天，Q1 = 32天，Q3 = 180天）。33例患者中有25例（75.8%）rTMS在0 - 4天后导致RSE停止。(5)随访的17例患者中有8例（47%）RSE复发。有3人死于潜在疾病。结论：rTMS使75.8%的(S)RSE患者在4天内戒烟，47%复发。为了确定rTMS对(S)RSE患者的治疗潜力，考虑到目前的研究结果来自IV级研究，可能存在报告偏倚，需要进一步的研究。

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引用次数: 0

High-Resolution Computational Modeling of Transcranial Photobiomodulation: Light Propagation and Thermal Effects 经颅光生物调节的高分辨率计算模型：光传播和热效应。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-07-25 DOI: 10.1016/j.neurom.2025.06.003

Alexander R. Guillen MS , Dennis Q. Truong PhD , Paula Cristina Faria PhD , Brian Pryor PhD , Luis de Taboada MSEE , Abhishek Datta PhD

Background

Transcranial photobiomodulation (tPBM) is the noninvasive application of light to modulate underlying brain activity. There is increasing interest in evaluating tPBM as a therapeutic option. The typical technological questions are extent of light penetration and associated tissue temperature increases. Limited computational efforts to quantify these aspects are restricted to simplified models.

Materials and Methods

We considered a three-dimensional high-resolution (1 mm) anatomically realistic head model to simulate tPBM with the light source targeting the F3 region at 800 nm wavelength. Power densities spanning three decades (10, 100, and 1000) mW/cm² were investigated. We also tested time-variant application at 100 mW/cm² for up to 20 minutes. Finally, tissue temperature increases for the American National Standards Institute safety limit of 330 mW/cm² also were determined at a test case.

Results

Our predictions reveal that the induced cortical irradiance is largely focal, demarcated by the shape and extent of the source. Approximately 1% of the injected irradiance reaches the gray matter. Aligned with previous efforts, the scalp accounts for the greatest loss (∼65%). The irradiance reduces to a hundredth of the value from gray matter at an approximately 113-mm perpendicular distance from its surface. There is a growing halo-like effect at the level of cerebrospinal fluid (CSF), which is extended down to the underlying cortex. The CSF was found to be mainly responsible for this effect. We observe scalp temperature increases of 0.38 °C and 3.76 °C for 100 and 1000 mW/cm² power density, respectively. The corresponding brain temperature increases are predicted to be 0.06 °C and 0.57 °C. As expected, irradiance absorption is linear with applied power density. Although the maximum induced scalp temperature increases linearly with power density, maximum brain temperature increases less slowly with power density. Transient analysis at 100 mW/cm² power density indicates expected scalp temperature increase with increasing stimulation duration. Temperature increases asymptote in approximately 10 minutes.

Conclusions

tPBM presents unique potential to directly impose a desired spatial profile using simple alteration of the shape and size of the source. Usage of power density of 1000 mW/cm² exceeds scalp and brain temperature safety limits. Contrary to prior reports, light penetration can exceed >10 cm from gray matter surface.

背景：经颅光生物调节（tPBM）是一种非侵入性应用光来调节潜在的大脑活动。人们对评价tPBM作为一种治疗选择的兴趣越来越大。典型的技术问题是光穿透的程度和相关的组织温度升高。量化这些方面的有限计算工作仅限于简化的模型。材料和方法：我们考虑了一个三维高分辨率（1mm）的解剖学逼真的头部模型来模拟tPBM，光源瞄准F3区域，波长为800 nm。研究了三十年（10、100和1000）mW/cm2的功率密度。我们还测试了100mw /cm2的时变应用，持续时间长达20分钟。最后，在一个测试案例中，还确定了美国国家标准协会安全限值330 mW/cm2的组织温度升高。结果：我们的预测表明，诱发的皮层辐照度主要是聚焦的，由源的形状和程度划分。大约1%的入射光到达灰质。与之前的研究一致，头皮损失最大（约65%）。在离灰质表面垂直距离约113毫米处，辐照度降低到灰质值的百分之一。在脑脊液（CSF）水平上有一种日益增长的晕状效应，这种效应向下延伸到底层皮层。研究发现脑脊液是造成这种效果的主要原因。我们观察到当功率密度为100和1000 mW/cm2时，头皮温度分别升高0.38°C和3.76°C。相应的脑温升高预计为0.06°C和0.57°C。正如预期的那样，辐照度吸收与施加的功率密度呈线性关系。虽然最大诱导头皮温度随功率密度线性增加，但最大脑温度随功率密度增加的速度较慢。在100 mW/cm2功率密度下的瞬态分析表明，预期头皮温度随着刺激时间的增加而增加。温度在大约10分钟后渐近线上升。结论：tPBM具有独特的潜力，可以通过简单改变源的形状和大小直接施加所需的空间轮廓。功率密度1000 mW/cm2的使用超过了头皮和大脑温度的安全限制。与先前的报道相反，光可以穿透灰质表面超过10厘米。

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引用次数: 0

A Review of Mechanistic Effects of Low-Intensity Focused Ultrasound 低强度聚焦超声的机理研究进展。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-10-16 DOI: 10.1016/j.neurom.2025.07.006

Pravarakhya Puppalla BA , Ugur Kilic MD, PhD , Derek D. George MD , AnneLeigh Twer , Minza Haque MBBS , Lotanna Ojukwu BS , Julie G. Pilitsis MD, PhD, MBA

Background/Objectives

Low-intensity focused ultrasound (LIFU) has become increasingly used in neuromodulation. However, its mechanisms of action are less well understood. Here, we provide a scoping review of the effects of LIFU on nervous system tissue.

Materials and Methods

We evaluated the PubMed, SCOPUS, and Web of Science data bases for articles using the keywords related to LIFU and neuromodulation; 3970 articles were retrieved and titles screened by two authors (AT and MH) with conflicts resolved by one author (PP). The abstract review included 837 articles, and full-text review included 371 articles; 157 articles were included in the final manuscript.

Results

The mechanisms of action of LIFU for neuromodulation have been studied in vitro, in preclinical models, and in humans. LIFU exerts both excitatory and inhibitory modulatory effects through ion channel activation, changes in neurotransmission, and certain gene expression pathways. These changes cause localized and distributed effects in brain tissue and in behavioral modification in human trials and nonhuman models, depending on stimulation parameters and region targeted. Most LIFU research focuses on cerebral neuromodulation whereas some data exist for spinal cord and peripheral nerve neuromodulation.

Conclusion

Considerable growth in research evaluating LIFU’s ability to modulate the nervous system has occurred. Although safety and efficacy have been indicated, heterogeneity in LIFU operating parameters may cause nuanced differential effects on target tissue. By further elucidating the mechanisms of LIFU neuromodulation, future research will advance treatments for chronic neurologic diseases.

背景/目的：低强度聚焦超声（LIFU）在神经调节中的应用越来越广泛。然而，其作用机制尚不清楚。在此，我们对LIFU对神经系统组织的影响进行了综述。材料和方法：我们对PubMed、SCOPUS和Web of Science数据库中使用LIFU和神经调节相关关键词的文章进行了评估；共检索到3970篇文章，标题由两位作者（AT和MH）筛选，冲突由一位作者（PP）解决。摘要综述纳入837篇，全文综述纳入371篇；定稿中收录了157篇文章。结果：在体外、临床前模型和人体中研究了LIFU对神经调节的作用机制。LIFU通过激活离子通道、改变神经传递和某些基因表达途径发挥兴奋性和抑制性调节作用。在人体试验和非人体模型中，这些变化在脑组织和行为改变中引起局部和分布的影响，这取决于刺激参数和目标区域。大多数LIFU研究集中于脑神经调节，而脊髓和周围神经的神经调节则有一些数据。结论：评价LIFU调节神经系统能力的研究已经出现了相当大的增长。虽然安全性和有效性已经得到证实，但LIFU操作参数的异质性可能会对靶组织产生细微的差异影响。通过进一步阐明LIFU神经调节的机制，未来的研究将推动慢性神经疾病的治疗。

{"title":"A Review of Mechanistic Effects of Low-Intensity Focused Ultrasound","authors":"Pravarakhya Puppalla BA , Ugur Kilic MD, PhD , Derek D. George MD , AnneLeigh Twer , Minza Haque MBBS , Lotanna Ojukwu BS , Julie G. Pilitsis MD, PhD, MBA","doi":"10.1016/j.neurom.2025.07.006","DOIUrl":"10.1016/j.neurom.2025.07.006","url":null,"abstract":"<div><h3>Background/Objectives</h3><div>Low-intensity focused ultrasound (LIFU) has become increasingly used in neuromodulation. However, its mechanisms of action are less well understood. Here, we provide a scoping review of the effects of LIFU on nervous system tissue.</div></div><div><h3>Materials and Methods</h3><div>We evaluated the PubMed, SCOPUS, and Web of Science data bases for articles using the keywords related to LIFU and neuromodulation; 3970 articles were retrieved and titles screened by two authors (AT and MH) with conflicts resolved by one author (PP). The abstract review included 837 articles, and full-text review included 371 articles; 157 articles were included in the final manuscript.</div></div><div><h3>Results</h3><div>The mechanisms of action of LIFU for neuromodulation have been studied in vitro, in preclinical models, and in humans. LIFU exerts both excitatory and inhibitory modulatory effects through ion channel activation, changes in neurotransmission, and certain gene expression pathways. These changes cause localized and distributed effects in brain tissue and in behavioral modification in human trials and nonhuman models, depending on stimulation parameters and region targeted. Most LIFU research focuses on cerebral neuromodulation whereas some data exist for spinal cord and peripheral nerve neuromodulation.</div></div><div><h3>Conclusion</h3><div>Considerable growth in research evaluating LIFU’s ability to modulate the nervous system has occurred. Although safety and efficacy have been indicated, heterogeneity in LIFU operating parameters may cause nuanced differential effects on target tissue. By further elucidating the mechanisms of LIFU neuromodulation, future research will advance treatments for chronic neurologic diseases.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"29 2","pages":"Pages 163-186"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145302484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Theta-Burst Stimulation of the Right Temporoparietal Junction and Implicit Theory of Mind in Autism 自闭症右颞顶交界处的θ -爆发刺激与内隐心理理论。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-05-27 DOI: 10.1016/j.neurom.2025.04.005

Amir-Homayun Hallajian MSc , Fateme Dehghani-Arani PhD , Sepehr Sima MSc , Amirmahdi Heydari BSc , Kiomars Sharifi MSc , Yasamin Rahmati MSc , Reza Rostami MD , Zahra Vaziri PhD , Mohammad Ali Salehinejad PhD

Objectives

Theory of mind (ToM), or mentalizing, is the ability to attribute mental states to oneself and others and is altered in individuals with autism spectrum disorder (ASD). Recent evidence suggests that implicit rather than explicit ToM is impaired in individuals with ASD. The right temporoparietal junction (rTPJ), which plays a crucial role in ToM, has altered activity in ASD and is a potential terget by noninvasive brain stimulation.

Materials and Methods

In a randomized single-blind placebo-controlled study, we investigated, for what we believe is the first time, the effects of theta-burst stimulation of the rTPJ on implicit ToM and egocentric bias in 17 adolescents with ASD. Participants (mean age = 13.84 ± 3.32 years) were randomly assigned to three sessions of continuous theta-burst stimulation (cTBS), intermittent theta-burst stimulation (iTBS), and sham stimulation in a counterbalanced order. Stimulation intensity was set to 80% of the active motor threshold during cTBS and iTBS, with the coil centered on the rTPJ (CP6). Immediately after each stimulation, cognitive correlates of ToM, including implicit mentalizing and egocentric bias, were evaluated using the computerized Buzz-lightyear task.

Results

Both cTBS and iTBS significantly improved implicit ToM compared with sham stimulation, with cTBS yielding a numerically larger effect (379.2 milliseconds) than did iTBS (191.3 milliseconds), although this difference was not statistically significant. No effect was found on the egocentric bias index.

Conclusions

These findings show a causal link between the rTPJ activation and implicit mentalizing in ASD, suggesting that theta-burst stimulation of this region can be used to enhance ToM in ASD. Targeting the rTPJ may improve implicit mentalizing in ASD and other disorders with impaired ToM.

目的：心理理论（Theory of mind, ToM）或心理化（mentalizing）是一种将心理状态归因于自己和他人的能力，这种能力在自闭症谱系障碍（ASD）患者中会发生改变。最近的证据表明，ASD患者的内隐而非外显ToM功能受损。右颞顶交界处（rTPJ）在ToM中起着至关重要的作用，它在ASD中改变了活动，是无创脑刺激的潜在目标。材料与方法：在一项随机、单盲、安慰剂对照研究中，我们首次研究了rTPJ的theta-burst刺激对17名青少年ASD的内隐ToM和自我中心偏见的影响。参与者（平均年龄= 13.84±3.32岁）被随机分配到连续脉冲刺激（cTBS）、间歇脉冲刺激（iTBS）和假刺激的三个阶段，并按平衡顺序进行。在cTBS和iTBS期间，将刺激强度设置为主动运动阈值的80%，线圈以rTPJ （CP6）为中心。在每次刺激之后，ToM的认知相关因素，包括内隐心智化和自我中心偏见，被用计算机化的buzz光年任务评估。结果：与假刺激相比，cTBS和iTBS都显著改善了内隐ToM， cTBS的效果（379.2毫秒）比iTBS（191.3毫秒）在数值上更大，尽管这种差异没有统计学意义。对自我中心偏见指数没有影响。结论：这些发现表明rTPJ激活与ASD内隐心智化之间存在因果关系，表明该区域的θ -burst刺激可用于增强ASD的ToM。以rTPJ为靶点，可能会改善ASD和其他汤姆神经障碍患者的内隐精神化。

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引用次数: 0

2026 Calendar of Events 2026年事件日历

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2026-02-03 DOI: 10.1016/S1094-7159(25)01223-1

引用次数: 0

Cingulo-Opercular Connectivity Enhances the Repeatability of Transcranial Magnetic Stimulation Target Maps 脑-眼连通性增强经颅磁刺激靶图的可重复性。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-11-07 DOI: 10.1016/j.neurom.2025.09.316

Emma Komulainen MD, PhD , Annu-Sinikka Salminen MD , Dogu Baran Aydogan PhD , Siina Pamilo DSC (Tech) , Tuukka T. Raij MD, PhD

Introduction

The effectiveness of transcranial magnetic stimulation (TMS) in the treatment of major depressive disorder (MDD) may be enhanced through individualized targeting in the dorsolateral prefrontal cortex (DLPFC). Recent clinical trials have used TMS targeting based on the subgenual anterior cingulate cortex (sgACC) or right anterior insula (rAI) functional connectivity. However, the repeatability of such individual targeting may present significant challenges for feasibility.

We aimed to compare the repeatability of the novel depression core network model-based (CNM) target maps with the sgACC functional connectivity-based and the rAI effective connectivity-based target maps. We further tested whether using a movie stimulus increases the feasibility of individualized functional connectivity-based targeting.

Materials and Methods

In a final sample of 31 patients with treatment-resistant MDD, the repeatability of the target maps was computed as the within-subject spatial correlation among imaging sessions in the DLPFC. Repeatability was compared across the connectivity models. Furthermore, repeatability, head movement, and subjective alertness and comfortableness during functional magnetic resonance imaging (fMRI) were compared between movie and resting-state acquisition.

Results

The CNM functional connectivity-based DLPFC target maps were more repeatable than the sgACC- or rAI-based target maps when using a movie stimulus. In particular, the cingulo-opercular seeds from the CNM produced target maps with high repeatability in both resting-state and movie stimulus conditions. Compared with the resting-state, the movie stimulus reduced head movement during fMRI but did not enhance repeatability at a statistically significant level.

Conclusions

Our findings support future investigations of multiseed functional connectivity targeting methods, including those focused on the cingulo-opercular regions. These findings also encourage further research on the use of engaging naturalistic stimuli to enhance the feasibility of individualized TMS targeting.

导读：经颅磁刺激（TMS）治疗重度抑郁症（MDD）的效果可能通过个体化靶向背外侧前额叶皮层（DLPFC）来增强。最近的临床试验基于亚属前扣带皮层（sgACC）或右脑岛前叶（rAI）功能连接使用TMS靶向。然而，这种个体定位的可重复性可能对可行性提出重大挑战。我们的目的是比较基于新型抑郁核心网络模型（CNM）的目标图与基于sgACC功能连接的目标图和基于rAI有效连接的目标图的可重复性。我们进一步测试了使用电影刺激是否增加了基于个性化功能连接的定向的可行性。材料和方法：在31例难治性重度抑郁症患者的最终样本中，靶图的可重复性被计算为DLPFC成像过程中的受试者内部空间相关性。在连接模型之间比较了可重复性。在此基础上，比较了静息状态与电影状态在功能磁共振成像（fMRI）过程中的重复性、头部运动、主观警觉性和舒适度。结果：当使用电影刺激时，基于CNM功能连接的DLPFC目标图比基于sgACC或rai的目标图更具可重复性。特别是，来自CNM的cingulo- operocular种子在静息状态和电影刺激条件下都产生了高重复性的目标图。与静息状态相比，在fMRI过程中，电影刺激减少了头部运动，但在统计学上没有显著提高重复性。结论：我们的研究结果支持未来对多种子功能连接靶向方法的研究，包括那些专注于扣谷-眼窝区域的方法。这些发现也鼓励进一步研究使用自然刺激来提高个体化经颅磁刺激靶向的可行性。

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引用次数: 0

Challenging the Excitatory–Inhibitory Dichotomy Dogma of Intermittent Theta-Burst Stimulation and Continuous Theta-Burst Stimulation 挑战间歇性脉冲刺激和连续脉冲刺激的兴奋-抑制二分法。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-07-23 DOI: 10.1016/j.neurom.2025.06.011

Molly S. Hermiller PhD

引用次数: 0

Ultrasound Applications in the Treatment of Major Depressive Disorder: A Systematic Review of Techniques and Therapeutic Potentials in Clinical Trials and Animal Model Studies 超声在重度抑郁症治疗中的应用：临床试验和动物模型研究的技术和治疗潜力的系统综述。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-10-16 DOI: 10.1016/j.neurom.2025.08.001

Gansheng Tan MEng , Hong Chen PhD , Eric C. Leuthardt MD

<div><h3>Objective</h3><div>Major depressive disorder (MDD) is a debilitating condition that inflicts significant personal and economic burdens and affects approximately 8% of the US population. Approximately 30% of patients with MDD do not respond to conventional antidepressant and psychotherapeutic treatments. Current treatment options for refractory MDD include transcranial magnetic stimulation (TMS) and invasive surgical procedures such as surgical ablation, vagus nerve stimulation, and deep brain stimulation. In this context, therapeutic ultrasound emerges as a promising alternative for treating refractory MDD, which has the unique advantage of combining noninvasiveness with selective targeting. Over the past ten years, there has been growth in focused ultrasound research, leading to an exponential increase in interest in the technology. To support the future development of ultrasound for treating MDD, we conducted a systematic review following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.</div></div><div><h3>Materials and Methods</h3><div>We identified 86 relevant studies from 1975 through June 2025. Our inclusion criteria were peer-reviewed prospective cohort studies, case-control studies, and randomized controlled trials that report ultrasound efficacy for treating depression in humans or depressive-like behaviors in animal models (International Prospective Register of Systematic Reviews registration number: CRD42024626093); 23 studies met all the inclusion criteria. We summarized ultrasonic techniques for treating depression and their efficacy.</div></div><div><h3>Results</h3><div>We identified two focused ultrasound techniques used to treat depression, including magnetic resonance-guided focused ultrasound (MRgFUS) for capsulotomy and low-intensity focused ultrasound (LIFUS) neuromodulation. MRgFUS capsulotomy causes permanent lesioning, whereas LIFUS is nonlesional and believed to have temporary effects. In human trials, the response rate (≥50% improvement in depression score from baseline) was 41.7% at 12 months postoperatively for MRgFUS capsulotomy and 56.3% for LIFUS neuromodulation, respectively. The odds ratio for LIFUS neuromodulation was 5.8. In addition, LIFUS neuromodulation had a large effect (|Cohen’s <em>d</em>| > 0.8) on reducing standard depression scale scores in humans or resolving depressive-like behaviors in rodents. The certainty of evidence is moderate for human trials and low for rodent models. MRgFUS capsulotomy had inconsistent lesioning success and a limited response rate, whereas LIFUS neuromodulation lacked systematic exploration of the parameter space and clear delineation of the underlying mechanisms. Future work should refine patient selection for MRgFUS capsulotomy and optimize the parameters for individualized functional targeting.</div></div><div><h3>Conclusions</h3><div>LIFUS neuromodulation achieved a large reduction in depressive behaviors in both rodent models and

目的：重度抑郁症（MDD）是一种使人衰弱的疾病，它给个人和经济造成了巨大的负担，影响了大约8%的美国人口。大约30%的重度抑郁症患者对传统的抗抑郁药和心理治疗无效。目前难治性重度抑郁症的治疗方案包括经颅磁刺激（TMS）和侵入性外科手术，如手术消融、迷走神经刺激和深部脑刺激。在这种背景下，治疗性超声作为治疗难治性重度抑郁症的一种有希望的替代方法，具有非侵入性和选择性靶向的独特优势。在过去的十年里，聚焦超声的研究一直在增长，导致人们对这项技术的兴趣呈指数级增长。为了支持超声治疗重度抑郁症的未来发展，我们根据系统评价和荟萃分析指南的首选报告项目进行了系统评价。材料和方法：从1975年到2025年6月，我们确定了86项相关研究。我们的纳入标准是同行评审的前瞻性队列研究、病例对照研究和随机对照试验，这些研究报告了超声治疗人类抑郁症或动物模型中抑郁样行为的疗效（国际前瞻性系统评价注册号：CRD42024626093）；23项研究符合所有纳入标准。综述了超声技术在抑郁症治疗中的应用及其疗效。结果：我们确定了两种用于治疗抑郁症的聚焦超声技术，包括用于囊膜切开术的磁共振引导聚焦超声（MRgFUS）和低强度聚焦超声（LIFUS）神经调节。MRgFUS囊切除术会造成永久性损伤，而LIFUS则不会造成损伤，而且被认为有暂时的影响。在人体试验中，MRgFUS囊膜切除术术后12个月的缓解率（抑郁评分较基线改善≥50%）分别为41.7%和56.3%。LIFUS神经调节的优势比为5.8。此外，LIFUS神经调节在降低人类标准抑郁量表评分或解决啮齿动物抑郁样行为方面具有很大的作用（|Cohen's d| > 0.8）。证据的确定性在人体试验中是中等的，在啮齿动物模型中是低的。MRgFUS包膜切开术有不一致的病变成功和有限的反应率，而LIFUS神经调节缺乏对参数空间的系统探索和对潜在机制的明确描述。未来的工作应细化MRgFUS囊切开术的患者选择，并优化个性化功能靶向的参数。结论：LIFUS神经调节在啮齿动物模型和人体试验中均能显著减少抑郁行为。我们得出结论，LIFUS神经调节是治疗难治性重度抑郁症的一种有希望的、无创的选择。

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引用次数: 0

Long-term Efficacy of Repetitive Transcranial Magnetic Stimulation at Motor Cortex for Mild Traumatic Brain Injury-Related Headaches 重复经颅磁刺激运动皮层治疗轻度外伤性脑损伤相关头痛的长期疗效。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-02-01 Epub Date: 2025-10-19 DOI: 10.1016/j.neurom.2025.09.308

Albert Leung MD , Michael Ho BS , Michael Vaninetti MD , Paul Krug DNP , Thomas Rutledge PhD , Lisa Lin MD , Alice Tsai DO , Lu Le MD , Carl Rimmele PhD , Roland Lee MD , Shahrokh Golshan PhD

Objectives

Persistent headaches with frequent debilitating headache exacerbation are some of the most common debilitating chronic pain conditions in either military or civilian populations with mild traumatic brain injury (MTBI). This high prevalence of MTBI-related headaches (MTBI-HA), also known as persistent headache attributed to mild traumatic injury to the head by the International Classification of Headache Disorders, is often associated with neuropsychologic dysfunction in mood, attention, and memory. Thus, MTBI-HA casts a profound, negative impact on patients’ quality of life and increases stress in their caregivers. This double-blind, randomized controlled trial aimed to assess the effect of repetitive transcranial magnetic stimulation (rTMS) in reducing both persistent and debilitating headache symptoms and comorbid neuropsychologic impairments.

Methods and Materials

Ten sessions of active (10 Hz) or sham rTMS were delivered to the left motor cortex (MC) under magnetic resonance imaging-based neuronavigation guidance with headache, cognitive, and mood assessments up to three months post treatment.

Results

Overall mixed effect model indicates active rTMS can significantly (p < 0.001) reduce the between-visit frequency of persistent headache and the duration of debilitating headache, respectively, long-term (three-month) and midterm (two-month) posttreatment visits with associated improvement in daily activity and concentration interference, attention and word processing speed, and retention and recall accuracy.

Conclusions

In short, ten sessions of rTMS at the left MC can effectively reduce headache symptoms and interferences of concentration and daily activities. The treatment also can improve concentration and relieve some aspects of cognitive impairment associated with MTBI-HA although the treatment may cause a mild degree of transient short-term persistent headache exacerbation without ongoing maintenance intervention. Future studies should focus on the utilization of maintenance rTMS after the induction treatment phase in sustaining the benefits of the intervention.

Clinical Trial Registration

The Clinicaltrials.gov registration number for the study is NCT03314584.

目的：持续性头痛伴频繁的衰弱性头痛加重是军人或平民轻度创伤性脑损伤（MTBI）人群中最常见的衰弱性慢性疼痛状况。mtbi相关性头痛（MTBI-HA）的高流行率，也被称为持续性头痛，根据国际头痛疾病分类归因于头部轻度创伤性损伤，通常与情绪、注意力和记忆方面的神经心理功能障碍有关。因此，MTBI-HA对患者的生活质量产生了深远的负面影响，并增加了护理人员的压力。这项双盲、随机对照试验旨在评估重复性经颅磁刺激（rTMS）在减少持续性和衰弱性头痛症状以及共病神经心理损伤方面的效果。方法和材料：治疗后3个月，在基于磁共振成像的神经导航引导下，将10次主动（10hz）或假rTMS送入左运动皮质（MC），并进行头痛、认知和情绪评估。结果：总体混合效应模型显示，主动rTMS治疗组可显著（p < 0.001）降低持续性头痛的访视频次和衰弱性头痛的持续时间，治疗后长期（3个月）和中期（2个月）访视，并改善日常活动和注意力干扰、注意力和文字处理速度、记忆和回忆准确性。结论：简而言之，10次rTMS可有效减轻头痛症状，减少对注意力和日常活动的干扰。该治疗还可以提高注意力，缓解与MTBI-HA相关的认知障碍的某些方面，尽管该治疗可能导致轻度的短暂性、短期持续性头痛加剧，而无需持续的维持干预。未来的研究应侧重于在诱导治疗阶段后使用维持性rTMS来维持干预的益处。临床试验注册：该研究的Clinicaltrials.gov注册号为NCT03314584。

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引用次数: 0