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重复经颅磁刺激治疗在儿童和青少年神经发育障碍中的临床疗效:系统评价。

Clinical effectiveness of repetitive transcranial magnetic stimulation treatment in children and adolescents with neurodevelopmental disorders: A systematic review.

机构信息

1 Keio University School of Medicine, Japan.

2 Shiga University of Medical Science, Japan.

出版信息

Autism. 2019 Oct;23(7):1614-1629. doi: 10.1177/1362361318822502. Epub 2019 Jan 20.

Abstract

Neurodevelopmental disorders, including autism spectrum disorder, are common in children and adolescents, but treatment strategies remain limited. Although repetitive transcranial magnetic stimulation has been studied for neurodevelopmental disorders, there is no clear consensus on its therapeutic effects. This systematic review examined literature on repetitive transcranial magnetic stimulation for children and adolescents with neurodevelopmental disorders published up to 2018 using the PubMed database. The search identified 264 articles and 14 articles met eligibility criteria. Twelve of these studies used conventional repetitive transcranial magnetic stimulation and two studies used theta burst stimulation. No severe adverse effects were reported in these studies. In patients with autism spectrum disorder, low-frequency repetitive transcranial magnetic stimulation and intermittent theta burst stimulation applied to the dorsolateral prefrontal cortex may have therapeutic effects on social functioning and repetitive behaviors. In patients with attention deficit/hyperactivity disorder, low-frequency repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex and high-frequency repetitive transcranial magnetic stimulation applied to the right dorsolateral prefrontal cortex may target inattention, hyperactivity, and impulsivity. In patients with tic disorders, low-frequency repetitive transcranial magnetic stimulation applied to the bilateral supplementary motor area improved tic symptom severity. This systematic review suggests that repetitive transcranial magnetic stimulation may be a promising intervention for children and adolescents with neurodevelopmental disorders. The results warrant further large randomized controlled trials of repetitive transcranial magnetic stimulation in children with neurodevelopmental disorders.

摘要

神经发育障碍,包括自闭症谱系障碍,在儿童和青少年中很常见,但治疗策略仍然有限。尽管重复性经颅磁刺激已被用于神经发育障碍的研究,但对于其治疗效果尚无明确共识。本系统评价使用 PubMed 数据库,对截至 2018 年发表的关于重复性经颅磁刺激治疗神经发育障碍儿童和青少年的文献进行了研究。检索共确定了 264 篇文章,其中 14 篇符合纳入标准。这些研究中有 12 篇使用了传统的重复性经颅磁刺激,有 2 篇使用了 theta 爆发刺激。这些研究均未报告严重不良事件。在自闭症谱系障碍患者中,低频重复性经颅磁刺激和间歇性 theta 爆发刺激应用于背外侧前额叶可能对社会功能和重复行为具有治疗作用。在注意缺陷/多动障碍患者中,低频重复性经颅磁刺激应用于左侧背外侧前额叶和高频重复性经颅磁刺激应用于右侧背外侧前额叶可能针对注意力不集中、多动和冲动。在抽动障碍患者中,双侧辅助运动区的低频重复性经颅磁刺激改善了抽动症状的严重程度。本系统评价表明,重复性经颅磁刺激可能是神经发育障碍儿童和青少年有希望的干预措施。结果需要进一步在神经发育障碍儿童中开展重复性经颅磁刺激的大型随机对照试验。

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