英智經(jīng)顱磁刺激（TMS）治療如何定位？

發(fā)布時(shí)間：2024-10-18
來(lái)源：
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精準(zhǔn)定位是進(jìn)行閾值檢測(cè)和保證治療效果的重要基石。英智經(jīng)顱磁刺激儀（TMS）定位方法基于國(guó)際公認(rèn)的10-20腦電定位系統(tǒng)，具有快速準(zhǔn)確找尋刺激靶點(diǎn)的優(yōu)勢(shì)，適用于常規(guī)臨床的大樣本治療和腦區(qū)功能探究。

未標(biāo)題-1-1024x300

定位流程

1. 閾值測(cè)定后，依據(jù)安全篩查量表及患者病情，在英智經(jīng)顱磁刺激儀（TMS）系統(tǒng)軟件中選擇治療方案。

2. 根據(jù)治療方案，確定目標(biāo)靶區(qū)與定位帽刺激靶點(diǎn)（見(jiàn)下圖）。

3. 移動(dòng)線圈使磁場(chǎng)輸出中心與刺激靶點(diǎn)重合，線圈須與頭皮相切，保證磁場(chǎng)接收最大化。

4. 調(diào)整好位置后，將線圈固定，按照所選方案的參數(shù)開始治療。

注意事項(xiàng)

1. 治療過(guò)程中，應(yīng)主動(dòng)詢問(wèn)患者感受及耐受度以決定是否需要調(diào)整刺激強(qiáng)度。如需調(diào)整，以1%的幅度調(diào)整刺激強(qiáng)度。

2. 治療期間，應(yīng)要求患者保持姿勢(shì)不變，避免刺激脫靶。

基于國(guó)際10-20系統(tǒng)的TMS刺激靶點(diǎn)及適應(yīng)癥^[1]

腦區(qū)名稱	電極位點(diǎn)		Brodmann分區(qū)^[1,29]	TMS適應(yīng)癥^[30]
腦區(qū)名稱	左半球	右半球	Brodmann分區(qū)^[1,29]	TMS適應(yīng)癥^[30]
眶額葉皮質(zhì) （Orbitofrontal cortex，OFC）	Fp1^[2]	Fp2^[3]	10區(qū)	抑郁癥^[31]；強(qiáng)迫癥^[32]；中風(fēng)后意識(shí)障礙^[33]等
背外側(cè)前額葉（Dorsolateral prefrontal cortex，DLPFC）	F3^[4]	F4^[5]	46區(qū)	抑郁癥^[34]；焦慮抑郁癥^[35]；帕金森抑郁^[36]；纖維肌痛^[37]；物質(zhì)成癮^[38]；精神分裂癥陰性癥狀^[39]；意識(shí)障礙^[40]；失眠^[41]；創(chuàng)傷后應(yīng)激障礙^[42]；強(qiáng)迫癥^[43]等
前額下回（Inferior frontal gyrus，IFG）	F7^[6]	F8^[7]	45，46區(qū)	卒中后失語(yǔ)癥^[44]；兒童注意力缺陷障礙（語(yǔ)言發(fā)育遲緩）^[45]等
初級(jí)運(yùn)動(dòng)皮層-手部熱點(diǎn) （Hand hotspots in primary motor cortex,HH-M1）	C3^[8]	C4^[9]	4區(qū)	腦卒中運(yùn)動(dòng)障礙^[46]；神經(jīng)性疼痛^[47]；帕金森運(yùn)動(dòng)障礙^[48]；意識(shí)障礙^[49]；纖維肌痛^[50]；肌張力異常^[51]；多發(fā)性硬化^[52]等
顳中上回（Superior middle temporal gyrus，SMTG）	T3^[10]	T4^[11]	21，22區(qū)	耳鳴^[53]，幻聽^[54]等
頂枕交界處角回（Angular gyrus of parietal occipital junction，AG-POJ）	P3^[12]	P4^[13]	7區(qū)	卒中后偏側(cè)忽視^[55]；冰毒成癮^[56]等
緣上回（Superior marginal gyrus，SMG）	TP3^[14]	TP4^[15]	39，40區(qū)	精神分裂幻聽癥狀^[57]；耐藥性幻聽^[58]；抑郁癥幻聽^[59]
后顳葉海馬旁回（Parahippocampal gyrus of posterior temporal lobe，PHG-PTL）	T5^[16]	T6^[17]	37，19，37，39區(qū)	阿爾茨海默病輕度認(rèn)知障礙^[60]；耳鳴^[61]等
輔助運(yùn)動(dòng)區(qū) （Supplementary Motor Cortex，SMA）	Fz^[18]		6區(qū)	帕金森病運(yùn)動(dòng)障礙^[62]；震顫^[63]；肌張力異常^[64]；不寧腿綜合征^[65]；抽動(dòng)穢語(yǔ)綜合癥^[66]；強(qiáng)迫癥^[67]等
枕葉（Occipital lobe）	O1^[19]	O2^[20]	17區(qū)	卒中后吞咽障礙^[68]；慢性腦卒中肢體功能障礙^[69]；帕金森病共濟(jì)失調(diào)^[70]等
顳頂聯(lián)合區(qū) （Temporoparietal junction,TPJ）	T3-P3連線的中點(diǎn)^[21]	T4-P4連線的中點(diǎn)^[22]	41，42區(qū)	慢性耳鳴^[71]；精神分裂癥幻聽^[72]等
布洛卡區(qū) （Broca's area）	T3-Fz連線與F7-Cz連線的交叉點(diǎn)^[23]	T4-Fz連線與F8-Cz連線的交叉點(diǎn)^[24]	44，45區(qū)	失語(yǔ)癥^[73]；卒中后失語(yǔ)^[74]；阿爾茨海默病語(yǔ)言認(rèn)知異常^[75]；精神分裂幻聽^[76]等
韋尼克區(qū) （Wernicke’s area）	C3-T5連線與T3-P3連線的交叉點(diǎn)^[25]	C4-T6連線與P4-T4連線的交叉點(diǎn)^[26]	22區(qū)	阿爾茨海默病（語(yǔ)言理解異常）^[75]；卒中后失語(yǔ)^[77]等
初級(jí)運(yùn)動(dòng)皮層吞咽功能（Swallowing functional area of primary motor cortex，SFA-M1）	C3-T3連線的中點(diǎn)[27]	C4-T4連線的中點(diǎn)[28]	4區(qū)	卒中后吞咽障礙[78]；帕金森吞咽困難[79]等

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