英智经颅磁刺激（TMS）治疗如何定位？

发布时间：2022-05-30
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精准定位是进行阈值检测和保证治疗效果的重要基石。英智经颅磁刺激仪（TMS）定位方法基于国际公认的10-20脑电定位系统，具有快速准确找寻刺激靶点的优势，适用于常规临床的大样本治疗和脑区功能探究。

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定位流程

1. 阈值测定后，依据安全筛查量表及患者病情，在英智经颅磁刺激仪（TMS）系统软件中选择治疗方案。

2. 根据治疗方案，确定目标靶区与定位帽刺激靶点（见下图）。

3. 移动线圈使磁场输出中心与刺激靶点重合，线圈须与头皮相切，保证磁场接收最大化。

4. 调整好位置后，将线圈固定，按照所选方案的参数开始治疗。

注意事项

1. 治疗过程中，应主动询问患者感受及耐受度以决定是否需要调整刺激强度。如需调整，以1%的幅度调整刺激强度。

2. 治疗期间，应要求患者保持姿势不变，避免刺激脱靶。

基于国际10-20系统的TMS刺激靶点及适应症^[1]

脑区名称	电极位点		Brodmann分区^[1,29]	TMS适应症^[30]
脑区名称	左半球	右半球	Brodmann分区^[1,29]	TMS适应症^[30]
眶额叶皮质（Orbitofrontal cortex，OFC）	Fp1^[2]	Fp2^[3]	10区	抑郁症^[31]；强迫症^[32]；中风后意识障碍^[33]等
背外侧前额叶（Dorsolateral prefrontal cortex，DLPFC）	F3^[4]	F4^[5]	46区	抑郁症^[34]；焦虑抑郁症^[35]；帕金森抑郁^[36]；纤维肌痛^[37]；物质成瘾^[38]；精神分裂症阴性症状^[39]；意识障碍^[40]；失眠^[41]；创伤后应激障碍^[42]；强迫症^[43]等
前额下回（Inferior frontal gyrus，IFG）	F7^[6]	F8^[7]	45，46区	卒中后失语症^[44]；儿童注意力缺陷障碍（语言发育迟缓）^[45]等
初级运动皮层-手部热点（Hand hotspots in primary motor cortex,HH-M1）	C3^[8]	C4^[9]	4区	脑卒中运动障碍^[46]；神经性疼痛^[47]；帕金森运动障碍^[48]；意识障碍^[49]；纤维肌痛^[50]；肌张力异常^[51]；多发性硬化^[52]等
颞中上回（Superior middle temporal gyrus，SMTG）	T3^[10]	T4^[11]	21，22区	耳鸣^[53]，幻听^[54]等
顶枕交界处角回（Angular gyrus of parietal occipital junction，AG-POJ）	P3^[12]	P4^[13]	7区	卒中后偏侧忽视^[55]；冰毒成瘾^[56]等
缘上回（Superior marginal gyrus，SMG）	TP3^[14]	TP4^[15]	39，40区	精神分裂幻听症状^[57]；耐药性幻听^[58]；抑郁症幻听^[59]
后颞叶海马旁回（Parahippocampal gyrus of posterior temporal lobe，PHG-PTL）	T5^[16]	T6^[17]	37，19，37，39区	阿尔茨海默病轻度认知障碍^[60]；耳鸣^[61]等
辅助运动区（Supplementary Motor Cortex，SMA）	Fz^[18]		6区	帕金森病运动障碍^[62]；震颤^[63]；肌张力异常^[64]；不宁腿综合征^[65]；抽动秽语综合症^[66]；强迫症^[67]等
枕叶（Occipital lobe）	O1^[19]	O2^[20]	17区	卒中后吞咽障碍^[68]；慢性脑卒中肢体功能障碍^[69]；帕金森病共济失调^[70]等
颞顶联合区（Temporoparietal junction,TPJ）	T3-P3连线的中点^[21]	T4-P4连线的中点^[22]	41，42区	慢性耳鸣^[71]；精神分裂症幻听^[72]等
布洛卡区（Broca's area）	T3-Fz连线与F7-Cz连线的交叉点^[23]	T4-Fz连线与F8-Cz连线的交叉点^[24]	44，45区	失语症^[73]；卒中后失语^[74]；阿尔茨海默病语言认知异常^[75]；精神分裂幻听^[76]等
韦尼克区（Wernicke’s area）	C3-T5连线与T3-P3连线的交叉点^[25]	C4-T6连线与P4-T4连线的交叉点^[26]	22区	阿尔茨海默病（语言理解异常）^[75]；卒中后失语^[77]等
初级运动皮层吞咽功能（Swallowing functional area of primary motor cortex，SFA-M1）	C3-T3连线的中点[27]	C4-T4连线的中点[28]	4区	卒中后吞咽障碍[78]；帕金森吞咽困难[79]等

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