重複經顱磁刺激於心身醫學的應用

functional somatic symptoms, repeated transcranial magnetic stimulation, placebo effect

近年來重複經顱磁刺激是精神醫學頗受重視的新治療模式，透過磁場感應電流剌激特定的腦區，可讓該腦區被活化或抑制，進而產生治療效果。重複經顱磁刺激常以背外側前額葉為刺激標的，刺激此區域，可能使數個腦部神經網路（預設模式網路、中央執行網路、警覺網路）的功能性連結正常化，而改善憂鬱、焦慮、功能性身體症狀。刺激初級運動皮質，則有助於改善慢性疼痛；除前述機轉，可能額外活化導水管周圍灰質而分泌內源性嗎啡。近年功能性腦影像研究發現，安慰劑效應與重複經顱磁刺激活化的腦區高度重疊，暗示其神經機轉可能有共通之處。本文回顧近期文獻，整理重複經顱磁刺激，對功能性的身體症狀有實證的治療模式；嘗試探討神經機轉，以期能對未來臨床與研究有所啟發。

Repeated transcranial magnetic stimulation (rTMS) is a promising new treatment modality in psychiatry. It involves the use of induced electric current of a magnetic field to stimulate specific areas of the brain, which can lead to changes in brain activity and subsequent therapeutic effects. The dorsolateral prefrontal cortex (DLPFC) is a commonly targeted area for rTMS treatment. Stimulation of the DLPFC has been shown to normalize the functional connectivity of several neural networks, including the default mode network, central executive network, and salience network. This can lead to improvements in symptoms of depression, anxiety, and functional somatic symptoms. The primary motor cortex is another target for rTMS treatment, and it has been shown to relieve chronic pain by activating the periaqueductal grey and increasing endorphin release. Recent research using functional brain imaging has revealed overlap between the brain areas associated with the placebo effect and those activated by rTMS, suggesting a common neural mechanism at play. This article reviews recent studies on the use of rTMS for functional somatic symptoms and discusses the potential underlying neural mechanisms. The goal is to provide guidance for future clinical practice and research in this area.