重复经颅磁刺激改善帕金森病运动症状的脑功能网络分析

目的 重复经颅磁刺激（rTMS）技术已广泛应用在临床中，实现对神经、精神类疾病的治疗，特别在抑郁症、强迫症中取得较好的临床治疗效果。近年来越来越多的研究将其应用于帕金森病（PD）的辅助、康复治疗，以期缓解患者的运动症状改善运动功能。目前临床中多以PD统一量表、运动任务评估rTMS对运动症状的辅助治疗效果，缺乏对高频rTMS刺激调控作用机制的探究。方法 本研究采用10 Hz rTMS刺激肢体症状始发侧对侧初级运动皮层（M1），对比分析刺激前后各脑区神经元活动及其连接性的变化，研究高频rTMS刺激初级运动皮层对PD患者大脑神经元活动的调节作用。结果 运动皮层beta振荡增加、gamma振荡降低（P<0.05），额、顶叶脑区间连接性减弱（P<0.05）。结论 10 Hz rTMS主要改变了PD患者beta、gamma振荡，其中运动皮层beta、gamma神经振荡的变化可能与磁刺激对运动功能的改善作用有关，而前额叶gamma振荡的变化可能是磁刺激抑制神经元异常放电活动调节患者运动控制功能。     

Gamma节律：认知障碍疾病的潜在诊断靶点

神经精神类疾病是威胁人类健康的重大疾病,具有高患病率的特点,且患者通常伴随有认知障碍.长期以来,临床针对神经精神疾病的诊断主要是根据患者的临床表现,缺乏统一的客观标准,治疗手段也具有一定的难度且会产生副作用.因此开发高效客观的诊疗方式是神经精神疾病研究和临床实践的重难点.脑电图是反映脑功能变化的一种临床检查方式,其特征性节律的检测可作为大脑损伤的指标. Gamma节律(γ节律)作为与认知相关的一个重要神经节律,在大脑高级功能中扮演重要角色.众多研究发现神经精神类疾病的患者和动物模型伴随有γ节律的紊乱,这预示着基于认知核心脑区γ节律的神经检测与调控可能实现精准诊疗.本文综述了面向神经退行性疾病和精神类疾病开展的γ节律研究进展,通过梳理以往研究中γ节律在调节认知、学习记忆时的特征规律和相关分子基础,提出γ节律可能成为未来临床检测神经精神疾病无创高效的客观靶标,并在此基础上对未来的研究进行了展望.     

神经调控技术在阿尔茨海默病认知障碍研究中的应用

阿尔茨海默病（Alzheimer’s disease, AD）是发生于老年和老年前期的中枢神经系统退行性疾病，其临床主要表现为进行性认知障碍。目前针对AD尚无有效的治疗方法，药物治疗只能延缓其病情进展，治疗效果有限，且常伴随副作用。近些年，神经调控作为一种可以靶向刺激调节目标脑区活动的方法受到广泛关注，逐渐被应用于AD的治疗和研究，包括无创的经颅磁刺激、电刺激以及有创的脑深部电刺激、光遗传刺激等。本文从作用效果、作用机制、刺激脑区、刺激参数等方面对这四种典型的神经调控方法在AD的应用研究现状进行综述，为今后神经调控应用于临床治疗AD提供新思路。     

节律性听觉刺激下的神经振荡同步化及其应用

大脑的感觉、情绪、认知等功能与其神经振荡模式有密切的联系。通过施加节律性刺激可以调控大脑的神经振荡模式,进而影响个体感受、情绪状态和认知功能等。与近年来常见的非侵入性电刺激和磁刺激相比,同样依赖于外部刺激输入的节律性感觉刺激具有成本低、易操作等优点,被认为是一种极具潜力的神经调控手段。本文以节律性听觉刺激为例,系统综述了不同类型的节律性听觉刺激如何影响大脑的神经振荡模式,进而影响相关状态和功能;并通过总结外部节律性听觉刺激对个体感知觉、情绪与认知功能的影响,讨论其生理机制和应用前景。     

经颅磁刺激和经颅直流电刺激在调控大脑共情功能中的应用

共情可以帮助人们建立和谐的人际关系，更好地适应现实社会，是一种重要的社会认知功能。已有研究表明，诸多神经和精神类疾病的发生发展和复发与共情缺陷有关。非侵入性脑刺激技术（经颅磁刺激和经颅直流电刺激）可以通过调节大脑皮层兴奋性来调控个体的共情水平，缓解共情缺陷症状。针对健康群体使用该技术的现有证据显示：内侧前额叶、初级运动皮层、额下回、背外侧前额叶和颞顶交界处的活动有助于提升个体的认知共情水平，其中双侧背外侧前额叶的活动还有助于下调个体的情感共情水平，而右侧颞顶交界处的活动则可以增强自我表征从而支持个体在共情时进行自我和他人的区分。少数针对共情缺陷群体使用该技术的临床证据提示，增强左侧背外侧前额叶和内侧前额叶的活动可以分别提升精神疾病和神经退行性疾病患者的认知共情水平。未来的研究应探讨在统一的行为测量范式下针对不同刺激参数和刺激位点进行共情干预研究，通过融合其他神经生理技术进一步考察非侵入性脑刺激技术改善共情功能的作用机制，并考虑个体差异性对大脑共情功能干预效果的影响。     

创伤后应激障碍的经颅磁刺激研究进展

创伤后应激障碍会损伤记忆、注意和执行等认知功能,引起异常的脑活动及脑区间功能连接.尽管药物治疗和心理干预能够取得一定的治疗效果,但存在药物副作用和起效延迟等问题.经颅磁刺激作为新的创伤后应激障碍干预手段受到越来越多的关注.本文通过综述经颅磁刺激干预创伤后应激障碍以及调控认知功能和脑活动的相关研究,系统探讨了创伤后应激障碍干预中经颅磁刺激模式、刺激靶点和疗效评估等问题,并提出未来借助更有效的技术手段进行定位、建立全面有效的评估体系和结合新的记忆理论探索具有长期临床改善效果的干预方案.     

经颅磁刺激与神经调控

近年来,人们已经认识到脑科学研究的重要性,而无创式脑神经刺激和调节技术已是脑科学领域一个常用的技术手段和工具,经颅磁刺激(transcranial magnetic stimulation, TMS)作为无创脑刺激最常用的技术,更是在治疗神经性疾病和脑科学研究中展示出了非常有潜力的应用价值。本文简单介绍了经颅磁刺激以及利用此项技术进行的临床和生理研究。     

太赫兹刺激听神经的测试平台搭建

目的 近年来，用于脑功能调控的神经调控技术蓬勃发展，很多方法已在临床上被推广应用，主要包括电极深部脑刺激、经颅磁刺激、光遗传技术、超声深脑刺激等。但是这些调控技术存在刺激靶点改变灵活性差、空间分辨率不足、需要注射病毒转染等问题。与这些技术相比，太赫兹波调控则能以较高的时空分辨率、无需引入外源基因的方式对神经活动进行干预。激光神经刺激是一种具有较明确靶向性的刺激方法，可以通过调整不同激光参数（激光波长、脉冲能量等）控制引起神经兴奋或者抑制。但是由于该研究方向的实验手段和实验平台的缺乏，相关研究开展较少。方法 针对这个问题，从听觉神经入手，在分子、细胞和在体不同层面为相关领域的研究搭建了不同的测试平台。结果 实验结果表明，这些系统在时间和空间上具有良好的耦合性和靶向性，测得的信号受噪音干扰小。结论 这些系统可以有效测试神经系统对太赫兹刺激的响应并精确控制刺激时间和位置。     

时域相干刺激研究进展

脑深部电刺激已成为许多神经和精神疾病的有效治疗方法。然而,侵入性的电极植入会带来手术并发症的风险,并且刺激靶区在植入后很难改变。经颅磁刺激和经颅电刺激等非侵入性刺激方法为调节大脑功能提供了新的途径。但是,尚未证明这些非侵入性脑刺激方法可以直接调节脑深部神经元活动而不影响皮层神经元。因此,这些方法主要用于调节大脑表层脑区的神经活动。时域相干（temporal interference,TI）刺激是通过两个高频电场相互作用,产生低频包络调节神经活动的一种非侵入式脑深部电刺激的新方法,该方法有望解决无创脑深部刺激的需求。本文首先介绍TI刺激的概念以及安全性,然后阐述TI刺激现有研究中的电场分析方法,并讨论电场分析相关的生理模型建模方法和仿真平台以及TI刺激诱发场分布的研究进展与在动物和人体中的应用进展。最后,本文展望了TI刺激技术未来发展方向,以期为无创脑深部刺激研究提供新的研究思路。     

重复经颅磁刺激对卒中后抑郁的治疗效果及机制

卒中后抑郁（post-stroke depression,PSD）是并发于脑血管病的一种情感障碍疾病，发病率高，预后差。重复经颅磁刺激（repetitive transcranial magnetic stimulation,r TMS）是通过磁场变化在大脑中产生感应电流来刺激皮层的非创伤性脑刺激技术，是临床上治疗PSD的一种重要非药物治疗方法，可以显著改善PSD患者的抑郁症状。但目前rTMS的作用机制不明确。本文总结了PSD治疗中有效的rTMS刺激方案，并结合PSD的单胺类神经递质相关致病假说及PSD的临床治疗手段，探索了rTMS通过对单胺类神经递质的调控参与PSD治疗的可能机制。rTMS刺激诱导的皮层单胺类递质释放增加、葡萄糖代谢上升、皮层兴奋性增加，提高了单胺类神经递质和脑源性神经营养因子（brain-derived neurotrophic factor,BDNF）水平，进而引发前额叶抑制功能上升、与下游脑区连接改变、脑网络功能的调整，可能是rTMS治疗PSD的重要机制之一。     

Sustained neural rhythms reveal endogenous oscillations supporting speech perception

Rhythmic sensory or electrical stimulation will produce rhythmic brain responses. These rhythmic responses are often interpreted as endogenous neural oscillations aligned (or “entrained”) to the stimulus rhythm. However, stimulus-aligned brain responses can also be explained as a sequence of evoked responses, which only appear regular due to the rhythmicity of the stimulus, without necessarily involving underlying neural oscillations. To distinguish evoked responses from true oscillatory activity, we tested whether rhythmic stimulation produces oscillatory responses which continue after the end of the stimulus. Such sustained effects provide evidence for true involvement of neural oscillations. In Experiment 1, we found that rhythmic intelligible, but not unintelligible speech produces oscillatory responses in magnetoencephalography (MEG) which outlast the stimulus at parietal sensors. In Experiment 2, we found that transcranial alternating current stimulation (tACS) leads to rhythmic fluctuations in speech perception outcomes after the end of electrical stimulation. We further report that the phase relation between electroencephalography (EEG) responses and rhythmic intelligible speech can predict the tACS phase that leads to most accurate speech perception. Together, we provide fundamental results for several lines of research—including neural entrainment and tACS—and reveal endogenous neural oscillations as a key underlying principle for speech perception.

Just as a child on a swing continues to move after the pushing stops, this study reveals similar entrained rhythmic echoes in brain activity after hearing speech and electrical brain stimulation; perturbation with tACS shows that these brain oscillations help listeners to understand speech.     

综述: 知觉相关的神经振荡-外界节律同步化现象

具有特定频率的节律性刺激能同步大脑内相应频率的神经振荡,使神经活动与外界刺激发生相位锁定,称之为神经振荡-外界节律同步化(neural entrainment).这种同步化的现象伴随着大脑内神经元集群兴奋水平的周期性波动,并与节律信息加工、知觉及注意等认知过程存在关联.得益于其非侵入、易操作以及能有效调控神经活动的特性,神经振荡-外界节律同步化成为了研究神经振荡与知觉和认知功能关系的有力手段,也为认知障碍诊断及干预提供了新的思路和方法.     

Alpha-Band Rhythms in Visual Task Performance: Phase-Locking by Rhythmic Sensory Stimulation

Oscillations are an important aspect of neuronal activity. Interestingly, oscillatory patterns are also observed in behaviour, such as in visual performance measures after the presentation of a brief sensory event in the visual or another modality. These oscillations in visual performance cycle at the typical frequencies of brain rhythms, suggesting that perception may be closely linked to brain oscillations. We here investigated this link for a prominent rhythm of the visual system (the alpha-rhythm, 8–12 Hz) by applying rhythmic visual stimulation at alpha-frequency (10.6 Hz), known to lead to a resonance response in visual areas, and testing its effects on subsequent visual target discrimination. Our data show that rhythmic visual stimulation at 10.6 Hz: 1) has specific behavioral consequences, relative to stimulation at control frequencies (3.9 Hz, 7.1 Hz, 14.2 Hz), and 2) leads to alpha-band oscillations in visual performance measures, that 3) correlate in precise frequency across individuals with resting alpha-rhythms recorded over parieto-occipital areas. The most parsimonious explanation for these three findings is entrainment (phase-locking) of ongoing perceptually relevant alpha-band brain oscillations by rhythmic sensory events. These findings are in line with occipital alpha-oscillations underlying periodicity in visual performance, and suggest that rhythmic stimulation at frequencies of intrinsic brain-rhythms can be used to reveal influences of these rhythms on task performance to study their functional roles.     

Transcranial alternating current stimulation enhances individual alpha activity in human EEG

Non-invasive electrical stimulation of the human cortex by means of transcranial direct current stimulation (tDCS) has been instrumental in a number of important discoveries in the field of human cortical function and has become a well-established method for evaluating brain function in healthy human participants. Recently, transcranial alternating current stimulation (tACS) has been introduced to directly modulate the ongoing rhythmic brain activity by the application of oscillatory currents on the human scalp. Until now the efficiency of tACS in modulating rhythmic brain activity has been indicated only by inference from perceptual and behavioural consequences of electrical stimulation. No direct electrophysiological evidence of tACS has been reported. We delivered tACS over the occipital cortex of 10 healthy participants to entrain the neuronal oscillatory activity in their individual alpha frequency range and compared results with those from a separate group of participants receiving sham stimulation. The tACS but not the sham stimulation elevated the endogenous alpha power in parieto-central electrodes of the electroencephalogram. Additionally, in a network of spiking neurons, we simulated how tACS can be affected even after the end of stimulation. The results show that spike-timing-dependent plasticity (STDP) selectively modulates synapses depending on the resonance frequencies of the neural circuits that they belong to. Thus, tACS influences STDP which in turn results in aftereffects upon neural activity.The present findings are the first direct electrophysiological evidence of an interaction of tACS and ongoing oscillatory activity in the human cortex. The data demonstrate the ability of tACS to specifically modulate oscillatory brain activity and show its potential both at fostering knowledge on the functional significance of brain oscillations and for therapeutic application.     

Physiological origins and functional correlates of EEG rhythmic activities: Implications for self-regulation

Recent neurophysiological findings in relation to thalamocortical mechanisms for sensory processing, together with established anatomical and expanding functional evidence, have provided a rational theoretical framework for the interpretation of normal and abnormal EEG rhythmic activities. This perspective is integrated here with earlier animal studies which were the foundation for many current applications of EEG self-regulation as a clinical tool. Basic evidence concerning the origins, frequency modulation, and functional significance of normal EEG rhythmic activities is reviewed here in an effort to provide guiding principles for the interpretation of clinical abnormalities and their remediation with EEG feedback training.     

Modulation of Cortical Oscillations by Low-Frequency Direct Cortical Stimulation Is State-Dependent

Cortical oscillations play a fundamental role in organizing large-scale functional brain networks. Noninvasive brain stimulation with temporally patterned waveforms such as repetitive transcranial magnetic stimulation (rTMS) and transcranial alternating current stimulation (tACS) have been proposed to modulate these oscillations. Thus, these stimulation modalities represent promising new approaches for the treatment of psychiatric illnesses in which these oscillations are impaired. However, the mechanism by which periodic brain stimulation alters endogenous oscillation dynamics is debated and appears to depend on brain state. Here, we demonstrate with a static model and a neural oscillator model that recurrent excitation in the thalamo-cortical circuit, together with recruitment of cortico-cortical connections, can explain the enhancement of oscillations by brain stimulation as a function of brain state. We then performed concurrent invasive recording and stimulation of the human cortical surface to elucidate the response of cortical oscillations to periodic stimulation and support the findings from the computational models. We found that (1) stimulation enhanced the targeted oscillation power, (2) this enhancement outlasted stimulation, and (3) the effect of stimulation depended on behavioral state. Together, our results show successful target engagement of oscillations by periodic brain stimulation and highlight the role of nonlinear interaction between endogenous network oscillations and stimulation. These mechanistic insights will contribute to the design of adaptive, more targeted stimulation paradigms.     

Rhythm-suggestive compensation and unconscious regulatory mechanisms

The article describes a novel method of rhythm-suggestive compensation (RSC) for autonomous psychological support of crews, which takes into account the brain regulatory mechanisms of psychological defense. This method integrates several ways of optimization, such as rhythmic stimulation, binaural drumming, and verbal suggestion. The techniques of RSC are individually specific, taking into account the current features of the functional interaction between the brain’s hemispheres, the personal reaction to suggestive information, and individual psychological defense. Semantic suggestive patterns are modulated according to a certain algorithm and combined with rhythmic sensory stimulation. Therefore, controlled changes in the activities of the brain’s hemispheres and different regions of the brain are combined with an efficacious form of suggestion. The efficiency of RSC was evaluated in two groups of five combatants. The subjects of the first group received compensatory procedures that consisted of a simple combination of rhythmic audiovisual stimulation and verbal suggestion. The efficiency of the procedures was evaluated using the technique for the measurement of brain potentials evoked by emotionally engaging images. The subjects of the second group were treated using the RSC procedure. The RSC showed greater efficiency than rhythmic audiovisual stimulation. It was shown that regular repetition of rhythm-suggestive procedures enables us to optimize the mental state of subjects and form a stable mental set.     

Role of sound stimulation in reprogramming brain connectivity

Sensory stimulation has a critical role to play in the development of an individual. Environmental factors tend to modify the inputs received by the sensory pathway. The developing brain is most vulnerable to these alterations and interacts with the environment to modify its neural circuitry. In addition to other sensory stimuli, auditory stimulation can also act as external stimuli to provide enrichment during the perinatal period. There is evidence that suggests that enriched environment in the form of auditory stimulation can play a substantial role in modulating plasticity during the prenatal period. This review focuses on the emerging role of prenatal auditory stimulation in the development of higher brain functions such as learning and memory in birds and mammals. The molecular mechanisms of various changes in the hippocampus following sound stimulation to effect neurogenesis, learning and memory are described. Sound stimulation can also modify neural connectivity in the early postnatal life to enhance higher cognitive function or even repair the secondary damages in various neurological and psychiatric disorders. Thus, it becomes imperative to examine in detail the possible ameliorating effects of prenatal sound stimulation in existing animal models of various psychiatric disorders, such as autism.