非侵入性脑刺激应用于创伤后应激障碍和物质滥用障碍的记忆干预

记忆是进行思维、想象等高级心理活动的基础，是累积经验、促进个体生存的重要功能。然而，创伤后应激障碍和物质滥用障碍具有某种非适应性记忆过强的特征，不利于个体生存。因此，以病理性改变的记忆为靶点，通过削弱或更新非适应性记忆，可以达到缓解症状甚至治愈的目的。记忆并非是对经验的刻板记录，而是对经验不断更新整合的过程，因此记忆有被干预的可能。记忆的再次激活可能会诱发记忆消退和再巩固，这为记忆相关精神疾病的干预提供了思路和启发。非侵入性脑刺激（noninvasive brain stimulation,NIBS）技术作为一种时间、空间分辨率较高的无创神经调控技术，近年来开始被结合运用到记忆干预研究中。不同刺激参数的NIBS （如频率、极性，以及受刺激区域的初始神经激活状态）应用于特定大脑皮质区域，可以调节神经可塑性，增强或降低靶点脑区的兴奋性，从而削弱或增强行为表现，实现记忆消退增强或在再巩固时间窗内干预记忆。本文首先介绍了记忆相关的脑功能基础研究与局部脑区干预方案的理论联系，继而回顾了近年来NIBS与记忆干预相结合应用于创伤或物质滥用相关障碍的临床干预研究，为精神疾病临床诊疗提供理论依据和启发。

Areview of Memory Intervention With Noninvasive Brain Stimulation in Post-traumatic Stress Disorder and Substance Use Disorder

Memory is an essential function for accumulating experience and promoting individual survival. However, post-traumatic stress disorder (PTSD) and substance use disorders (SUD) are characterized by maladaptive memory, which is unfavorable for individual survival. Therefore, one idea to develop treatment for PTSD and SUD, psychiatric disorders characterized by excessive fear memories or addiction memories, is to extinguish or update maladaptive memories. Memory intervention is based on the fact that memory is an ongoing process that allows updating and integrating information. The reactivation of memory may induce memory retrieval and reconsolidation, rendering a time window with increase plasticity of the neural circuits underlying the pieces of the retrieved memory. Interventions within this critical time window may have better therapeutic effect compared to interventions outside the time window. Noninvasive brain stimulation (NIBS), as a non-invasive physical therapy, has been viewed a candidate for maladaptive memory intervention. NIBS can be applied with specific stimulation parameters (anatomical targets, frequency, polarity, behavioral state, etc.) to achieve varied stimulation effects. NIBS can alter cortical excitability and modulate neuroplasticity in the targeted region or other brain regions connected to the targeted region. When NIBS is applied to memory related brain areas, it may disrupt or alter memory-related neural circuit activity thereby changing memory related emotion or behavioral performance. In this review, we summarize recent studies using NIBS (transcranial magnetic stimulation, TMS, and transcranial direct current stimulation, tDCS, mainly) interventions for trauma- or substance-use-related memory during memory reconsolidation, along with theoretical basis from brain imaging or preclinical evidence from rodent studies. There are two basic ideas for NIBS interventions in maladaptive memories, to enhance activity in extinction-related neural circuit by TMS or tDCS, or to suppress activity in brain areas related to maladaptive emotional or motivational processing during memory reconsolidation. Both ideas got supporting results from research in the laboratory, while there has been no convincing evidence from clinical application yet. This review summarizes research evidence about the application of NIBS in fear and addiction memory intervention and hopes to contribute to breed insights for the development of NIBS treatment for memory-related psychiatric disorders targeting reconsolidation process.