반복 경두개 자기자극의 임상적용과 자극효과의 뇌파연구 = The Clinical Applications and the Electroencephalogram Effects of Repeated Transcranial Magnetic Stimulation

다국어 초록 (Multilingual Abstract)

Repetitive transcranial magnetic stimulation (rTMS) has been applied in a variety of diseases due to the clinical effects through the plasticity of the brain. The effects of TMS appear differently depending on the methods of stimulation. Single pulse TMS depolarizes and discharges nerves temporally under the cortex areas stimulated, whereas rTMS induces longlasting effects of nerves stimulated. According to the intensity of stimulation, the direction of coil and stimulation frequency,rTMS can increase or decrease the excitability of the corticospinal tract and has been verified as techniques to treat a variety of neuropsychiatric disorders. In rTMS studies using electroencephalogram (EEG), changes in brain waves have been measured before and after TMS or simultaneously during TMS. In these studies, low frequency (≤1 Hz) rTMS, high-frequency (5-25 Hz) rTMS, theta burst stimulation, paired association stimulation have been studied and somatosensory, visual, cognitive,and motor potentials and oscillatory activities were measured and compared before and after TMS. Combined with neurophysiological and, neuroimaging methods, TMS techniques could be used to study cortical excitability, cortical inhibition and excitement, and the cortical plasticity of local areas and neural network. In particular, because simultaneous measurement during TMS as well as measurement before and after TMS is possible, EEG could be very useful to determine the effects of TMS compared to other brain imaging tools.

국문 초록 (Abstract)

신경생리학적(neurophysiologic) 방법이나 신경영상학적(neuroimaging) 방법들과 병합한 rTMS, TBS, PAS를 포함한TMS 자극기법들은 피질의 생리학적 과정을 조절할 수 있는수많은 TMS 실험 패러다임으로 많은 연구들이 진행되어 왔다. 특히 이 기법으로 TMS는 피질 흥분성, 피질내 억제와 흥분 기전, 국지영역 및 연결망의 피질 가소성을 연구할 수 있다. 기능 및 전기생리학적 방법과 함께 TMS는 정상적인 신경발달과 노화뿐만 아니라 신경정신과적 질환의 기제를 연구하는 데 있어 통찰을 제공할 수 있다.99) 또한 TMS는 인지적 과제에 대한 뇌의 국부 활성화 또는 억제 기제를 통해 실험적 연구에 활용될 수 있을 뿐만 아니라 정신과 질환이나 신경과 질환의 치료 목적으로 사용될 수 있다. 최근 fRMI나PET과 같은 뇌영상 연구뿐만 아니라 EEG를 이용하여 TMS 의 효과를 확인한 연구들이 나오고 있는데, 특이 EEG는TMS 전후의 효과 측정뿐만 아니라 동시에 측정도 가능하기에 다른 뇌영상 도구에 비해 효과를 확인하는 데 매우 유용하게 활용될 수 있을 것이다. 하지만 이런 TMS와 EEG 병합연구는 모두 일시적인 효과를 확인한 연구였다. 장기적인 치료효과를 확인한 연구는 아직까지 없었다. 앞으로는 이러한 장기 효과를 확인하는 연구를 진행하는 것이 의미가 있을 것이다.

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