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ENGLISH ABSTRACT
经颅直流电刺激治疗常见神经精神疾病的临床应用专家共识
唐睿
宋洪文
孔卓
艾珂丹·阿合买江
巫思宇
范川
崔官宝
王小平
王玉平
王化宁
王继军
邓伟
安建雄
孙洪强
李达
李则宣
李春波
何红波
周东升
单春雷
郭毅
曹歆轶
崔东红
胡少华
张效初
李凌江
作者及单位信息
·
DOI： 10.3760/cma.j.cn113661-20220527-00131
Chinese experts′ consensus on clinical application of transcranial direct current stimulation in the treatment of common neurological diseases and mental disorders
Tang Rui
Song Hongwen
Kong Zhuo
Aikedan·Ahemaijiang
Wu Siyu
Fan Chuan
Cui Guanbao
Wang Xiaoping
Wang Yuping
Wang Huaning
Wang Jijun
Deng Wei
An Jianxiong
Sun Hongqiang
Li Da
Li Zexuan
Li Chunbo
He Hongbo
Zhou Dongsheng
Shan Chunlei
Guo Yi
Cao Xinyi
Cui Donghong
Hu Shaohua
Zhang Xiaochu
Li Lingjiang
Authors Info & Affiliations
Tang Rui
Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230041,China
Song Hongwen
Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230041,China
Kong Zhuo
Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230041,China
Aikedan·Ahemaijiang
Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230041,China
Wu Siyu
Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230041,China
Fan Chuan
Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230041,China
Cui Guanbao
Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230041,China
Wang Xiaoping
National Clinical Research Center for Mental Disorders, Department of Psychiatry,the Second Xiangya Hospital of Central South University, Changsha 410011,China
Wang Yuping
Department of Neurology,Xuanwu Hospital, Capital Medical University,Beijing 100053,China
Wang Huaning
Department of Psychiatry,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032, China
Wang Jijun
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders,Shanghai 200030,China
Deng Wei
Affiliated Mental Health Center, Zhejiang University School of Medicine/Hangzhou Seventh People's Hospital,Hangzhou 310013,China
An Jianxiong
School of Anesthesiology and Department of Anesth,Pain and Sleep Medicine,Weifang Medical University,Weifang 261035,China
Sun Hongqiang
Peking University Sixth Hospital,Beijing 100191,China
Li Da
School of Scial Development, East China Normal University,Shanghai 200241,China
Li Zexuan
National Clinical Research Center for Mental Disorders, Department of Psychiatry,the Second Xiangya Hospital of Central South University, Changsha 410011,China
Li Chunbo
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders,Shanghai 200030,China
He Hongbo
Department of Psychosomatic Medicine, Brain Hospital Affiliated to Guangzhou Medical University,Guangzhou 513700,China
Zhou Dongsheng
Physical Diagnosis and Treatment Center of Ningbo Kangning Hospital, Ningbo 315201,China
Shan Chunlei
School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China
Guo Yi
Shenzhen People's Hospital (the First Affiliated Hospital of Southern University of Science and Technology), Shenzhen 518020,China
Cao Xinyi
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders,Shanghai 200030,China
Cui Donghong
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders,Shanghai 200030,China
Hu Shaohua
Department of Psychiatry, the First Affiliated Hospital, School of Medicine, Zhejiang Uneversity, Hangzhou 310003,China
Zhang Xiaochu
Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230041,China
Li Lingjiang
National Clinical Research Center for Mental Disorders, Department of Psychiatry,the Second Xiangya Hospital of Central South University, Changsha 410011,China
·
DOI： 10.3760/cma.j.cn113661-20220527-00131
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摘要

经颅直流电刺激（transcranial direct current stimulation，tDCS）是一种耐受性好且安全无创的大脑物理刺激方法，目前已广泛用于治疗某些常见精神障碍和神经疾病并取得了一定的临床效果。为进一步完善相关领域的使用规范，有必要制定临床治疗专家共识。本专家共识根据截至2021年8月发表的临床研究并基于循证医学的方法，发布tDCS在抑郁障碍、精神分裂症、物质使用所致障碍、强迫症、注意缺陷多动障碍、孤独症、焦虑症、创伤后应激障碍、睡眠障碍、疼痛、帕金森病、脑卒中和癫痫治疗的专家共识，并介绍了临床上tDCS治疗的安全性和有效性，描述了治疗流程和操作技术。希望为tDCS的临床应用提供指导，促进该治疗技术未来的规范发展。

经颅直流电刺激;专家共识;精神障碍;神经疾病
ABSTRACT

Transcranial direct current stimulation (tDCS) is a well-tolerated, safe and noninvasive physical brain stimulation method, which has been widely used in the treatment of some common mental disorders and neurological diseases and has achieved certain clinical effects. It is necessary to develop expert consensus on clinical treatment to improve the use norms in related fields. According to the clinical research published before August 2021 and the method of evidence-based medicine, we published an expert consensus on tDCS in the treatment of depressive disorders, schizophrenia, substance use-related disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, autism, anxiety disorders, post-traumatic stress disorder, sleep disorders, pain, Parkinson′s disease, stroke, and epilepsy. The consensus also introduced the safety and efficacy of the clinical use of tDCS, and standardized the treatment process and operation technology, aiming to provide guidance for the clinical application of tDCS and promote the standardized development of this treatment technology in the future.

Transcranial direct current stimulation;Experts′ consensus;Psychiatric disorders;Neurological diseases
Zhang Xiaochu, Email: nc.defudabe.ctsuctsucxz
Hu Shaohua, Email: nc.defudabe.ujzauhoahsuhrod

Tang Rui and Song Hongwen are contributed equally to the article

Wang Xiaoping to Cui Donghong and other 16 authors in order according to the surname stroke order

Copyright by Chinese Medical Association
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All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

唐睿,宋洪文,孔卓,等. 经颅直流电刺激治疗常见神经精神疾病的临床应用专家共识[J]. 中华精神科杂志,2022,55(05)：327-382.

DOI:10.3760/cma.j.cn113661-20220527-00131

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19世纪60年代，经颅直流电刺激（transcranial direct current stimulation，tDCS）开始被应用于临床研究，但由于样本量小、诊断标准不一、电极放置位置不一、结果不一等因素，以及精神障碍治疗药物的发展，tDCS的研究进入低谷。近十几年来，由于一系列神经生理学标志物的发现，tDCS再次广泛应用于临床并取得了部分成果。tDCS是一种通过置于头皮的两个或者多个电极产生微弱直流电（通常1~2 mA，最高不宜超过4 mA）来调节大脑皮质兴奋性的非侵入性神经调控技术 ［ 1 , 2 , 3 ］ （见 图1 ），通常持续20~30 min。tDCS可能通过以下机制影响大脑功能：（1）改变皮质兴奋性。tDCS阳极电流可促进神经元去极化从而增强大脑皮质兴奋性，阴极电流的作用则与之相反。上述作用可能与tDCS电场能改变局部pH值与细胞内外离子浓度（如钙离子）有关 ［ 4 , 5 , 6 , 7 ］ 。（2）改变局部脑血流量。阳极tDCS可增加电极作用区域的脑血流灌注，阴极刺激可诱导作用区域的局部脑血流产生可逆性降低 ［ 8 , 9 , 10 ］ 。（3）增加突触可塑性。tDCS刺激可促使大脑皮质神经元N-甲基-D-天冬氨酸（N-methyl-D-aspartic acid，NMDA）受体的表达以及γ-氨基丁酸、多巴胺等的释放，从而介导长时程增强及长时程抑制作用 ［ 11 , 12 ］ ，进而增强突触效能并提高神经通路的信号转导效率。（4）调节皮质兴奋/抑制平衡。阳极tDCS可降低刺激区域的抑制性递质γ-氨基丁酸浓度，阴极tDCS可降低刺激区域兴奋性递质谷氨酸浓度，从而改变皮质的兴奋/抑制比值 ［ 13 ］ 。（5）调节局部皮质间的脑网络连接。tDCS刺激能增强皮质间或者皮质与皮质下的神经网络成分的连接活性 ［ 14 ］ ，表明tDCS可增强受刺激区域与相关区域的功能连接从而影响大脑功能。（6）影响脑内神经递质。tDCS可有效激活大脑内啡肽系统，表明tDCS能改善内啡肽缺乏引起的人类心理、生理功能紊乱 ［ 15 ］ 。
经颅直流电刺激系统示意图

A为桌面式，B为便携式

在实际应用过程中，单次tDCS的效果可以维持几秒甚至长达90 min ［ 16 ］ ，此外，tDCS作为一种简单、易操作的干预技术，还具有不良反应短暂且轻微 ［ 17 , 18 ］ ，安全且耐受性好 ［ 19 , 20 ］ ，高效、无创、低价、便携 ［ 21 , 22 , 23 ］ 等特点。近20年来，利用tDCS治疗精神障碍和神经疾病的研究快速增加 ［ 24 , 25 , 26 , 27 , 28 ］ 。然而，由于目前已有研究数量多、刺激靶点多样、刺激参数以及结论不一，许多临床医生可能无法把握tDCS治疗的潜在有效性，不易快速寻找到合适的治疗方案，因此有必要对tDCS的临床研究进行较全面的循证评估，以期帮助临床医生方便快速地找到合适的治疗方案。
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唐睿, 宋洪文, 孔卓, 等. 经颅直流电刺激治疗常见神经精神疾病的临床应用专家共识[J]. 中华精神科杂志, 2022, 55(5): 327-382. DOI: 10.3760/cma.j.cn113661-20220527-00131.

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