Extinction of traumatic memory, a primary treatment approach (termed exposure therapy) in posttraumatic stress disorder (PTSD), occurs through relearning and may be subserved at the molecular level by long-term potentiation of relevant circuits. In parallel, repetitive transcranial magnetic stimulation (TMS) is thought to work through long-term potentiation–like mechanisms and may provide a novel, safe, and effective treatment for PTSD. In a recent failed randomized controlled trial we emphasized the necessity of correctly identifying cortical targets, the directionality of TMS protocols, and the role of memory activation. Here, we provide a systematic review of TMS for PTSD to further identify how, where, and when TMS treatment should be delivered to alleviate PTSD symptoms. We conducted a systematic review of the literature by searching for repetitive TMS clinical trials involving patients with PTSD and outcomes. We searched MEDLINE through October 25, 2023, for “TMS and PTSD” and “transcranial magnetic stimulation and posttraumatic stress disorder.” Thirty-one publications met our inclusion criteria ( = 17 randomized controlled trials, = 14 open label). Randomized controlled trial protocols were varied in terms of TMS protocols, cortical TMS targets, and memory activation protocols. There was no clear superiority of low-frequency ( = 5) versus high-frequency ( = 6) protocols or by stimulation location. Memory provocation or exposure protocols ( = 7) appear to enhance response. Overall, TMS appears to be effective in treating PTSD symptoms across a variety of TMS frequencies, hemispheric target differences, and exposure protocols. Disparate protocols may be conceptually harmonized when viewed as potentiating proposed anxiolytic networks or suppressing anxiogenic networks.

中文翻译：

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批判性评估如何、在何处以及何时通过经颅磁刺激在创伤后应激障碍网络中诱导可塑性的悬而未决的问题


创伤记忆的消除是创伤后应激障碍（PTSD）的主要治疗方法（称为暴露疗法），通过重新学习而发生，并且可能通过相关回路的长期增强在分子水平上得到促进。与此同时，重复经颅磁刺激（TMS）被认为通过类似长时程增强的机制发挥作用，并可能为创伤后应激障碍（PTSD）提供一种新颖、安全、有效的治疗方法。在最近一项失败的随机对照试验中，我们强调了正确识别皮质目标的必要性、TMS 方案的方向性以及记忆激活的作用。在这里，我们对 TMS 治疗 PTSD 进行了系统回顾，以进一步确定应如何、在何处以及何时进行 TMS 治疗以缓解 PTSD 症状。我们通过检索涉及 PTSD 患者的重复 TMS 临床试验及其结果，对文献进行了系统回顾。我们在 MEDLINE 上搜索了截至 2023 年 10 月 25 日的“TMS 和 PTSD”和“经颅磁刺激和创伤后应激障碍”。 31 篇出版物符合我们的纳入标准（= 17 项随机对照试验，= 14 项开放标签）。随机对照试验方案在 TMS 方案、皮质 TMS 目标和记忆激活方案方面各不相同。低频 (= 5) 与高频 (= 6) 方案或刺激位置没有明显的优势。记忆激发或暴露协议 (= 7) 似乎可以增强反应。总体而言，TMS 似乎可以有效治疗各种 TMS 频率、半球目标差异和暴露方案的 PTSD 症状。 当被视为增强所提出的抗焦虑网络或抑制致焦虑网络时，不同的方案可以在概念上得到统一。