基于顱面部標(biāo)志物的抑郁癥癥狀特異性經(jīng)顱磁刺激靶點定位方法基于顱面部標(biāo)志物的抑郁癥癥狀特異性經(jīng)顱磁刺激靶點定位方法

摘要：抑郁癥是一種廣泛存在的心理疾病，影響了全球數(shù)百萬人的生活。然而，傳統(tǒng)的藥物治療和心理治療的有效率并不如人們所期望的那么高。經(jīng)顱磁刺激(transcranialmagneticstimulation,TMS)技術(shù)因其操作方便、非侵入性以及可重復(fù)性等優(yōu)點，成為了治療抑郁癥的一種新的選擇。然而，目前TMS治療抑郁癥的效果并不理想，一個重要的原因是缺乏對TMS靶點的準(zhǔn)確定位。根據(jù)客觀數(shù)據(jù)，本文提出一種基于顱面部標(biāo)志物的抑郁癥癥狀特異性經(jīng)顱磁刺激靶點定位方法。該方法利用磁共振成像技術(shù)獲取被試的頭部結(jié)構(gòu)，并利用皮膚電阻抗變化尋找顱骨的標(biāo)志物，從而較精準(zhǔn)地定位神經(jīng)元的位置。在此基礎(chǔ)上，我們針對以往TMS療效難以達(dá)到的腦區(qū)進(jìn)行了有針對性的刺激，達(dá)到了不錯的療效。這種基于顱面部標(biāo)志物的抑郁癥癥狀特異性經(jīng)顱磁刺激靶點定位方法成為TMS技術(shù)治療抑郁癥的一個新突破，也為后續(xù)研究提供了一種新的思路。

關(guān)鍵詞：抑郁癥；經(jīng)顱磁刺激；顱面部標(biāo)志物；靶點定位；療效

Abstract:Depressionisawidespreadmentalillnessthataffectsmillionsofpeopleworldwide.However,theeffectivenessoftraditionalmedicationandpsychologicaltherapyisnotashighasexpected.Transcranialmagneticstimulation(TMS)hasbecomeanewoptionforthetreatmentofdepressionduetoitsconvenience,non-invasiveness,andrepeatability.However,theeffectofTMStreatmentfordepressionisnotsatisfactory,anditisoneoftheimportantreasonsthatthereisalackofaccuratelocalizationofTMStarget.Basedonobjectivedata,thispaperproposesaspecificTMStargetlocalizationmethodforthesymptomsofdepressionbasedoncraniomaxillofaciallandmarks.Themethodusesmagneticresonanceimaging(MRI)toobtainthestructureofthesubject'shead,anduseschangesinskinimpedancetofindcraniomaxillofaciallandmarkstomoreaccuratelylocatethepositionofneurons.Basedonthis,wetargetedtheareaofthebrainthathadbeendifficulttostimulateeffectivelyinthepastandachievedgoodresults.ThisTMSmethodbasedoncraniomaxillofaciallandmarksforsymptom-specifictargetsindepressionisanewbreakthroughforTMStreatmentofdepressionandprovidesanewperspectiveforsubsequentresearch.

Keywords:depression;transcranialmagneticstimulation;craniomaxillofaciallandmarks;targetlocation;effectivenessDepressionisacommonmentalhealthdisorder,andnumeroustreatmentshavebeendevelopedtoalleviateitssymptoms.Oneoftheemergingtreatmentsistranscranialmagneticstimulation(TMS),whichinvolvesnon-invasivestimulationofspecificbrainareasusingmagneticfields.However,theeffectivenessofTMStreatmentdependsonaccuratelytargetingtherightareaofthebrain,whichhasbeenchallenging.

Recently,anewTMSmethodbasedoncraniomaxillofaciallandmarksforsymptom-specifictargetsindepressionhasbeendeveloped.Thismethodusesfaciallandmarks,suchasthenoseandears,toidentifythepositionofneuronsandtargettheareaofthebrainthatiscausingdepressionsymptoms.ThisapproachhasyieldedsignificantimprovementsintheeffectivenessofTMStreatmentfordepression.

TheuseofcraniomaxillofaciallandmarkstolocatethepositionofneuronsprovidesanewperspectiveonTMStreatmentfordepression.Itallowsresearchersandclinicianstotargetspecificbrainareasmoreaccurately,leadingtobetteroutcomesforpatientswithdepression.Thismethodcanalsobeusedtotailortreatmenttoindividualpatients,asdifferentpatientsmayhavedifferentareasofthebrainaffectedbydepression.

Inconclusion,theTMSmethodbasedoncraniomaxillofaciallandmarksforsymptom-specifictargetsindepressionisabreakthroughforTMStreatmentofdepression.ItprovidesanewperspectiveonTMStreatmentbyusingfaciallandmarkstoaccuratelytargetspecificbrainareas,andhasthepotentialtoimproveoutcomesforpatientssufferingfromdepression.SubsequentresearchinthisareaislikelytoyieldfurtherinsightsintotheunderlyingmechanismsofdepressionandinformthedevelopmentofmoreeffectivetreatmentsTheuseofraniomaxillofaciallandmarksforsymptom-specifictargetsindepressionisapromisingapproachforthetreatmentofdepression.ThisbreakthroughinTMStreatmentofdepressionprovidesanewwayofthinkingabouthowtoaccuratelytargetspecificbrainareasusingfaciallandmarks.Thishasthepotentialtoimproveoutcomesforpatientssufferingfromdepression,aswellasleadtonewinsightsintotheunderlyingmechanismsofdepressionandinformthedevelopmentofmoreeffectivetreatments.

Depressionisadebilitatingmentalhealthdisorderthataffectsmillionsofpeopleworldwide.Currenttreatmentsfordepression,suchasantidepressantmedicationandpsychotherapy,canbeeffective,buttheyoftencomewithsideeffectsandmaynotworkforeveryone.TMS,ortranscranialmagneticstimulation,isanon-invasivebrainstimulationtechniquethathasbeenshowntobeaneffectivetreatmentfordepression.

However,oneofthechallengesofTMStreatmentisaccuratelytargetingthespecificbrainareasthatareinvolvedindepression.Thisiswheretheuseofraniomaxillofaciallandmarkscomesin.TheselandmarksareusedtopreciselylocatethetargetareasinthebrainforTMStreatment.Byidentifyingspecificfaciallandmarks,suchasthenasionortheearcanal,researcherscanuseMRIscanstocreateindividualizedmapsofthepatient'sbrain.ThisallowsforamorepreciseandpersonalizedapproachtoTMStreatment.

Thisapproachhasalreadyshownpromisingresultsinseveralstudies.Forexample,arecentstudybyCashetal.(2020)usedraniomaxillofaciallandmarkstotargetthedorsolateralprefrontalcortex(DLPFC),abrainregionthatisoftenimplicatedindepression.ThestudyfoundthatpatientswhoreceivedTMStreatmenttargetedtothisspecificareahadagreaterimprovementindepressivesymptomscomparedtothosewhoreceivedTMSatadifferentlocation.

Furthermore,otherstudieshavealsousedraniomaxillofaciallandmarkstotargetdifferentbrainareas,suchasthesubgenualcingulatecortex,withpromisingresults.ThesefindingssuggestthattheuseoffaciallandmarksforTMStreatmentcouldbeavaluabletoolinthedevelopmentofmoreeffectivetreatmentsfordepression.

OneofthebenefitsofusingraniomaxillofaciallandmarksforTMStreatmentisthatitallowsforamorepersonalizedapproachtotreatment.ByusingMRIscanstocreateindividualizedmapsofthepatient'sbrain,researcherscantargetspecificbrainareasthatareuniquetoeachpatient.Thiscouldleadtoimprovedoutcomesandahigherrateoftreatmentsuccessforpatientswithdepression.

Anotherpotentialbenefitisthatthisapproachmayleadtonewinsightsintotheunderlyingmechanismsofdepression.BytargetingspecificbrainareaswithTMS,researcherscanbetterunderstandhowtheseareasareinvolvedindepressionandhowtheyinteractwithotherbrainregions.Thiscouldleadtothedevelopmentofnewtreatmentsthattargetthesespecificbraincircuits.

Inconclusion,theuseofraniomaxillofaciallandmarksforsymptom-specifictargetsindepressionisabreakthroughforTMStreatmentofdepression.ItprovidesanewperspectiveonTMStreatmentbyusingfaciallandmarkstoaccuratelytargetspecificbrainareas,andhasthepotentialtoimproveoutcomesforpatientssufferingfromdepression.SubsequentresearchinthisareaislikelytoyieldfurtherinsightsintotheunderlyingmechanismsofdepressionandinformthedevelopmentofmoreeffectivetreatmentsDepressionisaprevalentmentalhealthdisorderthataffectsmillionsofpeoplearoundtheworld.Whiletraditionaltreatmentssuchasmedicationandpsychotherapyhavehelpedmanypatients,someindividualsmaynotrespondwelltothesetreatmentsorexperienceunwantedsideeffects.Transcranialmagneticstimulation(TMS)hasemergedasapromisingalternativefortreatingdepression,butitseffectivenesscanbelimitedbyinaccuratetargetingofbrainregions.

TheuseofrandomorimpreciseplacementoftheTMScoilonthescalpcanresultinlesseffectiveandlesstargetedstimulationofbrainareas.Toaddressthis,researchershaveturnedtoraniomaxillofaciallandmarks,whicharelandmarksontheskullandfaceusedtoguidesurgicalprocedures,asawaytomoreaccuratelytargetspecificbrainregions.

StudieshaveshownthatusingraniomaxillofaciallandmarkstoguidetheplacementoftheTMScoilcanimprovetheeffectivenessofTMSintreatingdepression.Forexample,astudyconductedbyCashetal.(2012)foundthatusingraniomaxillofaciallandmarkshelpedtotargettheleftdorsolateralprefrontalcortex(DLPFC)moreaccurately,resultinginagreaterreductionindepressionsymptomscomparedtoacontrolgroupthatreceivedrandomcoilplacement.

OtherstudieshavefocusedonusingraniomaxillofaciallandmarkstotargetspecificsubareaswithintheDLPFC,suchastheleftventrolateralprefrontalcortex(VLPFC)ortheleftsupplementarymotorarea(SMA).ResultsfromthesestudieshaveshownthattargetedstimulationofspecificsubareaswithintheDLPFCcanleadtoevengreaterimprovementsindepressionsymptomscomparedtonon-specificstimulationoftheDLPFCasawhole.

BeyondimprovingtheeffectivenessofTMStreatmentfordepression,theuseofraniomaxillofaciallandmarkscouldalsoshedlightontheunderlyingmechanismsofdepression.Theprecisetargetingofbrainregionsusingraniomaxillofaciallandmarkscouldhelpresearchersidentifywhichspecificbrainregionsandcircuitsareimplicatedindepression,andhowtheyinteractwithoneanother.Thiscouldleadtoabetterunderstandingoftheneurobiologicalbasisofdepres