Stimulyaciya teta-vspyshkami (TBS) nahodit shirokoe primenenie blagodarya indukcii dolgovremennyh effektov pri korotkoj dlitel'nosti protokola. Dlya umen'sheniya variabel'nosti effekta issleduyut podhody k ee personalizacii, naprimer, po chastotam teta-gamma sopryazheniya (TGS). Cel'yu issledovaniya bylo razrabotat' protokol personalizirovannoj po TGS navigacionnoj stimulyacii intermittiruyushchimi teta-vspyshkami (iTBS-ind) i sravnit' ego so standartnym (iTBS-5/50) i imitaciej stimulyacii (iTBS-sham). V issledovanie vklyucheny 16 zdorovyh dobrovol'cev (M — 7; 29,6 let), kotorym v sluchajnom poryadke provodili po odnoj sessii kazhdogo protokola iTBS levoj dorsolateral'noj prefrontal'noj kory. Effekt ocenivali s pomoshch'yu testov n-back c odnovremennym pred"yavleniem verbal'nyh i prostranstvennyh stimulov (n = 2,3), Digit span, Corsi blocks, Tower of London; testirovanie provodili do, srazu i cherez 60 min posle stimulyacii. Ser'eznyh nezhelatel'nyh yavlenij ne zaregistrirovali. Statisticheski znachimyj effekt poluchen pri ocenke cherez 60 min dlya iTBS-5/50 na test n-back s prostranstvennymi stimulami (n = 3) (pcorr = 0,018), dlya vsekh protokolov — na test Tower of London (pcorr = 0,039 dlya iTBS-5/50, pcorr = 0,045 dlya iTBS-ind i pcorr = 0,003 dlya iTBS-sham). Effekt iTBS-5/50 byl statisticheski znachimo vyshe po sravneniyu s iTBS-sham v otnoshenii prostranstvennogo testa n-back (n = 3) (pcorr = 0,039), no nizhe po sravneniyu s iTBS-ind i iTBSsham v otnoshenii testa Corsi blocks (pcorr = 0,038 i 0,048 sootvetstvenno). Takim obrazom, ne udalos' podtverdit' effektivnost' i preimushchestva personalizirovannogo protokola po sravneniyu so standartnym i imitaciej stimulyacii. V svyazi s poluchennym effektom standartnogo protokola mozhet byt' perspektivnym dal'nejshee ego izuchenie.

Issledovanie protokolov transkranial'noj magnitnoj stimulyacii (TMS), osnovannyh na metaplastichnosti, yavlyaetsya intensivno izuchaemym podhodom k uluchsheniyu effektivnosti stimulyacii. Odnako effekty protokolov s raznym intervalom mezhdu blokami TMS v otnoshenii kognitivnyh funkcij izucheny nedostatochno. Cel'yu raboty bylo ocenit' effekt dvuh protokolov stimulyacii teta-vspyshkami (iTBS) s korotkim i dlinnym intervalami mezhdu blokami na pokazateli rabochej pamyati (RP) u zdorovyh dobrovol'cev. V sluchajnom poryadke 16 uchastnikam provodili po odnoj sessii TMS kazhdym protokolom (iTBS 0–15 — dva bloka iTBS levoj dorsolateral'noj prefrontal'noj kory (lDLPFK) s intervalom 15 min mezhdu nimi i posleduyushchej stimulyaciej oblasti verteksa cherez 60 min posle pervogo bloka; iTBS 0–60 — blok iTBS lDLPFK, blok stimulyacii verteksa cherez 15 min i vtoroj blok iTBS lDLPFK cherez 60 min posle pervogo, iTBS 0 — odin blok iTBS lDLPFK s dvumya blokami stimulyacii verteksa i kontrol'nyj protokol — tri bloka stimulyacii verteksa s analogichnymi intervalami). RP ocenivali s pomoshch'yu testa n-back pered pervym, posle vtorogo i tret'ego blokov stimulyacii. Statisticheski znachimyh effektov protokolov na RP, a takzhe razlichij mezhdu protokolami po izmeneniyu pokazatelej testa ili kolichestvu uchastnikov, otvetivshih na TMS, obnaruzheno ne bylo. Tendenciya k statisticheskoj znachimosti pokazana dlya protokola s korotkim intervalom (iTBS 0–15). Krome togo, podtverzhdena nizkaya individual'naya vosproizvodimost' effekta iTBS. Perspektivnymi predstavlyayutsya issledovanie protokolov s korotkim intervalom mezhdu blokami na bolee krupnyh vyborkah dobrovol'cev, a takzhe uchet drugih faktorov, potencial'no vliyayushchih na effekt protokola (kolichestvo blokov i dlitel'nost' odnogo bloka).

Stimulyaciya teta-vspyshkami (TBS) nahodit shirokoe primenenie blagodarya indukcii dolgovremennyh effektov pri korotkoj dlitel'nosti protokola. Dlya umen'sheniya variabel'nosti effekta issleduyut podhody k ee personalizacii, naprimer, po chastotam teta-gamma sopryazheniya (TGS). Cel'yu issledovaniya bylo razrabotat' protokol personalizirovannoj po TGS navigacionnoj stimulyacii intermittiruyushchimi teta-vspyshkami (iTBS-ind) i sravnit' ego so standartnym (iTBS-5/50) i imitaciej stimulyacii (iTBS-sham). V issledovanie vklyucheny 16 zdorovyh dobrovol'cev (M — 7; 29,6 let), kotorym v sluchajnom poryadke provodili po odnoj sessii kazhdogo protokola iTBS levoj dorsolateral'noj prefrontal'noj kory. Effekt ocenivali s pomoshch'yu testov n-back c odnovremennym pred"yavleniem verbal'nyh i prostranstvennyh stimulov (n = 2,3), Digit span, Corsi blocks, Tower of London; testirovanie provodili do, srazu i cherez 60 min posle stimulyacii. Ser'eznyh nezhelatel'nyh yavlenij ne zaregistrirovali. Statisticheski znachimyj effekt poluchen pri ocenke cherez 60 min dlya iTBS-5/50 na test n-back s prostranstvennymi stimulami (n = 3) (pcorr = 0,018), dlya vsekh protokolov — na test Tower of London (pcorr = 0,039 dlya iTBS-5/50, pcorr = 0,045 dlya iTBS-ind i pcorr = 0,003 dlya iTBS-sham). Effekt iTBS-5/50 byl statisticheski znachimo vyshe po sravneniyu s iTBS-sham v otnoshenii prostranstvennogo testa n-back (n = 3) (pcorr = 0,039), no nizhe po sravneniyu s iTBS-ind i iTBSsham v otnoshenii testa Corsi blocks (pcorr = 0,038 i 0,048 sootvetstvenno). Takim obrazom, ne udalos' podtverdit' effektivnost' i preimushchestva personalizirovannogo protokola po sravneniyu so standartnym i imitaciej stimulyacii. V svyazi s poluchennym effektom standartnogo protokola mozhet byt' perspektivnym dal'nejshee ego izuchenie.

Stenfordckaya nejromoduliruyushchaya terapiya (SNT) — novejshij protokol magnitnoj stimulyacii, razrabotannyj dlya lecheniya terapevticheski rezistentnyh depressij (TRD). Cel'yu issledovaniya bylo ocenit' vozmozhnosti realizacii SNT v klinicheskoj praktike, opredelit' bezopasnost' i effektivnost' protokola v nezavisimom centre u pacientov s TRD v ramkah rekurrentnogo depressivnogo i bipolyarnogo rasstrojstv. V issledovanie voshli shest' pacientov (iz nih tri zhenshchiny v vozraste 21–66 let) s TRD v ramkah rekurrentnoj depressii i bipolyarnogo rasstrojstva 1-go i 2-go tipov. V techenie pyati dnej pacientam provodili stimulyaciyu intermittiruyushchimi teta-vspyshkami po protokolu SNT: ezhednevno po 10 trojnyh blokov stimulyacii s intervalom 1 ch mezhdu sosednimi blokami i vyborom zony stimulyacii s maksimal'noj negativnoj funkcional'noj konnektivnost'yu s subgenual'noj poyasnoj koroj v predelah levoj dorsolateral'noj prefrontal'noj kory. Dlya klinicheskoj ocenki effekta primenyali shkalu Montgomeri–Asberg, dlitel'nost' perioda nablyudeniya sostavila tri mesyaca. U pyati pacientov srazu posle okonchaniya SNT otmecheno snizhenie vyrazhennosti depressii do urovnya remissii (≤10 ballov po MADRS). CHerez tri mesyaca dva pacienta ostavalis' v remissii, u troih sostoyanie sootvetstvovalo legkomu depressivnomu epizodu, odna pacientka vybyla iz issledovaniya iz-za logisticheskih trudnostej. Ser'eznyh nezhelatel'nyh yavlenij ne zaregistrirovano. Poluchennye rezul'taty podtverdzhayut bezopasnost' i potencial'no vysokuyu effektivnost' SNT v tom chisle pri bipolyarnyh rasstrojstvah 1-go i 2-go tipov.

Objective. To run a parallel placebo-controlled trial to assess the effects of navigated combined high-frequency rhythmic transcranial magnetic stimulation (rTMS) of the primary motor (bilateral) and left dorsolateral prefrontal cortex on the clinical dynamics of the symptoms of Parkinson’s disease (PD). Materials and methods. A total of 46 patients took part in the trial and were randomized to active ( n = 23) and placebo ( n = 23) rTMS. Navigated therapeutic and placebo rTMS were performed for areas of the primary motor and left dorsolateral prefrontal cortex at a frequency of 10 Hz (20 daily sessions for three weeks). Changes in clinical symptoms were assessed on the MDS-UPDRS (parts I–IV) before sessions, immediately after 20 sessions, and 4–6 weeks after courses of rTMS. Nonmotor and mental symptoms were evaluated on the Hamilton depression scale (HDRS-17), the Beck scale (BDI-II), the depression, anxiety, and stress scale (DASS-21), and the mini mental state examination (MMSE). Results. Statistically signifi cant therapeutic effects were obtained with rTMS as compared with placebo, with greater reductions in total scores on the MDS-UPDRS (parts I–IV), the severity of nonmotor (part I)and motor (Part III, with greater therapeutic effects for rigidity, bradykinesia, and postural instability) signs, as well as the severity of motor complications of dopamine replacement therapy (part IV). The effects of rTMS on motor symptoms persisted at four weeks after completion of stimulation courses. It is also important to note that the signifi cant improvements in the rTMS and placebo groups were similar in terms of the magnitudes of reductions in the severity of daily motor symptoms (part II of the MDS-UPDRS) and increases in the total scores on the MMSE, HDRS, BDI-II, and DASS-21. Conclusions. Combined high-frequency rTMS of two areas of the cerebral cortex – the motor (bilaterally) and the left dorsolateral prefrontal – had positive therapeutic effects on the motor and affective symptoms of PD which were signifi cantly greater than obtained using placebo stimulation.

U pacientov s nevralgiej trojnichnogo nerva (NTN), ne otvechayushchih na farmakoterapiyu, v kachestve al'ternativy mozhno primenyat' ritmicheskuyu transkranial'nuyu magnitnuyu stimulyaciyu (rTMS). Odnako effekt rTMS variabelen. Cel'yu issledovaniya byl poisk nejrovizualizacionnyh biomarkerov klinicheskoj effektivnosti navigacionnoj rTMS. Semnadcati pacientam s NTN (14 zhenshchin; mediana vozrasta — 56 let) provedeno 10 sessij vysokochastotnoj rTMS motornoj kory polushariya, kontrlateral'nogo lokalizacii boli. Provodili analiz korrelyacij funkcional'noj konnektivnosti (FK) i ob"ema serogo veshchestva golovnogo mozga (SVGM) so snizheniem intensivnosti boli. Pokazana polozhitel'naya korrelyaciya mezhdu snizheniem srednej intensivnosti boli i ob"emom SVGM v oblasti hvostatyh yader (p(unc) = 0,03), mozzhechka bilateral'no (p(unc) = 0,002) i kontrlateral'noj postcentral'noj izviline (p(unc) = 0,005); mezhdu snizheniem maksimal'noj intensivnosti boli i ob"emom SVGM v oblasti hvostatogo yadra kontrlateral'no boli (p(unc) = 0,04) i mozzhechka ipsilateral'no (p(unc) = 0,03). Prodemonstrirovana polozhitel'naya svyaz' snizheniya srednej intensivnosti boli s FK mezhdu talamusom (kontrlateral'no lokalizacii boli) i ipsilateral'noj postcentral'noj izvilinoj i pokryshkoj ostrovka (p(FWE) = 0,018), mezhdu poyasnoj koroj i perednimi otdelami poyasnoj kory ipsilateral'no boli (p(FWE) = 0,017), mezhdu kontrlateral'noj paraterminal'noj izvilinoj i mozzhechkom ipsilateral'no (p(FWE) = 0,018); otricatel'naya korrelyaciya dlya FK mezhdu kontrlateral'noj skorlupoj i zatylochnymi dolyami oboih polusharij (p(FWE) = 0,001). Poluchennye rezul'taty mogut stat' predposylkoj k razrabotke individual'nyh prediktorov effektivnosti rTMS u pacientov s hronicheskimi bolevymi sindromami.

Несмотря на интенсивное изучение, данные о функциональном значении отдельных областей головного мозга для процессов рабочей памяти (РП) остаются противоречивыми. Целью данного исследования было определить активацию участков коры на разных этапах выполнения задачи на РП (запечатление, удержание и извлечение информации). На 19 здоровых добровольцах была использована функциональная магнитная резонансная томография (фМРТ) с модифицированной задачей Стернберга. Суть задачи — в запоминании и удержании в памяти последовательности из семи букв с последующим сравнением с ней одной буквы. Проанализирована активация в трех периодах задачи по сравнению с периодом покоя, а также динамика изменения интенсивности BOLD-сигнала в зависимости от времени в трех областях: левой дорсолатеральной префронтальной коре (ДЛПФК), левой задней теменной коре и левой затылочной коре. По результатам анализа, на протяжении всех периодов задачи наблюдали статистически значимую активацию участков ПФК и задней теменной коры (р < 0,05), но с изменением их локализации и латерализации. При этом паттерн активации в периоде удержания соответствовал компонентам лобно-теменной сети контроля. По результатам анализа изменения интенсивности BOLD-сигнала наиболее выраженную активацию ДЛПФК и теменной коры наблюдали в конце периода запечатления, периоде удержания и начале периода извлечения, что подтверждает роль данных областей в процессах РП. Пик активации затылочной коры соответствовал периоду запечатления. Данное исследование подтверждает функциональное значение ДЛПФК и задней теменной коры для процессов РП на всех этапах выполнения задачи Стернберга.

Odnim iz metodov reabilitatsii patsiyentov s khronicheskim narusheniyem soznaniya (KHNS) yavlyayetsya transkranial'naya magnitnaya stimulyatsiya (TMS). Tsel'yu raboty bylo izuchit' neyrotroficheskiye faktory u patsiyentov s KHNS i ikh izmeneniye na fone primeneniya kursa TMS. Patsiyentam s KHNS razlichnoy etiologii v khronicheskikh srokakh (26 chelovek) i zdorovym dobrovol'tsam (21 chelovek) provodili kurs ritmicheskoy TMS levoy angulyarnoy izviliny. U vsekh uchastnikov sobirali obraztsy syvorotki krovi i likvora do i posle kursa. V biomateriale issledovali urovni BDNF, NSE, NGF, RDGF, GDNF, NT3. Pokazano, chto urovni BDNF, NSE, PDGF, GDNF, NT3 v krovi u patsiyentov s KHNS vyshe, chem u zdorovykh dobrovol'tsev (p < 0,05). Ne vyyavleno razlichiy v kontsentratsii neyrotroficheskikh faktorov v krovi i likvore v zavisimosti ot formy KHNS. U patsiyentov s posledstviyami cherepno- mozgovoy travmy uroven' BDNF v likvore okazalsya vyshe, chem u patsiyentov s netravmaticheskoy etiologiyey KHNS (p < 0,05). Posle provedeniya kursa TMS pokazano uvelicheniye urovnya BDNF v likvore u posttravmaticheskikh patsiyentov (p < 0,05). Drugikh znachimykh izmeneniy po gruppam i drugim biomarkeram v krovi i likvore vyyavleno ne bylo. Takim obrazom, urovni neyrotroficheskikh faktorov BDNF, NSE, PDGF, GDNF, NT3 v syvorotke krovi patsiyentov s KHNS vyshe, chem u zdorovykh dobrovol'tsev. Uroven' BDNF v likvore patsiyentov byl vyshe pri posttravmaticheskom KHNS i uvelichivalsya posle provedeniya kursa vysokochastotnoy TMS u etoy gruppy. Eto mozhet svidetel'stvovat' o dlitel'nykh protsessakh neyroplastichnosti, proiskhodyashchikh u patsiyentov posle cherepno-mozgovoy travmy, i boleye blagopriyatnom reabilitatsionnom prognoze.

Obesity is a pathological condition caused by overweight and requiring medical intervention. The clinical and scientific experience gained over the past decades has allowed researchers to consider this problem as an independent disease with its own pathophysiological features, prevalence, incidence, approaches to therapy and prevention. One of the most important factors in the pathogenesis of obesity is disordered eating behavior, the central regulation of which is carried out with the active participation of the prefrontal cortex. Impact on this area (for example, using non-invasive brain stimulation) may be one of the promising ways to modulate eating behavior. The article describes clinical cases of treatment of morbid obesity using navigated rhythmic transcranial magnetic stimulation (rTMS). Different patterns of dorsolateral prefrontal cortex (DLPFC) activation before and after rTMS are demonstrated. Possible mechanisms of the influence of DLPFC on the formation of eating behavior are also considered. These data underline the important role of DLPFC dysregulation in obesity, as well as show potentially effective neuromodulation techniques.

OBJECTIVE:To evaluate therapeutic effects of navigational dual-target high-frequency rTMS over the primary motor (M1, bilateral) and the left dorsolateral prefrontal cortex (DLPFC) on clinical dynamics of Parkinson's disease (PD) symptoms in a parallel placebo-controlled study.MATERIAL AND METHODS:The study included 46 patients randomized into equal therapeutic and placebo rTMS groups. Navigational therapeutic and placebo10 Hz rTMS was applied over the M1 and DLPFC areas (20 daily sessions, for 3 weeks). Assessment of the dynamics of clinical symptoms was performed using the MDS UPDRS scale (Parts I-IV) before the first session, immediately after 20 sessions, and 4-6 weeks after the rTMS course. Non-motor and mental symptoms were assessed using the Hamilton Depression Rating Scale (HDRS-17), Beck depression inventory (BDI-II), Depression, Anxiety and Stress (DASS-21) scales and the Mini Mental State Examination (MMSE).RESULTS:Significant therapeutic effects of rTMS compared to placebo were established: a greater decrease in overall score on the MDS-UPDRS scale (parts I-IV), a decrease in the severity of non-motor (part I) and motor symptoms (part III, with a large therapeutic effect for the symptoms of rigidity, bradykinesia and postural instability), as well as the severity of motor complications of dopamine replacement therapy (part IV). The effects of rTMS on motor symptoms persisted 4 weeks after the end of the stimulation course. It is also important to note significant positive dynamics in both rTMS and placebo groups in the form of comparable reduction in the severity of everyday motor symptoms (MDS-UPDRS part II), improvement of the total scores on MMSE, HDRS, BDI-II, DASS-21.CONCLUSIONS:The dual-target high-frequency rTMS over the primary motor cortex (bilateral) and the left dorsolateral prefrontal cortex has positive therapeutic effects on the motor and affective symptoms of Parkinson's disease, which are significantly stronger than that of the placebo stimulation.

Депрессия – распространенное психическое заболевание, затрагивающее преимущественно работоспособное население и являющееся одной из основных причин «глобального бремени болезней». Недостаточная эффективность существующих фармако и психотерапевтических подходов обусловливает высокую актуальность разработки и внедрения новых эффективных и безопасных методов лечения этого заболевания, в частности, с использованием технологий неинвазивной стимуляции мозга. Транскраниальная электрическая стимуляция (ТЭС) постоянным током – один из методов неинвазивной нейромодуляции, который может быть использован для терапии депрессии. В обзоре рассмотрены современные представления о патогенезе депрессии и обоснование применения ТЭС. Подробно освещены основные публикации, обзоры и метаанализы, затрагивающие как использование ТЭС в качестве монотерапии, так и возможные комбинации ТЭС с фармако-, психотерапией и другими методами. Отдельно рассмотрены вопросы методологии и безопасности применения метода.