评论:使用经颅脉冲刺激治疗从阿尔茨海默病到帕金森病的疾病:机制见解,最新证据和伦理考虑。

IF 1.6 Q3 CLINICAL NEUROLOGY
NeuroSci Pub Date : 2025-06-17 DOI:10.3390/neurosci6020056
Lars Wojtecki
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引用次数: 0

摘要

经颅脉冲刺激(TPS)是一种非侵入性的神经调节方法,它使用高强度的声学冲击波,以最小的热效应向神经组织提供集中的机械刺激。其作用机制包括但不限于通过机械转导促进血流和血管生成。迄今为止的临床数据有限且初步。在阿尔茨海默病(AD)中,TPS在初步研究和首次随机试验的次要终点分析中显示出认知和情绪改善。已经报道了伽马波段振荡和网络连通性的增强。帕金森病(PD)的临床观察表明,TPS是一种假说生成方法,通过理论调节基底神经节-皮质回路来解决非运动症状,如抑郁、认知能力下降和步态冻结。TPS在欧洲获得了AD的ce认证,并显示出良好的安全性;然而,伦理方面的考虑来自于有限的证据基础、痴呆患者自主性和判断力的潜在损害以及保留现有治疗方法的风险。TPS只能在结构化的科学方案下或在患者登记范围内提供,以确保严格的监督。确保同意过程考虑到认知能力,TPS作为辅助疗法而不是替代疗法,是至关重要的。未来的研究必须包括大规模随机对照试验(rct),标准化刺激方案,深化机制洞察,并嵌入健全的伦理框架。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Commentary: Treating Diseases from Alzheimer's to Parkinson's Using Transcranial Pulse Stimulation: Mechanistic Insights, Recent Evidence, and Ethical Considerations.

Transcranial pulse stimulation (TPS) is a non-invasive neuromodulation method that uses, high-intensity acoustic shockwaves to deliver focused mechanical stimulation to neural tissue with minimal thermal effects. The mechanism of action includes but is not limited to promotion of blood flow and angiogenesis through mechanotransduction. Clinical data to date are limited and preliminary. In Alzheimer's disease (AD), TPS has demonstrated cognitive and mood improvements in pilot studies and secondary endpoint analysis in first randomized trials. The enhancement of gamma-band oscillations and network connectivity has been reported. Clinical observations in Parkinson's disease (PD) suggest TPS as a hypothesis-generating approach to address non-motor symptoms-such as depression, cognitive decline, and the freezing of gait-through theoretical modulation of basal ganglia-cortical circuits. TPS is CE-marked in Europe for AD and shows a favorable safety profile; however, ethical considerations arise from the limited evidence base, potential impairment of patient autonomy and judgment in dementia, and the risk of withholding established treatments. TPS should only be offered under structured scientific protocols or within patient registries to ensure rigorous oversight. Ensuring that consent processes account for cognitive capacity, and that TPS is applied as adjunct rather than replacement therapy, is paramount. Future research must include large-scale randomized controlled trials (RCTs), standardize stimulation protocols, deepen mechanistic insight, and embed robust ethical frameworks.

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