经耳迷走神经刺激治疗重度抑郁症的神经、抗炎和临床效果:一项系统综述。

IF 4.5 2区 医学 Q1 CLINICAL NEUROLOGY
Joao Parente, Anna Carolyna Gianlorenco, Ingrid Rebello-Sanchez, Minkyung Kim, Jose Mario Prati, Chi Kyung Kim, Hyuk Choi, Jae-Jun Song, Felipe Fregni
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引用次数: 0

摘要

目的:发现治疗重度抑郁障碍(MDD)的有效方法可能有助于针对不同的大脑通路。有创迷走神经刺激(VNS)是治疗MDD的一种有效的神经调控技术;然而,非侵入性技术,经耳VNS(taVNS)的有效性仍然未知。此外,对其生物学和治疗作用背后的神经效应缺乏机制上的理解。本综述旨在评估taVNS在MDD中的临床证据以及神经和抗炎作用。回顾方法:使用系统搜索策略进行的两次搜索回顾了taVNS在人类MDD中的临床疗效和神经连接,并评估了人类或抑郁症动物模型中taVNS后炎症标志物的变化。所有人体研究均进行了偏倚风险评估。结果:只有五项研究评估了taVNS对抑郁症患者的影响。尽管这些研究证明了taVNS治疗抑郁症的疗效,但它们使用了异质性方法和有限的数据,从而阻止了合并定量分析的进行。对于研究大脑区域之间连接调节的研究,不能进行汇总分析;在六份出版物中,有五份是基于相同的实验。分析炎症标志物存在的动物研究显示,促炎细胞因子或受体表达水平降低。结论:关于taVNS治疗MDD的临床疗效的数据是有限的。尽管这些研究显示出积极的结果,但考虑到这些研究的异质性,无法就这一主题得出结论;如在功能连接性研究的情况下。根据动物研究,taVNS的应用会导致大脑不同部位炎症因子水平下降,而炎症因子也会调节免疫系统。因此,需要进一步的研究来了解taVNS对MDD患者的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neural, Anti-Inflammatory, and Clinical Effects of Transauricular Vagus Nerve Stimulation in Major Depressive Disorder: A Systematic Review.

Background: The discovery of effective treatments for major depressive disorder (MDD) may help target different brain pathways. Invasive vagus nerve stimulation (VNS) is an effective neuromodulation technique for the treatment of MDD; however, the effectiveness of the noninvasive technique, transauricular VNS (taVNS), remains unknown. Moreover, a mechanistic understanding of the neural effects behind its biological and therapeutic effects is lacking. This review aimed to evaluate the clinical evidence and the neural and anti-inflammatory effects of taVNS in MDD.

Methods: Two searches were conducted using a systematic search strategy reviewed the clinical efficacy and neural connectivity of taVNS in MDD in humans and evaluated the changes in inflammatory markers after taVNS in humans or animal models of depression. A risk of bias assessment was performed in all human studies.

Results: Only 5 studies evaluated the effects of taVNS in patients with depression. Although the studies demonstrated the efficacy of taVNS in treating depression, they used heterogeneous methodologies and limited data, thus preventing the conduct of pooled quantitative analyses. Pooled analysis could not be performed for studies that investigated the modulation of connectivity between brain areas; of the 6 publications, 5 were based on the same experiment. The animal studies that analyzed the presence of inflammatory markers showed a reduction in the level of pro-inflammatory cytokines or receptor expression.

Conclusions: Data on the clinical efficacy of taVNS in the treatment of MDD are limited. Although these studies showed positive results, no conclusions can be drawn regarding this topic considering the heterogeneity of these studies, as in the case of functional connectivity studies. Based on animal studies, the application of taVNS causes a decrease in the level of inflammatory factors in different parts of the brain, which also regulate the immune system. Therefore, further studies are needed to understand the effects of taVNS in patients with MDD.

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来源期刊
CiteScore
8.40
自引率
2.10%
发文量
230
审稿时长
4-8 weeks
期刊介绍: The central focus of the journal is on research that advances understanding of existing and new neuropsychopharmacological agents including their mode of action and clinical application or provides insights into the biological basis of psychiatric disorders and thereby advances their pharmacological treatment. Such research may derive from the full spectrum of biological and psychological fields of inquiry encompassing classical and novel techniques in neuropsychopharmacology as well as strategies such as neuroimaging, genetics, psychoneuroendocrinology and neuropsychology.
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