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정신질환에서 뇌자극술의 적용

The Application of Brain Stimulation in Psychiatric Disorders : An Overview

김도훈|노대영|강리영
대한생물정신의학회 (The Korean Society Of Biological Psychiatry)|2017.11|생물정신의학 (Journal of Korean Society of Biological Psychiatry)|제24권 제4호|pp. 167-174|DOI 10.22857/kjbp.2017.24.4.001

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신경조절술·반복 경두개자기자극· 경두개직류전류자극·경두개교류전류자극.
주제분류정신과학

초록

뇌자극술(brain stimulation)은 전기나 자기와 같은 에너지장을 이용한 자극으로 뇌신경계의 기능을 바꾸는 방법이다. 전극을 뇌 심부에 심거나, 전극을 두피에 부착하거나, 두부를 자기장에 노출시키는 등 자극방법은 다양하다. 정신의학적 임상 현장에서 뇌자극술은 약물요법이나 정신요법보다는 널리 사용되고 있지 못하다. 적어도 약물요법이나 정신요법 등에 반응을 보이지 않는 환자에게는 뇌자극술이 유력한치료적 대안이 될 수 있다. 가장 오래되고 잘 연구된 뇌자극술은 전기경련요법(electroconvulsive therapy, 이하 ECT)이다.1) 다소 침습적인 방법으로 뇌심부자극술(deep brain stimulation, 이하 DBS), 미주신경자극술(vagus nerve stimulation, 이하 VNS) 등이 있다. 비침습적인 방법으로는 반복적 경두개자기자극술(repetitive transcranial magnetic stimulation, 이하 rTMS), 경두개직류전기자극술(transcranial direct current stimulation, 이하 tDCS) 등이 많은 관심을 받고 있다. 뇌자극술은 약물 치료 및 정신 치료와 병행하여 적용하는 것도가능한데, 환자의 의학적 상태나 요구 등을 고려해 치료자가판단하여 결정한다. 특히 최근 뇌자극술이 임상적으로 많은 관심을 끌고 있는데에는 몇 가지 이유가 있다. 하나는 기존의 약물 치료와는 다른 새로운 기전의 치료법이라는 점이다. 특히 정신질환과 관련된 뇌신경회로의 이해가 높아지면서 일부 뇌 부위를 뇌자극술로 조절(modulation)하여 증상을 호전시킬 수 있다는 기대를 갖게 한다. 또한 다양한 비침습적 뇌자극술이 소개되면서부작용이 적은 치료법이라는 인식과, 스마트폰과 같은 개인화된 기기와의 연동 및 맞춤 치료의 가능성이 대두되었기 때문이다. 더불어 적은 부작용과 간편한 적용방법 때문에 뇌자극술의 비임상적 이용, 즉 일반인이 인지기능 개선 등을 목적으로 사용하는 기능성 의료기기로의 활용 가능성과2) 사업화에대한 관심도 한 몫을 하고 있다. 미국의 clinicaltrials.gov와 국내 임상연구정보서비스(Clinical Research information Service, CRIS) 검색 결과, 국내뇌자극술 임상연구가 급속히 늘고 있으며, 관련 연구 결과들도3-5) 활발하게 보고되고 있다. 하지만 다양한 뇌자극술의 임상적용에 대한 포괄적인 고찰과 논의는 여전히 부족한 편이다. 이에 본고에서는 다양한 뇌자극술을 개관하고, 연구 및 임상적용에 관련된 문제점과 가능성을 함께 살펴보기로 한다.

Abstract

Based on advances in biotechnology and neuroscience, neuromodulation is poised to gain clinical importance as a treatment modality for psychiatric disorders. In addition to old-established electroconvulsive therapy (ECT), clinicians are expected to understand newer forms of neurostimulation, such as deep brain stimulation (DBS), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS). Given the growing interest in non-invasive neuromodulation technologies, clinicians may seek sufficient information about neuromodulation to inform their clinical practice. A growing literature suggests that applications of non-invasive neuromodulation have evidence particularly for indications where treatments are currently insufficient, such as drug-resistant depression. However, positive neuromodulation studies require replication, and the precise interactions among stimulation, antidepressant medication, and psychotherapy are unknown. Further studies of long-term safety and the impact on the developing brain are needed. Non-invasive neuromodulatory devices could enable more individualized treatment. However, do-it-yourself (DIY) stimulation kits require a better understanding of the effects of more frequent patterns of stimulation and raise concerns about clinical supervision, regulation, and reimbursement. Wide spread enthusiasm for therapeutic potential of neuromodulation in clinical practice settings should be mitigated by the fact that there are still research gaps and challenges associated with non-invasive neuromodulatory devices.

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