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경두개 자기 자극이 인지 기능에 미치는 영향

Effects of Transcranial Magnetic Stimulation on Cognitive Function

채정호|이상민
대한생물정신의학회 (The Korean Society Of Biological Psychiatry)|2016.08|생물정신의학 (Journal of Korean Society of Biological Psychiatry)|제23권 제3호|pp. 89-101

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인지CognitionTranscranial magnetic stimulation경두개 자기자극
주제분류정신과학

초록

자기 자극(transcranial magnetic stimulation, 이하TMS)은 코일을 통해 생성된 자기장에 의해 기능하는 뇌 자극법이다. 이 자기장은 피험자에게 큰 고통을 주지 않고 두개골을 통과해 뇌 조직에 전기장을 생성하고, 신경세포의 과분극 혹은 탈분극을 유도할 수 있다. 비약물적, 비침습적인 방식이며 중심 부위를 밀리 초(millisecond) 단위로 자극할 수있다는 장점이 있다.1) TMS는 높은 해상도로 피질의 흥분성을 촉진 혹은 억제할 수 있기 때문에 특정 피질 구조의 기능을 탐색하고 구조와 기능 간의 관계를 조사하는 데 활용될 수 있는 기술이다. 그 자극 방식에 따라 인지 기능에도 영향을 미칠 수 있을 것으로 기대되어 왔다.2) 그러나 TMS에 의한 인지 기능의 향상혹은 억제를 보고한 연구는 많지만, 자극 빈도, 지속 시간, 과제 수행 중 자극하는 시점 등에 따라 그 양상이 매우 다른 것으로 보고되고 있다.3) TMS는 항우울 효과가 있다는 충분한 근거를 갖고 있으며, 2007년 FDA 승인을 받았지만, 우울증 이외에는 치료에 활용할 수 있는 프로토콜이 뚜렷이 정립되어 있지 않다.4) 따라서 우울증 이외의 정신과적 치료에 TMS를 활용하기 위해선정상인을 대상으로 TMS 자극을 진행했을 때, 그 효과가 어떤 과정으로 인지 기능을 변화시키는지 연구가 더 필요하다. 본 종설에서는 정상인을 대상으로 인지 기능에 미치는 영향에 관해 연구한 문헌 73건을 찾았다. 이를 통해 두뇌 부위별로 자극한 각 프로토콜이 어떤 인지 능력을 변화시키는지조명함으로써, TMS가 인지 기능에 미치는 영향을 정리하고더 나아가 이러한 인지 변화를 임상적 치료, 연구 목적에 연결하는 것에 대해 개괄하고자 한다.

Abstract

Transcranial magnetic stimulation (TMS) is a safe, noninvasive and useful technique for exploring brain function. Especially, for the study of cognition, the technique can modulate a cognitive performance if the targeted area is engaged, because TMS has an effect on cortical network. The effect of TMS can vary depending on the frequency, intensity, and timing of stimulation. In this paper, we review the studies with TMS targeting various regions for evaluation of cognitive function. Cognitive functions, such as attention, working memory, semantic decision, discrimination and social cognition can be improved or deteriorated according to TMS stimulation protocols. Furthermore, potential therapeutic applications of TMS, including therapy in a variety of illness and research into cortical localization, are discussed

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