Penggunaan Non Invasive Brain Stimulation (NIBS) pada Gangguan Cemas Menyeluruh

Oleh :

dr. Irwan Supriyanto PhD SpKJ

Non invasive brain stimulation (NIBS) telah banyak diteliti sebagai modalitas manajemen berbagai gangguan neurologis dan psikiatri, salah satunya gangguan cemas menyeluruh. Metode ini dipertimbangkan karena relatif aman dan mudah digunakan. Gangguan cemas merupakan salah satu gangguan psikiatri yang banyak ditemukan.[1]

Di antara spektrum gangguan cemas, gangguan cemas menyeluruh termasuk yang sulit ditangani karena tidak adanya faktor pemicu gejala yang jelas. Beberapa modalitas farmakoterapi yang sering digunakan untuk menangani gangguan cemas bisa menimbulkan adiksi. Farmakoterapi mempunyai batasan dalam profil keamanan, tolerabilitas, dan efikasi.[2]

Psikoterapi pada pasien dengan gangguan cemas juga dilaporkan mempunyai efikasi yang rendah. Oleh karena itulah, NIBS bisa menjadi alternatif dalam tata laksana gangguan cemas, khususnya gangguan cemas menyeluruh.[3]

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Li LM, Violante IR, et al. Traumatic axonal injury influences the cognitive effect of non-invasive brain stimulation. Brain 2019;142:3280–93. https://www.ncbi.nlm.nih.gov/pubmed/31504237
2. Bystritsky A, Kerwin L, et al. A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder. J Clin Psychiatry 2008;69:412–7. https://www.ncbi.nlm.nih.gov/pubmed/18348596
3. Polanía R, Nitsche MA, et al. Studying and modifying brain function with non-invasive brain stimulation. Nat Neurosci 2018;21:174–87. https://www.nature.com/articles/s41593-017-0054-4
4. Chalah MA, Ayache SS. Noninvasive Brain Stimulation and Psychotherapy in Anxiety and Depressive Disorders: A Viewpoint. Brain Sci 2019;9. https://www.ncbi.nlm.nih.gov/pubmed/31013983
5. Terranova C, Rizzo V, et al. Is There a Future for Non-invasive Brain Stimulation as a Therapeutic Tool? Front. Neurol. 2019;9:1146. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353822/
6. Nitsche MA, Müller-Dahlhaus F, et al. The pharmacology of neuroplasticity induced by non-invasive brain stimulation: building models for the clinical use of CNS active drugs. J. Physiol. (Lond.) 2012;590:4641–62. https://www.ncbi.nlm.nih.gov/pubmed/22869014
7. Ueyama E, Ukai S, et al. Chronic repetitive transcranial magnetic stimulation increases hippocampal neurogenesis in rats. Psychiatry Clin. Neurosci. 2011;65:77–81. https://www.ncbi.nlm.nih.gov/pubmed/21265939
8. Nitsche MA, Fricke K, et al. Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. J. Physiol. (Lond.) 2003;553:293–301. https://www.ncbi.nlm.nih.gov/pubmed/12949224
9. Sagliano L, Atripaldi D, et al. Non-invasive brain stimulation in generalized anxiety disorder: A systematic review. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2019;93:31–8. https://www.ncbi.nlm.nih.gov/pubmed/30876986
10. Rodrigues PA, Zaninotto AL, et al. Transcranial magnetic stimulation for the treatment of anxiety disorder. NDT 2019;Volume 15:2743–61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765211/
11. Bystritsky A, Kerwin LE, et al. A Preliminary Study of fMRI-Guided rTMS in the Treatment of Generalized Anxiety Disorder: 6-Month Follow-Up. J. Clin. Psychiatry 2009;70:431–2. https://www.ncbi.nlm.nih.gov/pubmed/18572984
12. Kar SK, Sarkar S. Neuro-stimulation Techniques for the Management of Anxiety Disorders: An Update. Clin Psychopharmacol Neurosci 2016;14:330–7. https://www.ncbi.nlm.nih.gov/pubmed/27776384
13. Zwanzger P, Fallgatter AJ, et al. Anxiolytic effects of transcranial magnetic stimulation--an alternative treatment option in anxiety disorders? J Neural Transm (Vienna) 2009;116:767–75. https://www.ncbi.nlm.nih.gov/pubmed/19137237
14. Diefenbach GJ, Bragdon LB, et al. Repetitive transcranial magnetic stimulation for generalised anxiety disorder: A pilot randomised, double-blind, sham-controlled trial. The British Journal of Psychiatry 2016;209:222–8.https://www.ncbi.nlm.nih.gov/pubmed/27198484
15. Donse L, Padberg F, et al. Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study. Brain Stimulation 2018;11:337–45.https://www.ncbi.nlm.nih.gov/pubmed/29174304
16. Vergallito A, Gallucci A, et al. Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies. J Psychiatry Neurosci. 2021 Nov 9;46(6):E592-E614. doi: 10.1503/jpn.210050. PMID: 34753789; PMCID: PMC8580831.