Poulet Emmanuel, Brunelin Jérôme, Bediou Benoit, Bation Rémi, Forgeard Louis, Dalery Jean, d'Amato Thierry, Saoud Mohamed
Vulnérabilité à la Psychose de la Prédiction à la Prévention, UCBL, France.
Biol Psychiatry. 2005 Jan 15;57(2):188-91. doi: 10.1016/j.biopsych.2004.10.007.
BACKGROUND: Almost a quarter of patients with schizophrenia present with resistant auditory verbal hallucinations (AVH), a phenomenon that may relate to activation of brain areas underlying speech perception. Repetitive transcranial magnetic stimulation (rTMS) at 1 Hz reduces cortical activation, and recent results have shown that 1-Hz left temporoparietal rTMS may reduce AVH. The aim of this study was to replicate recent data and investigate whether low-frequency rTMS with a high total stimulation number delivered in a shorter 5-day block produces similar benefit. METHODS: Ten right-handed schizophrenia patients with resistant AVH received 5 days of active rTMS and 5 days of sham rTMS (2,000 stimulations per day at 90% of motor threshold) over the left temporoparietal cortex in a double-blind crossover design. The two weeks of stimulation were separated by a 1-week washout period. RESULTS: AVH were robustly improved (56%) by 5 days active rTMS, whereas no variation was observed after sham. Seven patients were responders to active treatment, five of whom maintained improvement for at least 2 months. CONCLUSIONS: These data confirm the efficiency of low-frequency rTMS applied to the left temporoparietal cortex, compared with sham stimulation, in reducing resistant AVH. This improvement can be obtained in only 5 days without serious initial adverse events.
背景:近四分之一的精神分裂症患者存在难治性幻听(AVH),这一现象可能与言语感知相关脑区的激活有关。1赫兹的重复经颅磁刺激(rTMS)可降低皮层激活,近期研究结果表明,1赫兹的左颞顶叶rTMS可能会减少幻听。本研究的目的是重复近期的数据,并调查在较短的5天疗程内给予高总刺激次数的低频rTMS是否能产生类似的效果。 方法:10名患有难治性幻听的右利手精神分裂症患者,采用双盲交叉设计,在左颞顶叶皮层接受5天的活性rTMS和5天的假rTMS(每天2000次刺激,强度为运动阈值的90%)。两周的刺激之间有1周的洗脱期。 结果:5天的活性rTMS使幻听显著改善(56%),而假刺激后未观察到变化。7名患者对活性治疗有反应,其中5名患者至少维持改善2个月。 结论:与假刺激相比,这些数据证实了低频rTMS应用于左颞顶叶皮层在减少难治性幻听方面的有效性。仅在5天内即可获得这种改善,且无严重的初始不良事件。
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