Hoffman Ralph E, Gueorguieva Ralitza, Hawkins Keith A, Varanko Maxine, Boutros Nash N, Wu Yu-te, Carroll Kathleen, Krystal John H
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
Biol Psychiatry. 2005 Jul 15;58(2):97-104. doi: 10.1016/j.biopsych.2005.03.041.
Auditory hallucinations are often resistant to treatment and can produce significant distress and behavioral difficulties. A preliminary report based on 24 patients with schizophrenia or schizoaffective disorder indicated greater improvement in auditory hallucinations following 1-hertz left temporoparietal repetitive transcranial magnetic stimulation (rTMS) compared to sham stimulation. Data from the full 50-subject sample incorporating 26 new patients are now presented to more comprehensively assess safety/tolerability, efficacy and moderators of this intervention.
Right-handed patients experiencing auditory hallucinations at least 5 times per day were randomly allocated to receive either rTMS or sham stimulation. A total of 132 minutes of rTMS was administered over 9 days at 90% motor threshold using a double-masked, sham-controlled, parallel design.
Hallucination Change Score was more improved for rTMS relative to sham stimulation (p = .008) as was the Clinical Global Impressions Scale (p = .0004). Hallucination frequency was significantly decreased during rTMS relative to sham stimulation (p = .0014) and was a moderator of rTMS effects (p = .008). There was no evidence of neurocognitive impairment associated with rTMS.
Left temporoparietal 1-hertz rTMS warrants further study as an intervention for auditory hallucinations. Data suggest that this intervention selectively alters neurobiological factors determining frequency of these hallucinations.
幻听往往对治疗有抵抗性，会产生严重的痛苦和行为困难。一份基于24例精神分裂症或分裂情感性障碍患者的初步报告表明，与假刺激相比，1赫兹左侧颞顶叶重复经颅磁刺激（rTMS）后幻听症状有更大改善。现在呈现纳入26例新患者的完整50例样本的数据，以更全面地评估这种干预措施的安全性/耐受性、疗效及调节因素。
每天至少经历5次幻听的右利手患者被随机分配接受rTMS或假刺激。采用双盲、假对照、平行设计，在9天内以90%运动阈值给予总共132分钟的rTMS。
相对于假刺激，rTMS的幻觉变化评分改善更明显（p = .008），临床总体印象量表评分也是如此（p = .0004）。相对于假刺激，rTMS期间幻觉频率显著降低（p = .0014），且是rTMS效果的调节因素（p = .008）。没有证据表明rTMS与神经认知损害有关。
左侧颞顶叶1赫兹rTMS作为幻听的一种干预措施值得进一步研究。数据表明，这种干预措施选择性地改变了决定这些幻觉频率的神经生物学因素。
