Mogg Andrew, Purvis Rick, Eranti Savitha, Contell Faith, Taylor John P, Nicholson Timothy, Brown Richard G, McLoughlin Declan M
Institute of Psychiatry, King's College London, Section of Old Age Psychiatry P070, De Crespigny Park, London SE5 8AF, UK.
Schizophr Res. 2007 Jul;93(1-3):221-8. doi: 10.1016/j.schres.2007.03.016. Epub 2007 May 2.
Negative symptoms in schizophrenia are associated with deficits in executive function and frequently prove highly resistant to neuroleptic medication. Using repetitive transcranial magnetic stimulation (rTMS) to activate the prefrontal cortex has been suggested as a treatment for negative symptoms.
We performed a double-blind randomized controlled pilot study of real versus sham rTMS for negative symptoms in schizophrenia. 17 right-handed patients with prominent negative symptoms (PANSS negative subscore >or=20) were randomized to a 10 day course of real (n=8) or sham rTMS (n=9) applied to the left dorsolateral prefrontal cortex (20 trains per day, 10 s treatment at 10 Hz, 50 s inter-train interval, 110% of motor threshold). The primary outcome measure was PANSS negative symptom score. Secondary outcomes included mood, cognitive function and side-effects. Patients were followed-up two weeks afterwards. The main effect of treatment arm was evaluated across end of treatment and two-week follow-up time points using ANCOVA.
All subjects completed the treatment course. There was no significant difference between the two groups on PANSS negative symptom scores at either time point. At the end of treatment, no subjects in either group met the criterion for response (i.e. a 20% reduction in baseline PANSS negative symptom score). The real rTMS group had better delayed recall on a test of verbal learning than the sham group at 2 week follow-up.
Real rTMS was not found to be better than sham rTMS in alleviating negative symptoms of schizophrenia although it was associated with some improvement in aspects of cognitive function at follow-up.
精神分裂症的阴性症状与执行功能缺陷相关，并且常常对抗精神病药物具有高度耐药性。有人提出使用重复经颅磁刺激（rTMS）激活前额叶皮质来治疗阴性症状。
我们进行了一项双盲随机对照试验性研究，比较真实rTMS与伪rTMS治疗精神分裂症阴性症状的效果。17名有明显阴性症状（阳性和阴性症状量表阴性子量表≥20）的右利手患者被随机分为两组，分别接受为期10天的左侧背外侧前额叶皮质真实rTMS治疗（n = 8）或伪rTMS治疗（n = 9）（每天20串，10赫兹，每次治疗10秒，串间间隔50秒，运动阈值的110%）。主要结局指标为阳性和阴性症状量表阴性症状评分。次要结局包括情绪、认知功能和副作用。两周后对患者进行随访。使用协方差分析在治疗结束和两周随访时间点评估治疗组的主要效应。
所有受试者均完成了治疗过程。在两个时间点，两组的阳性和阴性症状量表阴性症状评分均无显著差异。治疗结束时，两组均无受试者达到反应标准（即基线阳性和阴性症状量表阴性症状评分降低20%）。在两周随访时，真实rTMS组在言语学习测试中的延迟回忆比伪rTMS组更好。
虽然真实rTMS在随访时与认知功能某些方面的改善相关，但在减轻精神分裂症阴性症状方面并不比伪rTMS更好。
