Department of Neuroscience, University Medical Center Groningen, The Netherlands.
J Psychiatr Res. 2010 Aug;44(11):725-31. doi: 10.1016/j.jpsychires.2009.12.011. Epub 2010 Feb 26.
Auditory-verbal hallucinations are a hallmark symptom of schizophrenia. In recent years, repetitive transcranial magnetic stimulation (rTMS) targeting speech perception areas has been advanced as a potential treatment of medication-resistant hallucinations. However, the underlying neural processes remain unclear. This study aimed to assess whether 1 Hz rTMS treatment would affect functional connectivity of the temporo-parietal junction (TPJ). Resting state fMRI scans were obtained from 18 patients with schizophrenia. Patients were assessed before and after a 6 day treatment with 1 Hz rTMS to the left TPJ, or placebo treatment with sham rTMS to the same location. We assessed functional connectivity between a priori defined regions-of-interest (ROIs) comprising the putative AVH network and the bilateral TPJ seed regions, targeted with rTMS. Symptom improvement following rTMS treatment was observed in the left rTMS group, whereas no change at occurred in the placebo group. Although no corresponding changes were observed in the functional connections previously found to be associated with AVH severity, an increase in connectivity between the left TPJ and the right insula was observed in group receiving rTMS to the left TPJ. The placebo group conversely showed a decrease in connectivity between the left TPJ and left anterior cingulate. We conclude that application of 1 Hz rTMS to the left TPJ region may affect functional connectivity of the targeted region. However, the relationship between these functional changes during the resting state and the rate of clinical improvement needs further clarification.
听觉言语幻觉是精神分裂症的一个标志性症状。近年来，针对言语感知区域的重复经颅磁刺激(rTMS)已被提出作为治疗药物抵抗性幻觉的一种潜在方法。然而，其潜在的神经过程仍不清楚。本研究旨在评估 1Hz rTMS 治疗是否会影响颞顶联合区（TPJ）的功能连接。从 18 名精神分裂症患者中获得静息状态 fMRI 扫描。患者在接受左侧 TPJ 的 1Hz rTMS 治疗或相同位置的假刺激 rTMS 治疗 6 天后进行评估。我们评估了包含假定 AVH 网络的先验定义 ROI（感兴趣区）与双侧 TPJ 种子区域之间的功能连接，这些区域与 rTMS 目标区域相对应。在接受左侧 rTMS 治疗的患者中观察到 rTMS 治疗后症状改善，而在接受安慰剂治疗的患者中则没有变化。尽管在与 AVH 严重程度相关的功能连接中没有观察到相应的变化，但在接受左侧 TPJ rTMS 治疗的患者中观察到左侧 TPJ 与右侧岛叶之间的连接增加。相反，接受左侧 TPJ 假刺激 rTMS 的患者观察到左侧 TPJ 与左前扣带之间的连接减少。我们得出结论，应用 1Hz rTMS 于左侧 TPJ 区域可能会影响目标区域的功能连接。然而，这些在静息状态下的功能变化与临床改善率之间的关系需要进一步澄清。
