Alfred Psychiatry Research Centre, The Alfred and Monash University Department of Psychological Medicine, Melbourne, Victoria, Australia.
Brain Stimul. 2008 Jan;1(1):27-32. doi: 10.1016/j.brs.2007.08.001. Epub 2007 Dec 3.
Repetitive transcranial magnetic stimulation (rTMS) is increasingly being investigated as a potential treatment for a number of psychiatric disorders, including schizophrenia. Previous rTMS studies have targeted the left-side prefrontal cortex (PFC) in the treatment of negative symptoms, with inconsistent findings. Some imaging evidence suggests right-sided or bilateral PFC involvement in negative symptoms, areas yet to be investigated for rTMS treatment. The study therefore aimed to assess the efficacy of bilateral high-frequency rTMS in the treatment of negative symptoms.
A 2-arm double-blind randomized controlled trial was conducted with 20 patients with a diagnosis of schizophrenia or schizoaffective disorder, and moderate-to-severe treatment-resistant negative symptoms. Participants received a 3-week course of high-frequency bilateral rTMS or sham. Twenty trains (5 seconds duration) of 10 Hz rTMS at 110% of the RMT were administered to each PFC daily, 5 days a week.
No significant group or time differences in the Scale for the Assessment of Negative Symptoms (SANS) scores or cognitive outcomes were evident. However, a trend for greater reduction in scores on the autistic preoccupation scale of the Positive and Negative Symptom Scale for the active group compared to the sham group was observed (P = .05).
No substantial benefit of high-frequency bilateral rTMS was seen in the treatment of the negative symptoms of schizophrenia. Further research is required to explore whether rTMS may have benefits specific to particular cognitive or symptom domains.
重复经颅磁刺激（rTMS）作为治疗多种精神疾病（包括精神分裂症）的一种潜在疗法，其应用日益广泛。既往 rTMS 研究针对左前额叶皮层（PFC）治疗阴性症状，结果不一致。一些影像学证据表明，右侧或双侧 PFC 也与阴性症状有关，这些区域尚未进行 rTMS 治疗研究。因此，本研究旨在评估双侧高频 rTMS 治疗阴性症状的疗效。
采用 2 臂双盲随机对照试验，纳入 20 例精神分裂症或分裂情感障碍诊断患者，且存在中重度治疗抵抗的阴性症状。参与者接受为期 3 周的高频双侧 rTMS 或假刺激治疗。每天给予双侧 PFC 110%RMT 强度的 10 Hz rTMS，共 20 个脉冲（5 秒持续时间），每天 5 次。
在阴性症状量表（SANS）评分或认知结果方面，两组间或治疗时间上均无显著差异。然而，与假刺激组相比，活跃组的阳性和阴性症状量表的自闭症关注量表评分有更大程度降低的趋势（P =.05）。
高频双侧 rTMS 治疗精神分裂症阴性症状没有明显益处。需要进一步研究以探讨 rTMS 是否对特定认知或症状领域有获益。
