[重复经颅磁刺激(rTMS)在幻听(AVH)中的应用]

[The use of repetitive transcranial magnetic stimulation (rTMS) in auditory verbal hallucinations (AVH)].

作者信息

Jandl M

机构信息

Klinik für Psychiatrie und Psychotherapie I, Universitätsklinik Ulm, Ravensburg.

出版信息

Fortschr Neurol Psychiatr. 2010 Nov;78(11):632-43. doi: 10.1055/s-0029-1245499. Epub 2010 Jul 20.

Abstract

Up to one-third of all schizophrenic patients suffer from auditory verbal hallucinations (AVH) that are resistant to antipsychotics. The use of repetitive transcranial magnetic stimulation (rTMS) is a therapeutic option that may disrupt or attenuate treatment resistant (TR) AVHs. This article reviews the available literature on the use of rTMS to treat AVHs, particularly focusing on randomised controlled trials, which have introduced new definitions ("refractory AVHs"), and techniques (active comparator strategies and imaging-guided rTMS). A number of meta-analyses are considered, which support a range of positive effect sizes for AVH attenuation in response to rTMS. Larger maintenance and follow-up studies with clearer clinical definitions of TR AVH are required. The underlying mechanism of action of rTMS on language networks needs further clarification and future trials should focus on methods for assessing AVH changes, time courses of response, and the development of response markers.

摘要

高达三分之一的精神分裂症患者患有对抗精神病药物耐药的幻听(AVH)。重复经颅磁刺激(rTMS)的使用是一种治疗选择,可能会干扰或减轻耐药性(TR)AVH。本文综述了关于使用rTMS治疗AVH的现有文献,特别关注引入了新定义(“难治性AVH”)和技术(活性对照策略和成像引导rTMS)的随机对照试验。文中考虑了一些荟萃分析,这些分析支持rTMS对AVH减轻有一系列积极的效应量。需要开展更大规模的维持和随访研究,并对TR AVH进行更清晰的临床定义。rTMS对语言网络的潜在作用机制需要进一步阐明,未来的试验应侧重于评估AVH变化的方法、反应的时间进程以及反应标志物的开发。

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