Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands.
Brain Stimul. 2012 Oct;5(4):554-9. doi: 10.1016/j.brs.2011.10.005. Epub 2011 Oct 31.
BACKGROUND: Low-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the left temporoparietal area (TP) has been investigated as a treatment method for auditory verbal hallucinations (AVH) yielding inconsistent results. In vitro studies have indicated that the effects of low-frequency rTMS can be enhanced by a brief pretreatment phase consisting of high-frequency rTMS (i.e., priming rTMS). OBJECTIVE: The aim of this single-blind, randomized controlled study was to investigate whether the effects of rTMS on AVH can be enhanced with priming rTMS. METHODS: Twenty-three patients with medication-resistant AVH were randomized over two groups: one receiving low-frequency rTMS preceded by 5 minutes of 6 Hertz rTMS; and another receiving low-frequency rTMS without priming. Both treatments were directed at the left TP. The total duration of stimulation was equal in the two groups, namely, 15 sessions of 20 minutes each. The severity of AVH and other psychotic features were measured with the aid of the Auditory Hallucination Rating Scale (AHRS), the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS). RESULTS: The severity of AVH and other psychotic symptoms in the group with priming was not significantly lower after 3 weeks of treatment in comparison to baseline. The group treated with standard rTMS showed a trend toward improvement after 3 weeks of treatment. No significant differences were observed on any of the rating scales between the group with and without priming. CONCLUSIONS: This study does not provide evidence that priming rTMS is an effective treatment for AVH.
背景:低频重复经颅磁刺激(rTMS)应用于左颞顶区(TP)已被研究为治疗听觉言语幻觉(AVH)的一种方法,但结果不一致。体外研究表明,低频 rTMS 的效果可以通过一个短暂的预处理阶段来增强,该阶段由高频 rTMS 组成(即,启动 rTMS)。
目的:本单盲、随机对照研究旨在探讨启动 rTMS 是否可以增强 rTMS 对 AVH 的作用。
方法:23 例药物难治性 AVH 患者随机分为两组:一组接受低频 rTMS 前 5 分钟 6 赫兹 rTMS;另一组接受低频 rTMS 无启动。两种治疗均针对左 TP。两组的刺激总持续时间相等,即 15 次 20 分钟。AVH 和其他精神病特征的严重程度采用听觉幻觉评定量表(AHRS)、阳性和阴性综合征量表(PANSS)和精神病症状评定量表(PSYRATS)进行测量。
结果:与基线相比,经过 3 周的治疗,启动组 AVH 和其他精神病症状的严重程度并没有显著降低。标准 rTMS 治疗组在治疗 3 周后有改善的趋势。在任何评分量表上,启动组与无启动组之间均未观察到显著差异。
结论:本研究没有提供证据表明启动 rTMS 是治疗 AVH 的有效方法。
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