University Medical Centre, Department of Psychiatry and Psychotherapy, Georg August University Göttingen, von-Siebold-Str. 5, D-37075 Göttingen, Germany.
Behav Brain Res. 2013 Jan 15;237:300-7. doi: 10.1016/j.bbr.2012.09.034. Epub 2012 Sep 27.
In schizophrenia patients negative symptoms and cognitive impairment often persist despite treatment with second generation antipsychotics leading to reduced quality of life and psychosocial functioning. One core cognitive deficit is impaired working memory (WM) suggesting malfunctioning of the dorsolateral prefrontal cortex. High frequency repetitive transcranial magnetic stimulation (rTMS) has been used to transiently facilitate or consolidate neuronal processes. Pilot studies using rTMS have demonstrated improvement of psychopathology in other psychiatric disorders, but a systematic investigation of working memory effects outlasting the stimulation procedure has not been performed so far. The aim of our study was to explore the effect of a 3-week high frequency active or sham 10 Hz rTMS on cognition, specifically on working memory, in schizophrenia patients (n=25) in addition to antipsychotic therapy and in healthy controls (n=22). We used functional magnetic resonance imaging (fMRI) to compare activation patterns during verbal WM (letter 2-back task) before and after 3-weeks treatment with rTMS. Additionally, other cognitive tasks were conducted. 10 Hz rTMS was applied over the left posterior middle frontal gyrus (EEG electrode location F3) with an intensity of 110% of the individual resting motor threshold (RMT) over a total of 15 sessions. Participants recruited the common fronto- parietal and subcortical WM network. Multiple regression analyses revealed no significant activation differences over time in any contrast or sample. According to the ANOVAs for repeated measures performance remained without alterations in all groups. This is the first fMRI study that has systematically investigated this topic within a randomized, placebo-controlled, double-blind design, contrasting the effects in schizophrenia patients and healthy controls.
在精神分裂症患者中,尽管使用第二代抗精神病药物治疗,但阴性症状和认知障碍仍经常持续存在,导致生活质量和社会心理功能下降。核心认知缺陷之一是工作记忆(WM)受损,表明背外侧前额叶皮层功能障碍。高频重复经颅磁刺激(rTMS)已被用于暂时促进或巩固神经元过程。使用 rTMS 的初步研究表明,它可以改善其他精神障碍的精神病理学,但迄今为止,尚未对工作记忆效应进行系统研究,使其超过刺激过程。我们的研究目的是探讨为期 3 周的高频(10 Hz)rTMS 对认知,特别是工作记忆的影响,除了抗精神病药物治疗外,还在精神分裂症患者(n=25)和健康对照组(n=22)中进行。我们使用功能磁共振成像(fMRI)来比较 rTMS 治疗前和治疗后 3 周期间言语 WM(字母 2 回任务)期间的激活模式。此外,还进行了其他认知任务。10 Hz rTMS 应用于左后中额回(EEG 电极位置 F3),强度为个体静息运动阈值(RMT)的 110%,共进行 15 次。参与者招募了常见的额顶和皮质下 WM 网络。多元回归分析显示,在任何对比或样本中,随时间的激活差异均不显著。根据重复测量的 ANOVA,所有组的表现均未发生变化。这是第一项在随机、安慰剂对照、双盲设计中系统研究这一主题的 fMRI 研究,对比了精神分裂症患者和健康对照组的效果。
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