Zhuo Kaiming, Tang Yingying, Song Zhenhua, Wang Yingchan, Wang Junjie, Qian Zhenying, Li Hui, Xiang Qiong, Chen Tianyi, Yang Zhilei, Xu Yifeng, Fan Xiaoduo, Wang Jijun, Liu Dengtang
First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Department of EEG and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Neuropsychiatr Dis Treat. 2019 May 8;15:1141-1150. doi: 10.2147/NDT.S196086. eCollection 2019.
Effective treatment options for negative symptoms and cognitive impairment in patients with schizophrenia are still to be developed. The present study was to examine potential benefits of repetitive transcranial magnetic stimulation (rTMS) to improve negative symptoms and cognition in this patient population. The study was a 4-week, randomized, double-blind sham-controlled trial. Patients with schizophrenia were treated with adjunctive 20-Hz rTMS for 4 weeks or sham condition to the left dorsolateral prefrontal cortex (DLPFC). Negative symptoms were measured using the Scale for the Assessment of Negative Symptoms (SANS) and the Positive and Negative symptom scale (PANSS) negative subscale at baseline and week 4. Cognitive function was measured using the MATRICS Consensus Cognitive Battery (MCCB) at the same two time points. In addition, possible moderators for rTMS treatment efficacy were explored. Sixty patients (33 in the treatment group, 27 in the sham group) completed the study. There was a significant decrease in negative symptoms after 4-week rTMS treatment as measured by the SANS total score and the PANSS negative symptom subscale score. However, there was no significant improvement in cognition with rTMS treatment. Stepwise multiple linear regression analysis suggested that the baseline severity of positive symptoms may predict poorer improvement in negative symptoms at week 4. Twenty-Hz rTMS stimulation over left DLPFC as an adjunctive treatment might be beneficial in improving negative symptoms of schizophrenia. Future studies with a longer treatment duration and a larger sample size are needed. NCT01940939.
精神分裂症患者阴性症状和认知障碍的有效治疗方案仍有待开发。本研究旨在探讨重复经颅磁刺激（rTMS）改善该患者群体阴性症状和认知功能的潜在益处。该研究为一项为期4周的随机双盲假对照试验。精神分裂症患者接受为期4周的辅助性20赫兹rTMS治疗，刺激左侧背外侧前额叶皮质（DLPFC），或接受假刺激。在基线和第4周时，使用阴性症状评估量表（SANS）和阳性与阴性症状量表（PANSS）阴性分量表测量阴性症状。在相同的两个时间点，使用MATRICS共识认知成套测验（MCCB）测量认知功能。此外，还探索了rTMS治疗效果的可能调节因素。60名患者（治疗组33名，假刺激组27名）完成了研究。通过SANS总分和PANSS阴性症状分量表评分测量，4周rTMS治疗后阴性症状显著减轻。然而，rTMS治疗对认知功能没有显著改善。逐步多元线性回归分析表明，阳性症状的基线严重程度可能预示第4周时阴性症状改善较差。对左侧DLPFC进行20赫兹rTMS刺激作为辅助治疗可能有助于改善精神分裂症的阴性症状。未来需要开展治疗持续时间更长、样本量更大的研究。NCT01940939。
