Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Life Sciences, National Central University, Taoyuan, Taiwan.
J Psychiatr Res. 2021 Jan;132:151-160. doi: 10.1016/j.jpsychires.2020.10.008. Epub 2020 Oct 16.
High-frequency transcranial random noise stimulation (hf-tRNS) is a non-invasive neuromodulatory technique capable of increasing human cortex excitability. There were only published case reports on the use of hf-tRNS targeting the lateral prefrontal cortex in treating negative symptoms of schizophrenia, thus necessitating systematic investigation. We designed a randomized, double-blind, sham-controlled trial in a cohort of stabilized schizophrenia patients to examine the efficacy of add-on hf-tRNS (100-640 Hz; 2 mA; 20 min) using a high definition 4 × 1 electrode montage (anode AF3, cathodes AF4, F2, F6, and FC4) in treating negative symptoms (ClinicalTrials.gov ID: NCT04038788). Participants received either active hf-tRNS or sham twice daily for 5 consecutive weekdays. Primary outcome measure was the change over time in the Positive and Negative Syndrome Scale Factor Score for Negative Symptoms (PANSS-FSNS), which was measured at baseline, after 10-session stimulation, and at one-week and one-month follow-ups. Among 36 randomized patients, 35 (97.2%) completed the trial. Intention-to-treat analysis showed a significantly greater decrease in PANSS-FSNS score after active (-17.11%) than after sham stimulation (-1.68%), with a large effect size (Cohen's d = 2.16, p < 0.001). The beneficial effect lasted for up to one month. In secondary-outcome analyses, the authors observed improvements with hf-tRNS of disorganization symptoms, unawareness of negative symptoms, subjective response to taking antipsychotics, and antipsychotic-induced extrapyramidal symptoms. No effects were observed on the neurocognitive performance and other outcome measures. Overall, hf-tRNS was safe and efficacious in improving negative symptoms. Our promising findings should be confirmed in a larger sample of patients with predominant negative symptoms.
高频经颅随机噪声刺激（hf-tRNS）是一种非侵入性的神经调节技术，能够提高人类皮层的兴奋性。只有发表的病例报告显示，使用针对外侧前额叶皮层的 hf-tRNS 治疗精神分裂症的阴性症状，因此需要系统的研究。我们设计了一项随机、双盲、假对照试验，纳入了稳定的精神分裂症患者队列，使用高清晰度 4×1 电极导联（阳极 AF3、阴极 AF4、F2、F6 和 FC4），评估附加 hf-tRNS（100-640 Hz；2 mA；20 分钟）治疗阴性症状的疗效（ClinicalTrials.gov ID：NCT04038788）。参与者每天接受两次真刺激或假刺激，连续 5 天。主要观察指标是在时间上的变化，即阳性和阴性综合征量表阴性症状因子评分（PANSS-FSNS），分别在基线、10 次刺激后、1 周和 1 个月随访时进行测量。在 36 名随机分组的患者中，35 名（97.2%）完成了试验。意向性治疗分析显示，在真刺激组中，PANSS-FSNS 评分的下降明显大于假刺激组（-17.11%比-1.68%），具有较大的效应量（Cohen's d=2.16，p<0.001）。这种有益的效果持续了一个月。在次要结局分析中，作者观察到 hf-tRNS 可改善精神分裂症患者的紊乱症状、对阴性症状的认识不足、对服用抗精神病药物的主观反应以及抗精神病药物引起的锥体外系症状。对神经认知表现和其他结局指标没有影响。总的来说，hf-tRNS 治疗改善阴性症状是安全有效的。我们有希望的发现应该在更多的以阴性症状为主的患者中得到证实。
