Indiana University School of Medicine, Department of Psychiatry, 355W 16 St., Indianapolis, IN, USA.
Neurotherapeutics. 2021 Apr;18(2):827-844. doi: 10.1007/s13311-021-01046-1. Epub 2021 Apr 12.
Schizophrenia is a complex condition associated with perceptual disturbances, decreased motivation and affect, and disrupted cognition. Individuals living with schizophrenia may experience myriad poor outcomes, including impairment in independent living and function as well as decreased life expectancy. Though existing treatments may offer benefit, many individuals still experience treatment resistant and disabling symptoms. In light of the negative outcomes associated with schizophrenia and the limitations in currently available treatments, there is a significant need for novel therapeutic interventions. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that can modulate the activity of discrete cortical regions, allowing direct manipulation of local brain activation and indirect manipulation of the target's associated neural networks. rTMS has been studied in schizophrenia for the treatment of auditory hallucinations, negative symptoms, and cognitive deficits, with mixed results. The field's inability to arrive at a consensus on the use rTMS in schizophrenia has stemmed from a variety of issues, perhaps most notably the significant heterogeneity amongst existing trials. In addition, it is likely that factors specific to schizophrenia, rather than the rTMS itself, have presented barriers to the interpretation of existing results. However, advances in approaches to rTMS as a biologic probe and therapeutic, many of which include the integration of neuroimaging with rTMS, offer hope that this technology may still play a role in improving the understanding and treatment of schizophrenia.
精神分裂症是一种与感知障碍、动机和情感减退以及认知障碍有关的复杂疾病。患有精神分裂症的个体可能会经历多种不良后果，包括独立生活和功能受损以及预期寿命缩短。尽管现有的治疗方法可能会带来益处，但许多个体仍会经历治疗抵抗和致残症状。鉴于精神分裂症相关的负面后果以及现有治疗方法的局限性，因此需要新的治疗干预措施。重复经颅磁刺激（rTMS）是一种非侵入性的脑刺激技术，可调节离散皮质区域的活动，从而实现对局部脑激活的直接操纵和对目标相关神经网络的间接操纵。rTMS 已在精神分裂症中用于治疗幻听、阴性症状和认知缺陷，但其结果喜忧参半。该领域未能就 rTMS 在精神分裂症中的应用达成共识，这源于各种问题，也许最突出的是现有试验之间存在显著的异质性。此外，可能是精神分裂症特有的因素，而不是 rTMS 本身，阻碍了对现有结果的解释。然而，rTMS 作为生物探针和治疗方法的方法学进展，其中许多方法包括将神经影像学与 rTMS 相结合，为这项技术在改善对精神分裂症的理解和治疗方面仍可能发挥作用带来了希望。
