School of Education, Xinyang College, Xinyang, China; Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Psychiatry, Second Affiliated Hospital, Army Medical University, Chongqing, China.
J Psychiatr Res. 2022 May;149:87-96. doi: 10.1016/j.jpsychires.2022.02.030. Epub 2022 Mar 2.
Despite low-frequency repetitive transcranial magnetic stimulation (rTMS) is effective in treating schizophrenia patients with auditory verbal hallucinations (AVH), the underlying neural mechanisms of the effect still need to be clarified. Using the cerebellar dentate nucleus (DN) subdomain (dorsal and versal DN) as seeds, the present study investigated resting state functional connectivity (FC) alternations of the seeds with the whole brain and their associations with clinical responses in schizophrenia patients with AVH receiving 1 Hz rTMS treatment. The results showed that the rTMS treatment improved the psychiatric symptoms (e.g., AVH and positive symptoms) and certain neurocognitive functions (e.g., visual learning and verbal learning) in the patients. In addition, the patients at baseline showed increased FC between the DN subdomains and temporal lobes (e.g., right superior temporal gyrus and right middle temporal gyrus) and decreased FC between the DN subdomains and the left superior frontal gyrus, right postcentral gyrus, left supramarginal gyrus and regional cerebellum (e.g., lobule 4-5) compared to controls. Furthermore, these abnormal DN subdomain connectivity patterns did not persist and decreased FC of DN subdomains with cerebellum lobule 4-5 were reversed in patients after rTMS treatment. Linear regression analysis showed that the FC difference values of DN subdomains with the temporal lobes, supramarginal gyrus and cerebellum 4-5 between the patients at baseline and posttreatment were associated with clinical improvements (e.g., AVH and verbal learning) after rTMS treatment. The results suggested that rTMS treatment may modulate the neural circuits of the DN subdomains and hint to underlying neural mechanisms for low-frequency rTMS treating schizophrenia with AVH.
尽管低频重复经颅磁刺激（rTMS）在治疗伴有幻听的精神分裂症患者方面有效，但该效应的潜在神经机制仍需阐明。本研究使用小脑齿状核（DN）亚区（背侧和腹侧 DN）作为种子，探讨了接受 1 Hz rTMS 治疗的伴有幻听的精神分裂症患者的种子与全脑静息态功能连接（FC）变化及其与临床反应的关系。结果表明，rTMS 治疗改善了患者的精神症状（如幻听和阳性症状）和某些神经认知功能（如视觉学习和言语学习）。此外，与对照组相比，患者在基线时表现出 DN 亚区与颞叶（如右侧颞上回和右侧颞中回）之间的 FC 增加，以及 DN 亚区与左侧额上回、右侧中央后回、左侧缘上回和区域小脑（如 4-5 叶）之间的 FC 减少。此外，这些异常的 DN 亚区连接模式并未持续存在，并且 rTMS 治疗后患者的 DN 亚区与小脑 4-5 叶之间的 FC 减少得到逆转。线性回归分析显示，患者在基线和治疗后之间的 DN 亚区与颞叶、缘上回和小脑 4-5 之间的 FC 差异值与 rTMS 治疗后的临床改善（如幻听和言语学习）相关。结果表明，rTMS 治疗可能调节 DN 亚区的神经回路，并提示低频 rTMS 治疗伴有幻听的精神分裂症的潜在神经机制。
