Du Xiang-Dong, Li Zhe, Yuan Nian, Yin Ming, Zhao Xue-Li, Lv Xiao-Li, Zou Si-Yun, Zhang Jun, Zhang Guang-Ya, Li Chuan-Wei, Pan Hui, Yang Li, Wu Si-Qi, Yue Yan, Wu Yu-Xuan, Zhang Xiang-Yang
Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China.
Department of Psychiatry, Third People's Hospital of Changshu, Changshu 215501, Jiangsu Province, China.
World J Psychiatry. 2022 Sep 19;12(9):1169-1182. doi: 10.5498/wjp.v12.i9.1169.
BACKGROUND: Cognitive impairments are core characteristics of schizophrenia, but are largely resistant to current treatments. Several recent studies have shown that high-frequency repetitive transcranial magnetic stimulation (rTMS) of the left dor-solateral prefrontal cortex (DLPFC) can reduce negative symptoms and improve certain cognitive deficits in schizophrenia patients. However, results are inconsistent across studies. AIM: To examine if high-frequency rTMS of the DLPFC can improve visual memory deficits in patients with schizophrenia. METHODS: Forty-seven chronic schizophrenia patients with severe negative symptoms on stable treatment regimens were randomly assigned to receive active rTMS to the DLPFC ( = 25) or sham stimulation ( = 22) on weekdays for four consecutive weeks. Patients performed the pattern recognition memory (PRM) task from the Cambridge Neuropsychological Test Automated Battery at baseline, at the end of rTMS treatment (week 4), and 4 wk after rTMS treatment (week 8). Clinical symptoms were also measured at these same time points using the Scale for the Assessment of Negative Symptoms (SANS) and the Positive and Negative Syndrome Scale (PANSS). RESULTS: There were no significant differences in PRM performance metrics, SANS total score, SANS subscores, PANSS total score, and PANSS subscores between active and sham rTMS groups at the end of the 4-wk treatment period, but PRM performance metrics (percent correct and number correct) and changes in these metrics from baseline were significantly greater in the active rTMS group at week 8 compared to the sham group (all < 0.05). Active rTMS treatment also significantly reduced SANS score at week 8 compared to sham treatment. Moreover, the improvement in visual memory was correlated with the reduction in negative symptoms at week 8. In contrast, there were no between-group differences in PANSS total score and subscale scores at either week 4 or week 8 (all > 0.05). CONCLUSION: High-frequency transcranial magnetic stimulation improves visual memory and reduces negative symptoms in schizophrenia, but these effects are delayed, potentially due to the requirement for extensive neuroplastic changes within DLPFC networks.
背景：认知障碍是精神分裂症的核心特征，但目前的治疗方法对此大多无效。最近的几项研究表明，对左侧背外侧前额叶皮质（DLPFC）进行高频重复经颅磁刺激（rTMS）可以减轻精神分裂症患者的阴性症状，并改善某些认知缺陷。然而，各研究结果并不一致。 目的：探讨对DLPFC进行高频rTMS是否能改善精神分裂症患者的视觉记忆缺陷。 方法：47例在稳定治疗方案下有严重阴性症状的慢性精神分裂症患者被随机分配，在工作日接受对DLPFC的主动rTMS（n = 25）或假刺激（n = 22），连续四周。患者在基线、rTMS治疗结束时（第4周）以及rTMS治疗后4周（第8周）进行剑桥神经心理测试自动化成套测验中的模式识别记忆（PRM）任务。同时在这些相同时间点使用阴性症状评定量表（SANS）和阳性与阴性症状量表（PANSS）测量临床症状。 结果：在4周治疗期结束时，主动rTMS组和假刺激组在PRM表现指标、SANS总分、SANS子分数、PANSS总分和PANSS子分数方面没有显著差异，但在第8周时，主动rTMS组的PRM表现指标（正确百分比和正确数量）以及这些指标相对于基线的变化显著大于假刺激组（所有P < 0.05）。与假刺激治疗相比，主动rTMS治疗在第8周时也显著降低了SANS评分。此外，第8周时视觉记忆的改善与阴性症状的减轻相关。相比之下，在第4周或第8周时，两组在PANSS总分和各分量表分数方面没有组间差异（所有P > 0.05）。 结论：高频经颅磁刺激可改善精神分裂症患者的视觉记忆并减轻阴性症状，但这些效果具有延迟性，可能是由于DLPFC网络内需要广泛的神经可塑性变化。
Lancet. 2022-1-29
Ind Psychiatry J. 2021-10
Neuropsychopharmacology. 2022-1
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