强迫症患者经重复经颅磁刺激治疗后，前扣带回皮质吻部神经代谢浓度的直接变化。
Direct changes of neurometabolic concentrations in the pregenual anterior cingulate cortex among obsessive-compulsive patients after repetitive transcranial magnetic stimulation treatment.
机构信息
Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Shantou University Medical College, Shantou, China.
Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
出版信息
J Affect Disord. 2023 Jul 15;333:79-85. doi: 10.1016/j.jad.2023.04.052. Epub 2023 Apr 18.
BACKGROUND AND AIM
Although Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising new noninvasive brain stimulation therapy, its underlying mechanisms of action remain unknown. OCD patients exhibit impaired response control and attention shifting, which is linked to some brain areas such as anterior cingulate cortex and basal ganglia. OCD patients also display altered neurometabolic concentrations in cortical cortical-striatal-thalamic-cortical (CSTC). In this study, we aimed to elucidate efficacy of rTMS treatment in alleviating related symptoms and pregenual anterior cingulate cortex (pACC) neurometabolites.
METHODS
OCD patients were randomly divided into either drug (n = 23) or drug + rTMS (n = 29) groups, and those in the latter group subjected to 4-week rTMS treatment. All participants were visited twice, at baseline and follow-up after four weeks. During both visits, all patients were subjected to 1H-MRS, then Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Global Assessment Function (GAF) used to assess severity of obsessive-compulsive symptoms. We also evaluated synchronous anxiety and depression by Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D).
RESULTS
After 4 weeks of treatment, patients in the Drug + rTMS group displayed significantly lower Y-BOCS (p = 0.038), BDI (p = 0.009), HAM-D (p = 0.013), HAM-A (p = 0.012) scores than their counterparts in the Drug group. Conversely, patients in the Drug + rTMS group had significantly higher tNAA concentrations (p = 0.030) than those in the Drug group. Notably, the Drug + rTMS group exhibited higher, but insignificant Glu (p = 0.055) and Glx (p = 0.068) concentrations compared to the Drug group. Partial correlation analysis revealed a significant negative correlation between post HAM-A scores and 4-week change of pACC glutamate levels in the Drug + rTMS group (r = -0.434, p = 0.02).
CONCLUSION
rTMS treatment is an efficacious treatment therapy for OCD, mainly by inducing changes in neurometabolites.
背景与目的
重复经颅磁刺激（rTMS）是一种很有前途的新的非侵入性脑刺激治疗方法，但它的作用机制尚不清楚。强迫症（OCD）患者表现出反应控制和注意力转移受损，这与前扣带回皮层和基底节等一些脑区有关。OCD 患者也显示出皮质-纹状体-丘脑-皮质（CSTC）的神经代谢浓度改变。在这项研究中，我们旨在阐明 rTMS 治疗对减轻相关症状和预处理前扣带皮层（pACC）神经代谢物的疗效。
方法
OCD 患者随机分为药物组（n=23）或药物+rTMS 组（n=29），后者接受 4 周的 rTMS 治疗。所有参与者均在基线和 4 周后进行两次访问。在两次访问中，所有患者均接受 1H-MRS 检查，然后使用耶鲁-布朗强迫症量表（Y-BOCS）和总体功能评估（GAF）评估强迫症症状的严重程度。我们还通过贝克焦虑量表（BAI）、贝克抑郁量表（BDI）、汉密尔顿焦虑量表（HAM-A）和汉密尔顿抑郁量表（HAM-D）评估同步焦虑和抑郁。
结果
治疗 4 周后，药物+rTMS 组的 Y-BOCS（p=0.038）、BDI（p=0.009）、HAM-D（p=0.013）和 HAM-A（p=0.012）评分均明显低于药物组。相反，药物+rTMS 组的 tNAA 浓度明显高于药物组（p=0.030）。值得注意的是，药物+rTMS 组的谷氨酸（Glu）和谷氨酸盐（Glx）浓度高于药物组，但差异无统计学意义（Glu：p=0.055；Glx：p=0.068）。偏相关分析显示，药物+rTMS 组的 HAM-A 评分与 pACC 谷氨酸水平在 4 周时的变化呈显著负相关（r=-0.434，p=0.02）。
结论
rTMS 治疗是 OCD 的一种有效治疗方法，主要通过诱导神经代谢物的变化。
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