导航和个体化 α 峰频率引导经颅磁刺激治疗难治性精神分裂症男性患者。
Navigated and individual α-peak-frequency-guided transcranial magnetic stimulation in male patients with treatment-refractory schizophrenia.
机构信息
From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen).
出版信息
J Psychiatry Neurosci. 2024 Mar 1;49(2):E87-E95. doi: 10.1503/jpn.230063. Print 2024 Jan-Feb.
BACKGROUND
Previous electroencephalography (EEG) studies have indicated altered brain oscillatory α-band activity in schizophrenia, and treatment with repetitive transcranial magnetic stimulation (rTMS) using individualized α-frequency has shown therapeutic effects. Magnetic resonance imaging-based neuronavigation methods allow stimulation of a specific cortical region and improve targeting of rTMS; therefore, we sought to study the efficacy of navigated, individual α-peak-frequency-guided rTMS (αTMS) on treatment-refractory schizophrenia.
METHODS
We recruited medication-refractory male patients with schizophrenia or schizoaffective disorder in this doubleblind, sham-controlled study. We randomized patients to a 3-week course of either active αTMS or sham stimulation applied to the left dorsolateral prefrontal cortex (DLPFC). We assessed participants with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) at baseline and after treatment. We conducted a follow-up assessment with the PANSS 3 months after intervention.
RESULTS
We included 44 patients. After treatment, we observed a significantly higher PANSS total score ( = 0.029), PANSS general psychopathology score ( = 0.027) and PANSS 5-factor model cognitive-disorganized factor score ( = 0.011) in the αTMS group than the sham group. In addition, the CGI-Improvement score was significantly higher among those who received αTMS compared with sham stimulation ( = 0.048).
LIMITATIONS
The limited number of study participants included only male patients. Depression was not formally evaluated.
CONCLUSION
Navigated αTMS to the left DLPFC reduced total, general psychopathological, and cognitive-disorganized symptoms of schizophrenia. These results provide evidence for the therapeutic efficacy of individual α-peak-frequency-guided rTMS in treatment-refractory schizophrenia.
CLINICAL TRIAL REGISTRATION
NCT01941251; ClinicalTrials.gov.
背景
先前的脑电图 (EEG) 研究表明精神分裂症患者大脑振荡 α 频段活动发生改变，采用个体化 α 频率的重复经颅磁刺激 (rTMS) 治疗显示出治疗效果。基于磁共振成像的神经导航方法可刺激特定的皮质区域，提高 rTMS 的靶向性；因此，我们试图研究导航、个体化 α 峰频率引导 rTMS (αTMS) 治疗难治性精神分裂症的疗效。
方法
我们在这项双盲、假刺激对照研究中招募了药物难治性男性精神分裂症或分裂情感障碍患者。我们将患者随机分为接受为期 3 周的左侧背外侧前额叶皮质 (DLPFC) 活性 αTMS 或假刺激的治疗组。我们在基线和治疗后使用阳性和阴性症状量表 (PANSS) 和临床总体印象量表 (CGI) 评估参与者。在干预后 3 个月，我们进行了 PANSS 随访评估。
结果
我们纳入了 44 名患者。治疗后，αTMS 组的 PANSS 总分（ = 0.029）、PANSS 一般精神病学评分（ = 0.027）和 PANSS 5 因子模型认知障碍因子评分（ = 0.011）均显著高于假刺激组。此外，与假刺激相比，αTMS 组的 CGI-改善评分显著更高（ = 0.048）。
局限性
研究参与者人数有限，仅纳入了男性患者。未正式评估抑郁。
结论
左侧 DLPFC 的导航 αTMS 可降低精神分裂症的总症状、一般精神病学症状和认知障碍症状。这些结果为个体化 α 峰频率引导 rTMS 治疗难治性精神分裂症的疗效提供了证据。
临床试验注册
NCT01941251；ClinicalTrials.gov。
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