Probing the pathophysiology of auditory/verbal hallucinations by combining functional magnetic resonance Imaging and Transcranial magnetic stimulation
Probing the pathophysiology of auditory/verbal hallucinations by combining functional magnetic resonance Imaging and Transcranial magnetic stimulation
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DOI：
10.1093/cercor/bhl183
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发表时间：
2007-11-01
期刊：
影响因子：
3.7
通讯作者：
Krystal, John H.
中科院分区：
文献类型：
--
作者：
Hoffman, Ralph E.;Hampson, Michelle;Krystal, John H.
应用功能磁共振成像和重复经颅磁刺激(RTMS)技术探讨幻听/言语幻觉(AVH)的病理生理机制。对16例精神分裂症谱系障碍患者进行了连续和接近连续的AVH检查。对于有间歇性幻觉的患者(N=8)，生成了比较幻觉和非幻觉时期的血氧水平依赖(BOLD)激活图。对于有持续幻觉的患者(N=8)，利用Wernicke区和其他区域的BOLD信号时间进程之间的相关性来映射前者的功能耦合。这些地形图被用来识别每个患者3-6个皮质部位，这些部位用1赫兹rTMS和假刺激进行探测。将rTMS注射到左侧顶叶Wernicke区和邻近的缘上回，与假刺激和将rTMS注射到颞叶前部相比，AVH改善率更高。对于间歇性幻觉者，布罗卡区较低的幻觉相关激活水平强烈预示着对左侧颞顶rTMS的更高应答率。对于持续性幻觉者，Wernicke‘s和Broca’s区的右侧同系物之间的偶联减少强烈地预示着更大的左侧颞顶rTMS反应率。这些发现表明，优势半球的颞顶区参与了AVH的表达，额叶下部区域更高水平的共激活和/或耦合加强了潜在的病理生理。
Functional magnetic resonance imaging and repetitive transcranial magnetic stimulation (rTMS) were used to explore the pathophysiology of auditory/verbal hallucinations (AVHs). Sixteen patients with schizophrenia-spectrum disorder were studied with continuous or near continuous AVHs. For patients with intermittent hallucinations (N = 8), blood oxygenation level-dependent (BOLD) activation maps comparing hallucination and nonhallucination periods were generated. For patients with continuous hallucinations (N = 8) correlations between BOLD signal time course in Wernicke's area, and other regions were used to map functional coupling to the former. These maps were used to identify 3-6 cortical sites per patient that were probed with 1-Hz rTMS and sham stimulation. Delivering rTMS to left temporoparietal sites in Wernicke's area and the adjacent supramarginal gyrus was accompanied by a greater rate of AVH Improvement compared with sham stimulation and rTMS delivered to anterior temporal sites. For intermittent hallucinators, lower levels of hallucination-related activation in Broca's area strongly predicted greater rate of response to left temporoparietal rTMS. For continuous hallucinators, reduced coupling between Wernicke's and a right homologue of Broca's area strongly predicted greater left temporoparietal rTMS rate of response. These findings suggest that dominant hemisphere temporoparietal areas are involved in expressing AVHs, with higher levels of coactivation and/or coupling involving inferior frontal regions reinforcing underlying pathophysiology.