High-Frequency Neuronavigated rTMS in Auditory Verbal Hallucinations: A Pilot Double-Blind Controlled Study in Patients With Schizophrenia
High-Frequency Neuronavigated rTMS in Auditory Verbal Hallucinations: A Pilot Double-Blind Controlled Study in Patients With Schizophrenia
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DOI：
10.1093/schbul/sbx127
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发表时间：
2018-05-01
影响因子：
6.6
通讯作者：
Etard, Olivier
中科院分区：
文献类型：
--
作者：
Dollfus, Sonia;Jaafari, Nemat;Etard, Olivier
前言：尽管进行了广泛的测试，但低频(1 Hz)重复经颅磁刺激(RTMS)对精神分裂症患者听觉语言幻觉(AVH)的疗效仍存在争议，但高频和神经导航rTMS的疗效已有报道。在这里，我们报告了一项双盲假对照研究，通过神经导航，评估高频(20赫兹)rTMS应用于左侧颞区精确解剖部位的有效性。方法：随机选择74例精神分裂症或分裂情感性障碍(DSM-IV R)患者，其中59例接受rTMS或Sham治疗，并在4周内进行全面评估。在左侧沟升支投影与颞上沟(STS)的交叉处，通过形态MRI确定rTMS靶点。结果：主要结果是对治疗的反应，定义为在连续两次评估中观察到的幻听评定量表(AHRS)频率项减少30%。虽然两个治疗组之间的主要结果没有差异，但在第14天，AHRS评分(次要结果)下降超过30%的患者在活动组(34.6%)和假手术组(9.1%)之间确实存在差异(P=0.016)。讨论：这项对照研究报告了关于主要结果的阴性结果，但证实了20 HzrTMS在神经导航引导下的瞬时效应，并针对准确的解剖位置治疗精神分裂症患者的AVH。
Introduction: Despite extensive testing, the efficacy of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of temporo-parietal targets for the treatment of auditory verbal hallucinations (AVH) in patients with schizophrenia is still controversial, but promising results have been reported with both high-frequency and neuronavigated rTMS. Here, we report a double-blind sham-controlled study to assess the efficacy of high-frequency (20 Hz) rTMS applied over a precise anatomical site in the left temporal region using neuronavigation. Methods: Fifty-nine of 74 randomized patients with schizophrenia or schizoaffective disorders (DSM-IV R) were treated with rTMS or sham treatment and fully evaluated over 4 weeks. The rTMS target was determined by morphological MRI at the crossing between the projection of the ascending branch of the left lateral sulcus and the superior temporal sulcus (STS). Results: The primary outcome was response to treatment, defined as a 30% decrease of the Auditory Hallucinations Rating Scale (AHRS) frequency item, observed at 2 successive evaluations. While there was no difference in primary outcome between the treatment groups, the percentages of patients showing a decrease of more than 30% of AHRS score (secondary outcome) did differ between the active (34.6%) and sham groups (9.1%) (P = .016) at day 14. Discussion: This controlled study reports negative results on the primary outcome but demonstrates a transient effect of 20 Hz rTMS guided by neuronavigation and targeted on an accurate anatomical site for the treatment of AVHs in schizophrenia patients.