Can Repetitive Magnetic Stimulation Improve Cognition in Schizophrenia? Pilot Data from a Randomized Controlled Trial
Can Repetitive Magnetic Stimulation Improve Cognition in Schizophrenia? Pilot Data from a Randomized Controlled Trial
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DOI：
10.1016/j.biopsych.2012.08.020
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发表时间：
2013-03-15
影响因子：
10.6
通讯作者：
Daskalakis, Zafiris J.
中科院分区：
文献类型：
--
作者：
Barr, Mera S.;Farzan, Faranak;Daskalakis, Zafiris J.
背景资料：工作记忆是精神分裂症中受损的核心认知领域，目前还没有令人满意的治疗方法。针对背外侧前额叶皮层的重复经颅磁刺激（rTMS）已被证明可以调节与精神分裂症工作记忆相关的神经生理机制，并改善健康受试者的工作记忆表现，因此可能代表精神分裂症患者的治疗方式。目的是评估rTMS对精神分裂症患者工作记忆表现的影响，并评估rTMS是否能使工作记忆表现正常化至健康受试者水平。在为期4周的随机双盲假对照初步研究设计中，在成瘾和精神健康中心对27名服用药物的精神分裂症患者进行了测试，（一所大学教学医院，为一个大的城市集水区提供精神病护理，并作为安大略省的三级转诊中心）。患者在rTMS磁共振成像之前和之后进行言语工作记忆n-back任务，该磁共振成像以20 Hz的频率双侧依次靶向左和右背外侧前额叶皮层750个脉冲/侧，进行20次治疗。主要的结果测量是平均幅度的变化，在n-回准确性的目标响应与积极的（n = 13）或假（n = 12）rTMS治疗course.Results：rTMS显着提高3回准确性的目标相比，安慰剂假（科恩的d = 0.92）。3-回准确性的改善也被发现是在一个水平相媲美的健康subjects.Conclusions：这些试点数据表明，双边rTMS可能是一种新的，有效的，安全的治疗精神分裂症患者的工作记忆缺陷。
Background: Working memory represents a core cognitive domain that is impaired in schizophrenia for which there are currently no satisfactory treatments. Repetitive transcranial magnetic stimulation (rTMS) targeted over the dorsolateral prefrontal cortex has been shown to modulate neurophysiological mechanisms linked to working memory in schizophrenia and improves working memory performance in healthy subjects and might therefore represent a treatment modality for schizophrenia patients. The objectives were to evaluate the effects of rTMS on working memory performance in schizophrenia patients and evaluate whether rTMS normalizes performance to healthy subject levels.Methods: In a 4-week randomized double-blind sham-controlled pilot study design, 27 medicated schizophrenia patients were tested at the Centre for Addiction and Mental Health (a university teaching hospital that provides psychiatric care to a large urban catchment area and serves as a tertiary referral center for the province of Ontario). Patients performed the verbal working memory n-back task before and after rTMS magnetic resonance image targeted bilaterally sequentially to left and right dorsolateral prefrontal cortex 750 pulses/side at 20 Hz for 20 treatments. The main outcome measure was mean magnitude of change in the n-back accuracy for target responses with active (n = 13) or sham (n = 12) rTMS treatment course.Results: The rTMS significantly improved 3-back accuracy for targets compared with placebo sham (Cohen's d = .92). The improvement in 3-back accuracy was also found to be at a level comparable to healthy subjects.Conclusions: These pilot data suggest that bilateral rTMS might be a novel, efficacious, and safe treatment for working memory deficits in patients with schizophrenia.