Efficacy of fronto-temporal transcranial direct current stimulation for refractory auditory verbal hallucinations in schizophrenia: A randomized, double-blind, sham-controlled study
Efficacy of fronto-temporal transcranial direct current stimulation for refractory auditory verbal hallucinations in schizophrenia: A randomized, double-blind, sham-controlled study
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DOI：
10.1016/j.schres.2017.08.047
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发表时间：
2018-05-01
影响因子：
4.5
通讯作者：
Venkatasubramanian, Ganesan
中科院分区：
文献类型：
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作者：
Bose, Anushree;Shivakumar, Venkataram;Venkatasubramanian, Ganesan
据报道，约 20-30% 的精神分裂症患者存在抗精神病药物难以治愈的持续性幻听 (AVH)。经颅直流电刺激 (tDCS) 是一种无创且安全的神经调节技术，作为精神分裂症难治性 AVH 的附加治疗方法引起了人们的极大兴趣。检验 tDCS 对精神分裂症难治性 AVH 疗效的研究报告了不一致的结果。在这项研究中，我们采用随机、双盲、假对照设计 (RCT)，试图检查附加 tDCS 的效果 [阳极对应于左背外侧前额叶皮层，阴极对应于左颞顶交界处； 2-mA，每日两次，持续 5 天]治疗精神分裂症患者的难治性 AVH（N = 25）；在该 RCT 阶段之后，AVH 严重程度降低了 30% 的患者接受了开放标签扩展 (OLE) 主动刺激，以评估交叉到 verum tDCS 的效果。在 RCT 阶段，以 tDCS 类型 [verum(N= 12) 与 sham (N= 13)] 作为受试者之间因素的重复测量方差分析表明，tDCS 类型 X 时间点存在显着的相互作用 [F= 21.5，p < 0.001，partial-eta 2 = 0.48]，与假手术组相比，verum tDCS 组 AVH 评分显着降低。在 OLE 阶段，假手术与真假手术交叉的患者 (N = 13) 与 RCT 阶段的相应变化相比，AVH 严重程度显着降低 (t= 2.9；p= 0.01)。总之，这些观察结果进一步支持了附加 tDCS 治疗难治性 AVH 精神分裂症的有益效果。 (C) 2017 Elsevier B.V. 保留所有权利。
Persistent auditory verbal hallucinations (AVH) that are refractory to antipsychotic medications are reported in about 20-30% of schizophrenia patients. Transcranial Direct Current Stimulation (tDCS), a non-invasive and safe neuromodulatory technique, has attracted significant interest as an add-on treatment for refractory AVH in schizophrenia. Studies examining the efficacy of tDCS for refractory AVH in schizophrenia have reported inconsistent findings. In this study, using a randomized, double-blind, sham-controlled design (RCT), we sought to examine the effect of add-on tDCS [anode corresponding to left dorsolateral prefrontal cortex and cathode to left temporo-parietal junction; 2-mA, twice-daily sessions for 5-days] to treat refractory AVH in schizophrenia patients (N = 25); following this RCT phase, patients that had b30% reduction in AVH severity were offered an open-label extension (OLE) active stimulation to evaluate the effect of cross-over to verum tDCS. In the RCT phase, repeated measures ANOVA with tDCS type [verum(N= 12) vs. sham (N= 13)] as between subjects factor demonstrated a significant tDCS-type X time-point interaction [F= 21.5, p < 0.001, partial-eta 2 = 0.48] with significantly greater reduction of AVH score in verum tDCS group as compared to sham group. In the OLE phase, sham-to-verum crossed over patients (N = 13) showed significantly greater reduction in AVH severity than their corresponding change during RCT phase (t= 2.9; p= 0.01). Together, these observations add further support to the beneficial effects of add-on tDCS to treat refractory AVH schizophrenia. (C) 2017 Elsevier B.V. All rights reserved.