不同部位低频重复经颅磁刺激治疗顽固性幻听起效时间和安全性的双盲对照研究

Treatment with 1 Hz different region repetitive transcranial magnetic stimulation in auditory hallucination of schizophrenia： a doubleblind,randomized controlled trial

目的初步探讨背外侧前额叶和左侧颞顶叶低频重复经颅磁刺激（repetitive transcranial rragnetic stimulation,rTMS）治疗精神分裂症顽固性幻听的疗效（起效时间）和安全性。方法36例伴有顽固性幻听的精神分裂症患者随机分为三组，分别为背外侧前额叶rTMS治疗组（n1=12）、左侧颞顶叶rTMS治疗组（n2=14）及对照组（假性刺激）（n3=10），背外侧前额叶rTMS治疗组、左侧颞顶叶rTMS治疗组分别给予10次1HzrTMS真性刺激，对照组给予假刺激，治疗期间维持原有抗精神病药种类及剂量不变。采用阳性和阴性症状量表（Positiveand Negative Syndrome Scale，PANSS）评定临床症状，不良反应症状量表（Treatment Emergent Symptom Scale，TESS）、纯音听力测试评估副反应。结果两个真性治疗组疗效均明显优于假性治疗组，与基线比较，背外侧前额叶组第4次评估、左侧颞顶叶组第7次评估出现统计学差异，两个治疗组比较差异无统计学意义。无论治疗组、对照组均未观察到明显的副反应。结论1Hz背外侧前额叶、左侧颞顶叶低频重复经颅磁刺激治疗精神分裂症顽固性幻听均有效，且安全性高。

Objective To study the therapeutic effects of dorsolateral prefrontal cortex（DLPFC） and left temporoparietal repetitive transcranial magnetic stimulation （rTMS） on auditory hallucinations experienced by schizophrenic patients. Methods A doubleblind randomized controlled study was conducted. A total of 36 schizophrenic patients met DSM -IV criteria for schizophrenia and had auditory hallucination with stable antipsychotic drugs treatment were recruited. Subjects were randomly divided into two treatment groups（one group received dualdorsolateral prefrontal rTMS, the other received left temporoparietal rTMS）and sham group. Measurements included the Positive and Negative Symptom Scale （ PANSS ） for clinical symptom and the Treatment Emergent Symptom Scale （TESS） and pure tone audition test for side effects. Results All 36 subjects completed the trial. The treatment efficiency observed in the two active treatment groups was higher than that of sham group, but there is no significant difference between the two active groups. Compared with the baseline, the significant difference was observed on the fourth evaluation in DLPFC group and on the seventh evaluation in left temporoparietal group. Meanwhile no overt side effects of rTMS were observed. Conclusions Both dual dorsolateral prefrontal and left temporoparietal rTMS are effective and safe for schizophrenia with auditory hallucination.