摘要
目的:观察和评价脑电图引导的经颅磁刺激治疗对精神分裂症阳性症状和阴性症状的临床疗效以及刺激不同位点对疗效的影响。方法:于2004-12/2005-12选择两所三级甲等精神专科医院就诊的67例精神分裂症患者。采用严格区组随机化方法按照处理方式与刺激位点不同共分为4组。其中按照治疗方式分为治疗组和对照组(2∶1配比),按照刺激位点眼双侧背外侧前额叶和双侧顶叶演不同又将治疗组和对照组各分两组,分别为额叶治疗组、顶叶治疗组熏额叶对照组和顶叶对照组。对照组采用安慰剂对照、双盲设计。刺激频率依据每位患者脑电图的主频值而定,强度为每位患者运动阈值的80%,经颅磁刺激或模拟经颅磁刺激都将磁极安放在双侧背外侧前额叶或双侧顶叶皮质,每次治疗20min(20小节,每小节1min,连续刺激4s,间歇56s),治疗5次/周,连续治疗2周。治疗前后采用阳性与阴性症状量表和临床总体印象量表评定。治疗2周后的阳性/阴性症状量表评分减分率=眼ln穴治疗前阳性/阴性症状评分雪-ln穴治疗2周后阳性/阴性症状评分雪演/眼ln穴治疗前阳性/阴性症状评分雪-ln穴7雪演。临床总体印象量表评分总体进步分7级:0=未评;1=进步非常明显;2=进步明显;3=稍有进步;4=无变化;5=稍有恶化;6=明显恶化;7=恶化非常明显。结果:在67例患者中,完成2周治疗的患者63例,脱落4例(5%)。其中,额叶治疗组有3例,顶叶治疗组有1例。①治疗组治疗后的阳性症状改善程度显著好于对照组,两组的阴性症状改善程度差异和阳性与阴性症状量表总分变化差异均无显著性意义。②治疗组治疗2周后临床总体印象量表评分与对照组接近,差异无显著性眼(3.3±0.9),(3.6±0.7)分,t=-1.344,P=0.184演。③刺激双侧背外侧前额叶或双侧顶叶皮质对重复经颅磁刺激治疗精神分裂症的疗效无差异。④除1例患者因出现精神兴奋性增强而退出治疗外,未观察到其他严重的不良反应。结论:重复经颅磁刺激治疗能改善精神分裂症患者的阳性症状,可作为精神分裂症的一种有效治疗手段,其优点是无创、安全、副反应少。
AIM： To observe and evaluate the clinical effect of alpha electroencephalogram （EEG） guided transcranial magnetic stimulation （αTMS） on the positive symptoms and negative symptoms of patients with schizophrenia and the effect in stimulating different sites.
METHODS： Sixty-seven patients with schizophrenia were selected from the two special hospitals in psychiatry of third grade in first level between December 2004 and December 2005. According to the treatment and stimulating site, the patients were randomly divided into 4 groups. Besides, patients were divided into the treatment group and the control group （at the ratio of 2：1）, and these two groups were redivided into two groups according to the stimulating site [bilateral dorsolateral prefrontal cortex （DLPFC） and the bilateral parietal lobe]： frontal lobe （FL） treatment group, parietal lobe （PL） treatment group, FL control group and PL control group. Patients in the control group received placebo and double blind design. The stimulating frequency was set according to the basic frequency at EEG of each patient, and the intensity was 80% of the movement threshold value of each patient, α TMS was applied for 20 for minutes per day （each segment was stimulated for 4 s with an interval of 56 s for totally 20 segments）, and the treatment was given 5 times a week for 2 continuous weeks. PANSS and clinical global impressions scale （CGI） were used for evaluation before and after the treatment. The reducing rate in PANSS score at 2 weeks after the treatment = [ln （PANSS score before the treatment） - ln （PANSS score at 2 weeks after the treatment）]/[ln （PANSS score before the treatment） - ln （7）]. The score of CGI included 7 grades： Zero as no evaluation; 1 as much significant progress; 2 as obvious progress; 3 as slight progress; 4 as no change; 5 as slight aggravation; 6 as significant aggravation; 7 as much significant aggravation.
RESULTS： Of 67 patients, 63 patients accomplished 2-week treatment, while 4 patients withdrew from the experiment, including 3 patients in the FL treatment group and one patient in the PL treatment group. ① The positive symptoms in the treatment group after the treatment were significantly ameliorated than those in the control group, while there were no significant differences in negative symptom amelioration and the total score of Negative Symptom Scale between the two groups. ② The CGI score of the treatment groupa two weeks later approached to that of the control group, and the difference was not significant [（3.3±0.9）, （3.6±0.7） points, t=-1.344, P=0.184]. ③ α TMS treatment at both frontal and parietal locations showed no difference in therapeutic effect. ④ No severe adverse effects were observed except one patient withdrew from the study due to the exacerbation of psychotic symptoms.
CONCLUSION： The alpha EEG guided TMS can ameliorate the positive symptoms of patients with schizophrenia, which may be an effective treatment for schizophrenia, and it is characteristics of no wounds, safety and less side effects.
出处
《中国临床康复》
CSCD
北大核心
2006年第46期22-24,共3页
Chinese Journal of Clinical Rehabilitation
作者简介
徐婉姣，女，1975年生，辽宁省沈阳市人，汉族，北京大学精神卫生研究所在读硕士，医师，主要从事为社会精神病学方面的研究。
