| Schizophrenia is a complex disease,with high heterogeneous in patients' behavior and cognition,which is mainly caused by multi-factors such as genes and environment.At present,the treatment for schizophrenia is basically by using antipsychotic drugs.Since the pathogenesis of schizophrenia is heterogeneous,which make the effect of medication little to control the symptoms,we still need to explore some new technique or therapy with more effect.The rise of non-invasive repetitive transcranial magnetic stimulation(rTMS)in recent years has led to new breakthroughs in the treatment of drugrefractory schizophrenia or negative symptoms with poor medication effect.In this research,by using the also non-invasive magnetic resonance imaging(MRI)and functional MRI we try to explore the alteration of brain structure and function of schizophrenia patients,who underwent a treatment of high frequency rTMS in left dorsal lateral frontal cortex(L-DLPFC).In this study,we recruited 38 patients,including 20 in the study group,who underwent the treatment of 10 Hz rTMS in L-DLPFC for four weeks and also maintain the medication,and also including 18 in the control group who only received the medication.The evaluation of the positive and negative symptoms scale(PANSS),structural MRI and functional MRI were collected for every patient in basic line and four weeks later(followup).Then we analyzed the alteration of regional gray matter volume by used voxel-based morphology.And based on the difference of gray matter volume,the voxel-wised functional connectivity was calculated.At last,we analyzed the difference of network pattern and functional network connectivity(FNC).Through significant differences in the repeated measures variance analysis interaction,using the least significant difference(LSD)method for post-hoc testing found that the scores of the PANSS total score and subscale scores decreased significantly in the study group before and after 4 weeks,while the control group There was no significant difference before and after.In addition,after 4 weeks of rTMS treatment in the study group,the volume of gray matter in the right hippocampus and right occipital gyrus was significantly increased,and the right hippocampal milieu volume was significantly higher in the follow-up study group than in the follow-up control group.At the same time,the functional connectivity between the right occipital central gyrus and the left auxiliary mobilization area in the study group was significantly lower than that in the study group and the follow-up control group,while the functional connectivity between the right hippocampal gyri and the right cerebellar foot 1 was significant.Greater than the study group baseline and follow-up control group.By partial correlation analysis,it was found that there was a significant negative correlation between the right hippocampus periventricular grey matter volume change rate and the PANSS total score reduction rate.The above results show that rTMS has a certain influence on the brain structure and functional connectivity of patients,and the increase of the right hippocampal gray matter volume can significantly improve the patient's symptoms of schizophrenia.In order to further explore the impact of rTMS treatment on patient's functional network,this study used independent component analysis to analyze the resting state data of patients,and used repeated measures analysis of variance for the selected 12 network components.No significant interaction was found.Spatial model differences.In the analysis of functional connectivity between networks,it was found that there was an interaction between the network-secondary visual network and perceptual-motion network-primary visual network.Post-hoc tests found that the follow-up study group patients highlighted significantly less connectivity between the network and the secondary visual network than the follow-up control group,whereas the connection between the sensory-motor network and the primary visual network was significantly lower than the baseline.Therefore,these results suggest that rTMS may affect the sensory motor cortex and visual cortex,and highlighting the functional connectivity changes between the network and the secondary visual network may be the basis for rTMS to improve patient symptoms and cognitive function.This study conducted a comprehensive exploration of the onset mechanism of rTMS from point(VBM analysis)to line(analysis of functional connectivity)to surface(analysis of the spatial pattern of functional networks and the connection between networks).The results show that rTMS has a certain influence on the brain structure and function of patients,and the increase of gray matter volume in the right hippocampal region may be the key to improve the symptoms of patients.We hope to increase the understanding of the mechanism of action of rTMS in the treatment of schizophrenia through this study,which will help to improve the treatment plan. |
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