| Objective: In this study,we explored the clinical efficacy of cerebellar vermal repetitive transcranial magnetic stimulation with theta burst stimulation paradigm on negative symptoms,depressive symptoms and cognitive function of schizophrenia.We followed the patients for a 24-week follow-up after the treatment was completed to focus on the duration of efficacy.Method: This is a multi-center,randomized,sham-controlled,doubleblinded trial.64 patients diagnosed with schizophrenia from Shanghai Mental Health Center and six district-level mental health centers(Changning District,Yangpu District,Minhang District,Songjiang District,Pudong New Area and Nanhui)were randomized according to the odd-even sequence of enrollment,with odd numbers into the study group(32 patients)and even numbers into the control group(32 patients).32 patients in the study group received 100%MT rTMS with the intermittent theta burst stimulation paradigm,while another 32 patients were subjected to pseudostimulation treatment,both being given 2-week intervention(5 times per week).The type and dose of antipsychotic drugs taken by patients remained unchanged during the intervention period.Efficacy of psychotic symptoms and depressive symptoms were assessed with the Positive and Negative Symptoms Scale(PANSS),Hamilton Depression Scale(HAMD-24)at baseline,the end of treatment and 2,6,12,24 weeks after the end of treatment.The cognitive function was assessed with MATRICS Consensus Cognitive Battery(MCCB)at baseline,the end of treatment and 12,24 weeks after the end of treatment.Results: A total of 64 patients with schizophrenia were successfully enrolled,completing baseline assessment and rTMS treatment.At the end of treatment,1 patient in the control group dropped off due to the inability to cooperate with the MCCB test;during the follow-up period,1 patient(in the control group)was discharged from hospital due to tuberculosis,and 6 patients(4 in the study group and 2 in the control group)were unwilling to follow up due to discharge.At baseline,there were no significant differences in demographic characteristics,disease characteristics,PANSS-total score,PANSS subscale scores,HAMD24-total score and MCCB scores between two groups(P≥0.05).A mixed linear model was used to compare the scale scores of two groups at different times and found that:(1)In the PANSS-negative score,the interaction between group and time was statistically significant at 4 follow-ups after treatment(P<0.05).The scores of the study group were significantly lower than those of the control group,and the difference between two groups reached the maximum at 24 weeks after the end of treatment,which was 5.03 points.At 2 weeks after the end of treatment,the main effect of time was significant(P<0.05),and the estimated value of patients’ PANSS-negative score decreased by 1.51 points compared with baseline.However,the main effect of group did not show statistical significance(P>0.05).In the PANSS-positive score and PANSS-general score,the main effect of time were significant at the end of treatment and 4 follow-ups after treatment(P<0.05).Compared to baseline,estimates of patients’ PANSS-positive score and PANSS-general score were the lowest at 24 weeks of follow-up,2.54 points and 5.35 points less than baseline,respectively.There were no statistical significance in the main effect of group and in the interaction between group and time(P≥0.05).In the PANSS-total score,the interaction between group and time was statistically significant at 6 weeks and 24 weeks after the end of treatment(P<0.05),and the scores of the study group were 6.22 points and 8.15 points lower than the control group,respectively.At the end of the intervention and during the follow-up period,the main effect of time showed significance(P<0.05).At 12 weeks of follow-up,the difference between the estimated value of patients’ PANSS-total score and the baseline score was the largest,with a decrease of 9.28 points.However,the main effect of group was not significant(P>0.05).(2)In the HAMD-total score,the interaction between group and time showed statistical significance at 6 weeks,12 weeks and 24 weeks after the end of treatment(P<0.05).The scores of the study group were significantly lower than those of the control group,and the difference between two groups reached the maximum at 24 weeks after the end of treatment,which was 5.61 points.Moreover,the main effect of group and the interaction between group and time were not significant(P>0.05).(3)In the scores of each subtest of MCCB,there were no statistical significance in the main effect of group and in the interaction between group and time(P>0.05)Conclusions: These results indicate that rTMS intervention for cerebellar vermal may improve the negative symptoms and depressive symptoms of patients with schizophrenia.The effects are more evident at 24 weeks follow-up after treatment.The treatment is also effective for overall psychotic symptoms,but with a shorter duration of effect.The study also found that rTMS intervention has no effect on the positive symptoms,general psychopathological symptoms and cognitive function. |
PDF Full Text Request