重复经颅磁刺激治疗幻听的临床应用与展望  

Clinical application and prospect of repetitive transcranial magnetic stimulation for the treatment of auditory hallucinations

作　　者：孙蕴怡 孟雅婧[1] 阳雨露 沈聃琳[1] 王道锦 肖洪奇 李青[1] Smruthi Mohan 邱昌建[1] SUN Yunyi;MENG Yajing;YANG Yulu;SHEN Danlin;WANG Daojin;XIAO Hongqi;LI Qing;Smruthi Mohan;QIU Changjian(Mental Health Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610044,China;不详)

机构地区：[1]四川大学华西医院心理卫生中心,四川成都610044 [2]四川大学华西临床医学院,四川成都610044

出　　处：《中国临床研究》2024年第7期1109-1112,1119,共5页Chinese Journal of Clinical Research

基　　金：国家自然科学基金青年项目(81601172)。

摘　　要：近几年来重复经颅磁刺激(rTMS)治疗在幻听症状的临床应用研究上取得了较大进展。近期研究发现经颅磁刺激(TMS)某些特定的刺激模式和刺激靶点对精神分裂症患者的幻听症状有一定改善,一般认为优先选择靶点如颞顶区和背外侧前额叶区。低频刺激左颞顶交界区(TPJ)皮质是辅助治疗言语性幻听(AVH)的主要选择,疗效相对明确。然而,目前缺少大样本随机对照试验(RCT)等循证医学证据,以及对TMS的疗效缺乏客观有力的评估工具,rTMS对幻听症状的临床应用仍处于观望状态。本文从rTMS治疗AVH的刺激靶点、连续性θ短阵快速脉冲、rTMS治疗AVH的增强方案和深部TMS等方面对近年TMS治疗AVH的研究进展进行综述,以期推动临床对rTMS在干预幻听症状方面的认识,为未来进行大样本的RCT、建立客观的疗效评估方式等循证医学证据提供研究方向。In recent years,great progress has been made in the clinical application of repetitive transcranial magnetic stimulation(rTMS)in the treatment of auditory hallucinations.Recent studies have shown that some specific stimulation modes and targets of transcranial magnetic stimulation(TMS)can improve the auditory hallucinatory of schizophrenic patients.In general,the preferred targets are thought to be the temporoparietal area and the dorsolateral prefrontal area.Low-frequency stimulation of the left temporoparietal junction cortex is the first choice for adjunctive treatment of auditory verbal hallucination(AVH)and its efficacy is relatively clear.However,due to the lack of evidence-based medical evidence currently,such as large-scale randomized controlled trial(RCT),as well as the lack of objective and powerful tools for evaluating the efficacy of TMS,the clinical application of rTMS for auditory hallucination symptoms is still in a wait-and-see phase.This article reviews the research progress of TMS in the treatment of AVH in recent years from the aspects of rTMS stimulation targets,continuous theta burst stimulation,enhancement regimens of rTMS for AVH treatment,and deep TMS,in order to promote the clinical understanding that rTMS is an effective attempt to intervene in auditory hallucinations,and provide research directions for evidence-based medicine such as large-scale RCT and the establishment of evaluation methods for objective efficacy in the future.

关 键 词：经颅磁刺激 幻听 低频经颅磁刺激 颞顶交界区 θ短阵快速脉冲 

分 类 号：R749.059[医药卫生—神经病学与精神病学]