Abstract：
BACKGROUND: Auditory verbal hallucinations (AVH) are a disabling symptom for people with schizophrenia (SCZ), and do not always respond to antipsychotics. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for medication-refractory AVH, though the underlying neural mechanisms by which rTMS produces these effects remain unclear. This systematic review evaluated the structural and functional impact of rTMS for AVH in SCZ, and its association with clinical outcomes.
METHODS: A systematic search was conducted in Medline, PsychINFO, and PubMed using terms for four key concepts: AVH, SCZ, rTMS, neuroimaging. Using PRISMA guidelines, 18 studies were identified that collected neuroimaging data of an rTMS intervention for AVH in SCZ. Risk of bias assessments was conducted.
RESULTS: Low frequency (<5 Hz) rTMS targeting left hemispheric language processing regions may normalize brain abnormalities in AVH patients at structural, functional, electrophysiological, and topological levels, with concurrent symptom improvement. Amelioration of aberrant neural activity in frontotemporal networks associated with speech and auditory processing was commonly observed, as well as in cerebellar and emotion regulation regions. Neuroimaging analyses identified neural substrates with direct correlations to post-rTMS AVH severity, propounding their use as therapeutic targets.
CONCLUSIONS: Combined rTMS-neuroimaging highlights the multidimensional alterations of rTMS on brain activity and structure in treatment-resistant AVH, which may be used to develop more efficacious therapies. Larger randomized, sham-controlled studies are needed. Future studies should explore alternate stimulation targets, investigate the neural effects of high-frequency rTMS and evaluate long-term neuroimaging outcomes.
METHODS: A systematic search was conducted in Medline, PsychINFO, and PubMed using terms for four key concepts: AVH, SCZ, rTMS, neuroimaging. Using PRISMA guidelines, 18 studies were identified that collected neuroimaging data of an rTMS intervention for AVH in SCZ. Risk of bias assessments was conducted.
RESULTS: Low frequency (<5 Hz) rTMS targeting left hemispheric language processing regions may normalize brain abnormalities in AVH patients at structural, functional, electrophysiological, and topological levels, with concurrent symptom improvement. Amelioration of aberrant neural activity in frontotemporal networks associated with speech and auditory processing was commonly observed, as well as in cerebellar and emotion regulation regions. Neuroimaging analyses identified neural substrates with direct correlations to post-rTMS AVH severity, propounding their use as therapeutic targets.
CONCLUSIONS: Combined rTMS-neuroimaging highlights the multidimensional alterations of rTMS on brain activity and structure in treatment-resistant AVH, which may be used to develop more efficacious therapies. Larger randomized, sham-controlled studies are needed. Future studies should explore alternate stimulation targets, investigate the neural effects of high-frequency rTMS and evaluate long-term neuroimaging outcomes.
摘要：
背景：听觉言语幻觉（AVH）是精神分裂症（SCZ）患者的致残症状，并不总是对抗精神病药物有反应。重复经颅磁刺激（rTMS）已显示出对药物难治性AVH的功效，尽管rTMS产生这些效应的潜在神经机制仍不清楚。本系统评价了rTMS对SCZ中AVH的结构和功能影响，及其与临床结果的关联。
方法：在Medline进行了系统搜索，心理信息,和PubMed使用四个关键概念的术语：AVH，SCZ,rTMS,神经成像。使用PRISMA指南，确定了18项研究，这些研究收集了SCZ中AVH的rTMS干预的神经影像学数据。进行偏倚风险评估。
结果：针对左半球语言处理区域的低频（<5Hz）rTMS可能使AVH患者的大脑结构异常正常化，功能，电生理学,和拓扑层次，同时症状改善。通常观察到与语音和听觉处理相关的额颞叶网络中异常神经活动的改善，以及小脑和情绪调节区域。神经影像学分析确定了与rTMS后AVH严重程度直接相关的神经基质，宣传它们作为治疗目标的用途。
结论：联合rTMS神经成像突出了rTMS对治疗耐药AVH的脑活动和结构的多维改变，可用于开发更有效的疗法。较大的随机化，需要进行假对照研究.未来的研究应该探索替代刺激目标，研究高频rTMS的神经效应并评估长期神经影像学结果。
方法：在Medline进行了系统搜索，心理信息,和PubMed使用四个关键概念的术语：AVH，SCZ,rTMS,神经成像。使用PRISMA指南，确定了18项研究，这些研究收集了SCZ中AVH的rTMS干预的神经影像学数据。进行偏倚风险评估。
结果：针对左半球语言处理区域的低频（<5Hz）rTMS可能使AVH患者的大脑结构异常正常化，功能，电生理学,和拓扑层次，同时症状改善。通常观察到与语音和听觉处理相关的额颞叶网络中异常神经活动的改善，以及小脑和情绪调节区域。神经影像学分析确定了与rTMS后AVH严重程度直接相关的神经基质，宣传它们作为治疗目标的用途。
结论：联合rTMS神经成像突出了rTMS对治疗耐药AVH的脑活动和结构的多维改变，可用于开发更有效的疗法。较大的随机化，需要进行假对照研究.未来的研究应该探索替代刺激目标，研究高频rTMS的神经效应并评估长期神经影像学结果。
