| Background Schizophrenia patients of thinking, emotional, cognitive and behavioral abnormalities may be associated with abnormal brain white matter structure integrity and connection, Magnetic resonance Diffusion Tensor Imaging (coursing together Tensor Imaging, DTI) technology of provided important means for the study of brain white matter.Repetitive Transcranial Magnetic Stimulation (Repetitive Transcranial Magnetic Stimulation, rTMS) treatment technology is a new kind of physical therapy, has been widely used in the treatment of depression and schizophrenia, but has less to see the high frequency rTMS on the diffusion tensor imaging of patients with schizophrenia research reports.Objectives (1) High frequency rTMS study the influence of the DTI in patients with schizophrenia, from the aspects of nerve pathological basis as to provide theoretical basis for the treatment of schizophrenia; (2) Observate the high frequency rTMS clinical symptoms in patients with schizophrenia, from the aspects of clinical offers a new approach for the treatment of schizophrenia; (3) Study on patients with schizophrenia brain white matter structure and the correlation of clinical symptoms, etiology and pathogenesis of schizophrenia mechanism to provide theoretical basis for the research.Method 10th edition to conform to the International Classification of Diseases (International Classification of Diseases, the ICD-10) in 65 patients of schizophrenia diagnosis standard as the research object, the Positive and Negative symptoms Scale (Positive and Negative Symptom Scale, PANSS) score greater than 60 points. Cases were randomly divided into research group and the control group will research object, research group (n=33) give rTMS really stimulate joint risperidone treatment, cases in the control group (n=32) provides rTMS false stimulation combined risperidone treatment.Risperidone starting dose of 1 mg,4-6 mg dose gradually increased to treatment, points 2 times of oral in the morning and evening, no more than 6 mg daily dose. RTMS treatment using high frequency magnetic stimulation 10 hz, function area to the left frontal lobe dorsolateral Cortex (Dorso-lateral Perfrontal Cortex, DLPFC), intensity of 100% Threshold (Motor Threshold, MT). Two groups of observation cycle is 4 weeks. Raise 30 healthy volunteers with normal control group.Into the group of patients in rTMS respectively before and after treatment for 2 and 4 weekend weekend application of DTI detecting frontal lobe, temporal lobe, corpus callosum, the hippocampus brain white matter part of Anisotropy (Fractional Anisotropy, FA), event related potential P300 (P300) and Montreal Cognitive Assessment scale (Montreal Cognitive Assessment, MoCA) to assess Cognitive function, PANSS scale to evaluate mental symptoms, in the process of treatment according to the treatment of adverse reactions to scale (Teatment Emergent Symptomscale, TESS) to evaluate rTMS and drug related adverse reactions.Healthy volunteers only to check a DTI detection, P300 and MoCA scale assessment. All the data into the computer, using the SPSS 16.0 to general statistical description, repeated measurement data of variance analysis, independent sample t-test, Pearson correlation analysis and other statistical analysis.Result1. rTMS in combination with risperidone on the impact of schizophrenia patients of cerebral white matter structure.Comparison among groups:Three groups before treatment between the frontal lobe, temporal lobe, corpus callosum, hippocampal cerebral white matter FA value difference was statistically significant (P<0.05 or 0.01). The team frontal lobe, temporal lobe and cases in control group, corpus callosum, hippocampal cerebral white matter FA value difference is no statistical significance (P>0.05). Treat the weekend 2, the team frontal lobe, corpus callosum, hippocampus brain white matter FA values higher than the cases in the control group, but lower than that of normal control group, the difference was statistically significant (P<0.05 or 0.01); The team with the cases in the control group the temporal lobe brain white matter FA value comparison, there was no statistically significant difference (P>0.05).Treatment of 4 over the weekend, the team frontal lobe, corpus callosum, hippocampal cerebral white matter FA value there was no statistically significant difference compared with normal control group (P>0.05); Cases in the control group in the frontal lobes, corpus callosum, hippocampal cerebral white matter FA value is lower than the normal control group, the difference was statistically significant (P<0.05).Comparison among groups:hippocampal cerebral white matter FA value was higher, the difference was statistically significant (P<0.05), the temporal lobe brain white matter FA value compared with before treatment, no statistical significance (P>0.05), the cases in the control group there was no statistically significant difference compared with before treatment (P>0.05); Treatment of 4 over the weekend, the team and the cases of control group in frontal lobe, corpus callosum, hippocampal cerebral white matter FA value was higher, the difference was statistically significant (T<0.05 or 0.01), the temporal lobe brain white matter FA value compared with before treatment, no statistical significance (P>0.05).2. rTMS in combination with risperidone on the cognitive function of patients with schizophrenia.(1) rTMS in combination with risperidone P300 in patients with schizophrenia.Comparison among groups:The index comparison P300 differences between 3 groups before treatment was statistically significant (P<0.05 or 0.01). Comparison group and the control group in P300 of patients each index difference has no statistical significance (P>0.05). Treat the weekend,2 cases of control group in the P300 P3 and prepare monthly &weekly incubation period is higher than group and normal control group, amplitude is lower than the group and normal control group, the difference was statistically significant (P<0.05 or 0.01).4 weekend, the team P300 in P3 and prepare monthly &weekly incubation period, amplitude compared with normal control group, there was no statistically significant difference (P>0.05); Cases in the control group in P300 P3 and prepare monthly &weekly incubation period is higher than normal control group, the amplitude is lower than the normal control group, the difference was statistically significant (P<0.05).Comparison among groups:Compared with before treatment, treatment 2 the weekend, the team P300 in P3 and prepare monthly weekly shorten the incubation period, higher amplitude than before treatment (P<0.05 or 0.01); Cases in the control group in P300 P3 and prepare monthly weekly incubation period, amplitude has no obvious change (P>0.05).4 weekend, treatment group and the control group in P300 of patients in P3 and prepare monthly weekly shorten the incubation period, amplitude increases, the difference was statistically significant (P<0.05 or 0.01).(2) rTMS in combination with risperidone MoCA in patients with schizophrenia.Comparison among groups:MoCA scale scores compare differences between 3 groups before treatment was statistically significant (P<0.01). The team with the cases in the control group MoCA scale scores compare differences between the two groups has no statistical significance (P>0.05). Treat the weekend 2, the team MoCA scale scores higher than the cases in the control group, but lower than that of normal control group, the difference was statistically significant (P<0.05 or 0.01). Treatment of 4 over the weekend, the team MoCA scale scores compared with cases in the control group, the difference was statistically significant (P<0.01), compared with normal control group, there was no statistically significant difference (P>0.05).Comparison among groups:Compared with before treatment, treatment 2 the weekend, the team MoCA scale score higher than before treatment (P<0.05), and cases in the control group MoCA scale total score no significant change (P>0.05).4 weekend, treatment group and the control group MoCA scale scores of patients was increased, the difference was statistically significant (P<0.05 or<0.01).3. rTMS in combination with risperidone of negative and positive symptoms of schizophrenia patients.Comparison among groups:Treatment group and control group in total scores of PANSS and before each factor comparison, there was no statistically significant difference (P>0.05). Treat the weekend 2, the team PANSS score of positive and negative symptoms, symptoms and general mental pathological points below cases in the control group, the difference was statistically significant (P<0.05). Treatment 4 weekend, cases of control group in PANSS score of positive and negative symptoms, symptoms and general mental pathological points higher than the group (P<0.05 or 0.05).Comparison among groups:Compared with before treatment, treatment 2 the weekend, the team PANSS score, negative symptoms and general mental pathological points lower than before treatment (P<0.05); Case-control PANSS score and each factor has no obvious change (P>0.05).4 weekend, treatment group and control group in total scores of PANSS and each factor score was reduced, the difference was statistically significant (P<0.05 or<0.01).4. Schizophrenia patients of cerebral white matter FA value change and the correlation analysis of clinical symptoms.Correlation analysis found that the cognitive function of schizophrenia patients with left frontal lobe brain white matter and FA values (Fz points, Cz) P3 amplitude and NP3 amplitude and MoCA index of executive ability, memory and abstract thinking, calculation and directional force were positively correlated (r=0.313～0.378, P<0.05), and (Fz points, Cz) P3 latency and prepare monthly & weekly incubation period was significantly negative correlation (r=0.309～0.364, P<0.05). Corpus callosum body and left hippocampal cerebral white matter and FA values of Fz point P3 amplitude and NP3 amplitude and index of MoCA executive ability, memory and abstract thinking, calculation and directional force were positively correlated (r=0.310-0.367, P<0.05), and the incubation period of Fz point P3 latency and NP3 was significantly negative correlation (r=-0.308～-0.337, P<0.05); Right frontal lobe, temporal lobe, corpus callosum, corpus callosum knee, right hippocampus brain white matter FA value index and P300 and MoCA various index had no significant correlation (P>0.05).Negative symptoms and positive symptoms related analysis found that, the team left frontal lobe FA values change with PANSS scores, negative symptoms was negative correlation (r=-0.367,-0.386, P<0.05); Corpus callosum FA values change with PANSS scores, negative symptoms and general mental pathological points was a positive correlation (r=-0.338～-0.371; P<0.05); Corpus callosum knee FA values change with PANSS scores and the symptom score was positively correlation (r=-0.333～-0.352; P<0.05); Team right frontal body, temporal lobe, hippocampus and corpus callosum FA values change with PANSS scores and various symptoms points no correlation (P>0.05).Conclusion1.Compared with risperidone be used alone,10 Hz rTMS in combination with risperidone can improve cerebral white matter connections, abnormal in patients with schizophrenia, has the function of neurons in the brain structure and function.2. Compared with risperidone be used alone,10 Hz rTMS in combination with risperidone can improve the attention of patients with schizophrenia, memory and executive function, improve the cognitive function of patients.3. Schizophrenia patients abnormal brain’s white matter connections is closely related to the occurrence of clinical symptoms and development. |
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