MRI-guided cTBS Alleviated Auditory Hallucinations: A Randomized Double-blind Sham-controlled Trial
Poster No:
61
Submission Type:
Abstract Submission
Authors:
Qiang Hua1, Gong-Jun Ji1, Kai Wang1
Institutions:
1Anhui Medical University, Hefei, Anhui
First Author:
Co-Author(s):
Introduction:
The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant auditory verbal hallucinations (AVH) are undetermined. To address this issue, we develop an optimized continuous theta-burst stimulation (cTBS) protocol and test its efficacy in a randomized, double-blind, sham-controlled trial (NCT02863094).
Methods:
We randomly allocated schizophrenia patients with AVH to receive 14 days active or sham cTBS treatment, and collected structural and resting-state functional MRI data for each patient before treatment. Structural MRI was used to guide stimulations over the left temporoparietal junction area (TPJ, [-51, -31, 23] in MNI space). The primary outcome was the auditory hallucinations rating scale (AHRS) changes at post-treatment. The secondary outcomes were the AHRS score change at follow-up, the Positive and Negative Syndrome Scale (PANSS) score change and the number of responders at post-treatment and follow-up. Treatment responders were defined as 25% improvement or greater in AVH symptom alleviation. The efficacy of cTBS treatment was analyzed using linear mixed-effects models and Chi-squared test.
We try to explain the outcome variability between patients using the personalized electric field (E-field) and AVH network. E-field was simulated using SimNIBS toolbox and each patient's T1-/T2-weighted images. Personalized AVH network was defined as the connectivity map of AVH hub regions (Kim et al., 2021, Molecular Psychiatry) on each patient's functional MRI data. We tested whether that the effective E-field affecting AVH network can predict the AHRS alleviation for patients in the active group.
We try to explain the outcome variability between patients using the personalized electric field (E-field) and AVH network. E-field was simulated using SimNIBS toolbox and each patient's T1-/T2-weighted images. Personalized AVH network was defined as the connectivity map of AVH hub regions (Kim et al., 2021, Molecular Psychiatry) on each patient's functional MRI data. We tested whether that the effective E-field affecting AVH network can predict the AHRS alleviation for patients in the active group.
·Flow diagram of participant selection and schematic of the trail.
Results:
Sixty-one schizophrenia patients with AVH completed treatment (33 women [54.1%]; mean [SD] age, 27.52 [9.22] years). In the intention-to-treat analysis, patients in active group showed a significantly greater improvement in the AHRS score (difference, 6.10; 95% CI, 3.48 - 8.72; F = 18.60, P < .0001; Figure 2A) and the PANSS score (difference, 11.97; 95% CI, 6.70 - 17.25; F = 17.34, P < .0001; Figure 2B) at post-treatment. The responder rates were higher in the active group (15 of 32 [46.88%]) vs the sham group (4 of 29 [13.80%]) (2=7.76, P = 0.005; Figure 2C). These effects persisted at follow-up. The cTBS was well tolerated, and no adverse event occurs in both groups. The AHRS improvement predicted by the strength of TMS-induced E-field within the personalized AVH-network was positively correlated with the real improvement at post-treatment (r = 0.46, P = 0.009; Figure 2D).
·Clinical outcomes of cTBS and its underlying neural mechanism.
Conclusions:
MRI-guided cTBS effectively relieve AVH symptom in schizophrenia patients by modulating the personalized AVH network.
Brain Stimulation:
Non-invasive Magnetic/TMS 1
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 2
Modeling and Analysis Methods:
Connectivity (eg. functional, effective, structural)
Keywords:
Other - Auditory verbal hallucinations; Continuous theta-burst stimulation; Electric field; Neuronavigation; Repetitive transcranial magnetic stimulation; Schizophrenia
1|2Indicates the priority used for review