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치료저항성 정신분열병 환자에서 반복적 경두개자기자극술 병행치료시 혈장 BDNF 농도 변화 : 예비 연구

Alteration in Plasma BDNF Level after Repetitive Transcranial Magnetic Stimulation(rTMS) in Treatment-Resistant Schizophrenia : A Pilot Study

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초록

Objectives : To assess clinical improvement and change in plasma brain-derived neurotrophic factor(BDNF) level after repetitive transcranial magnetic stimulation(rTMS) in patients with treatment-resistant schizophrenia. Methods : Seven patients with DSM-IV schizophrenia, who were proven to be treatment-resistant, were treated with 15 sessions of rTMS for three weeks as an adjuvant therapy to antipsychotic treatment. Clinical improvement and change in plasma BDNF level were measured after the treatment period. The symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Korean Version of Calgary Depression Scale for Schizophrenia (K-CDSS) at baseline and 7 days after the treatment. Plasma BDNF level was measured by enzyme-linked immunosorbent assay(ELISA) at baseline and 7 days after the treatment. . . Results : After the rTMS treatment, there was no significant improvement in PANSS total score(Z=-1.693, p=0.090) and no significant change in plasma BDNF was found(Z=-1.183, p=0.237). Negative correlations were found between percentage change in PANSS positive subscale score and duration of illness (rho=-0.991, N=7, p<0.0005, two-tailed), and PANSS negative subscale score at baseline and percentage change in plasma BDNF level (rho=-0.821, N=7, p=0.023, two-tailed). Conclusion : This preliminary study suggests that rTMS didn’t make a significant change in clinical symptoms nor in plasma BDNF level in treatment-resistant schizophrenia. Percentage change in plasma BDNF, however, might be correlated with treatment resistance in schizophrenic patients. This is a pilot study with a small sample size, therefore, a further study with a larger sample size is needed.

Abstract

Objectives : To assess clinical improvement and change in plasma brain-derived neurotrophic factor(BDNF) level after repetitive transcranial magnetic stimulation(rTMS) in patients with treatment-resistant schizophrenia. Methods : Seven patients with DSM-IV schizophrenia, who were proven to be treatment-resistant, were treated with 15 sessions of rTMS for three weeks as an adjuvant therapy to antipsychotic treatment. Clinical improvement and change in plasma BDNF level were measured after the treatment period. The symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Korean Version of Calgary Depression Scale for Schizophrenia (K-CDSS) at baseline and 7 days after the treatment. Plasma BDNF level was measured by enzyme-linked immunosorbent assay(ELISA) at baseline and 7 days after the treatment. . . Results : After the rTMS treatment, there was no significant improvement in PANSS total score(Z=-1.693, p=0.090) and no significant change in plasma BDNF was found(Z=-1.183, p=0.237). Negative correlations were found between percentage change in PANSS positive subscale score and duration of illness (rho=-0.991, N=7, p<0.0005, two-tailed), and PANSS negative subscale score at baseline and percentage change in plasma BDNF level (rho=-0.821, N=7, p=0.023, two-tailed). Conclusion : This preliminary study suggests that rTMS didn’t make a significant change in clinical symptoms nor in plasma BDNF level in treatment-resistant schizophrenia. Percentage change in plasma BDNF, however, might be correlated with treatment resistance in schizophrenic patients. This is a pilot study with a small sample size, therefore, a further study with a larger sample size is needed.

참고문헌 (43)

  1. Thoenen H, "Neurotrophins and neuronal plasticity", Science, 270, pp.593~598 (1995)
  2. Mattson MP, "Glutamate and neurotrophic factors in neuronal plasticity and disease", Ann N Y Acad Sci, 1144, pp.97~112 (2008)
  3. Pillai A, "Brain-derived neurotropic factor", TrkB signaling in the pathogenesis and novel pharmacotherapy of schizophrenia, 2008, pp.16, 183~193
  4. Angelucci F, "BDNF in schizophrenia, depression and corresponding animal models", Mol Psychiatry, 10, pp.345~352 (2005)
  5. Marenco S, "The neurodevelopmental hypothesis of schizophrenia: following a trail of evidence from cradle to grave", Dev Psychopathol, 12, pp.501~527 (2000)
  6. Knable MB, "Molecular abnormalities of the hippocampus in severe psychiatric illness: postmortem findings from the Stanley Neuropathology Consortium", Mol Psychiatry, 9, pp.609~620 (2004)
  7. Russo-Neustadt A, "Brain-derived neurotrophic factor, behavior, and new directions for the treatment of mental disorders", Semin Clin Neuropsychiatry, 8, pp.109~118 (2003)
  8. Martinowich K, "Interaction between BDNF and serotonin: role in mood disorders", Neuropsychopharmacology, 33, pp.73~83 (2008)
  9. Durany N, "Brain-derived neurotrophic factor and neurotrophin 3 in schizophrenic psychoses", Schizophr Res, 52, pp.79~86 (2001)
  10. Iritani S, "Immunohistochemical study of brain-derived neurotrophic factor and its receptor, TrkB, in the hippocampal formation of schizophrenic brains", Prog Neuropsychopharmacol Biol Psychiatry, 27, pp.801~807 (2003)
  11. Toyooka K, "Decreased levels of brain-derived neurotrophic factor in serum of chronic schizophrenic patients", Psychiatry Res, 110, pp.249~257 (2002)
  12. Tan YL, "Decreased BDNF in serum of patients with chronic schizophrenia on long-term treatment with antipsychotics", Neurosci Lett, 382, pp.27~32 (2005)
  13. Pirildar S, "Low serum levels of brain-derived neurotrophic factor in patients with schizophrenia do not elevate after antipsychotic treatment", Prog Neuropsychopharmacol Biol Psychiatry, 28, pp.709~713 (2004)
  14. Buckley PF, "Brain derived neurotropic factor in first-episode psychosis", Schizophr Res, 91, pp.1~5 (2007)
  15. Shimizu E, "Serum brain-derived neurotrophic factor (BDNF) levels in schizophrenia are indistinguishable from controls", Neurosci Lett, 351, pp.111~114 (2003)
  16. Lee BH, "Increased plasma brain-derived neurotropic factor, not nerve growth factor-Beta, in schizophrenia patients with better response to risperidone treatment", Neuropsychobiology, 59, pp.51~58 (2009)
  17. Yoshimura R, "Treatment with risperidone for 4 weeks increased plasma 3-methoxy-4-hydroxypnenylglycol (MHPG) levels, but did not alter plasma brain-derived neurotrophic factor (BDNF) levels in schizophrenic patients", Prog Neuropsychopharmacol Biol Psychiatry, 31, pp.1072~1077 (2007)
  18. Brunelin J, "Low frequency repetitive transcranial magnetic stimulation improves source monitoring deficit in hallucinating patients with schizophrenia", Schizophr Res, 81, pp.41~45 (2006)
  19. Chibbaro G, "Repetitive transcranial magnetic stimulation in schizophrenic patients reporting auditory hallucinations", Neurosci Lett, 383, pp.54~57 (2005)
  20. d'Alfonso AA, "Transcranial magnetic stimulation of left auditory cortex in patients with schizophrenia: effects on hallucinations and neurocognition", J Neuropsychiatry Clin Neurosci, 14, pp.77~79 (2002)
  21. Hoffman RE, "Transcranial magnetic stimulation of left temporoparietal cortex in three patients reporting hallucinated "voices"", Biol Psychiatry, 46, pp.130~132 (1999)
  22. Hoffman RE, "Transcranial magnetic stimulation and auditory hallucinations in schizophrenia", Lancet, 355, pp.1073~1075 (2000)
  23. Hoffman RE, "Temporoparietal transcranial magnetic stimulation for auditory hallucinations: safety, efficacy and moderators in a fifty patient sample", Biol Psychiatry, 58, pp.97~104 (2005)
  24. Hoffman RE, "Transcranial magnetic stimulation of left temporoparietal cortex and medication-resistant auditory hallucinations", Arch Gen Psychiatry, 60, pp.45~56 (2003)
  25. Horacek J, "Effect of low-frequency rTMS on electromagnetic tomography (LORETA) and regional brain metabolism (PET) in schizophrenia patients with auditory hallucinations", Neuropsychobiology, 55, pp.132~142 (2007)
  26. Poulet E, "Slow transcranial magnetic stimulation can rapidly reduce resistant auditory hallucinations in schizophrenia", Biol Psychiatry, 57, pp.188~191 (2005)
  27. Chen R, "Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation", Neurology, 48, pp.1398~1403 (1997)
  28. Hajak G, "High-frequency repetitive transcranial magnetic stimulation in schizophrenia: a combined treatment and neuroimaging study", Psychol Med, 34, pp.1157~1163 (2004)
  29. Rollnik JD, "Repetitive transcranial magnetic stimulation and electroconvulsive therapy in a patient with treatment-resistant schizoaffective disorder", Depress Anxiety, 13, pp.103~104 (2001)
  30. Sachdev P, "Transcranial magnetic stimulation for the deficit syndrome of schizophrenia: a pilot investigation", Psychiatry Clin Neurosci, 59, pp.354~357 (2005)
  31. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders. 4th ed" (2000), American Psychiatric Association
  32. Kane J, "Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine", Arch Gen Psychiatry, 45, pp.789~796 (1988)
  33. Falkai P, "World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 1: acute treatment of schizophrenia", World J Biol Psychiatry, 6, pp.132~191 (2005)
  34. Lehman AF, "Practice guideline for the treatment of patients with schizophrenia, second edition", Am J Psychiatry, 161, pp.1~56 (2004)
  35. Kay SR, "The positive and negative syndrome scale (PANSS) for schizophrenia", Schizophr Bull, 13, pp.261~276 (1987)
  36. 김용구, "한국어판 정신분열병의 캘거리 우울증 척도의 신뢰도 및 타당도 연구", 신경정신의학, 44(4), pp.446~455 (2005), 대한신경정신의학회
  37. Montagne-Larmurier A, "Two-day treatment of auditory hallucinations by high frequency rTMS guided by cerebral imaging: A 6 month follow-up pilot study", Schizophr Res (2009)
  38. Lang UE, "Acute prefrontal cortex transcranial magnetic stimulation in healthy volunteers: no effects on brain-derived neurotrophic factor (BDNF) concentrations in serum", J Affect Disord, 107, pp.255~258 (2008)
  39. Lang UE, "Brain-derived neurotrophic factor serum concentrations in depressive patients during vagus nerve stimulation and repetitive transcranial magnetic stimulation", Psychopharmacology (Berl), 187, pp.56~59 (2006)
  40. Yukimasa T, "High-frequency repetitive transcranial magnetic stimulation improves refractory depression by influencing catecholamine and brain-derived neurotrophic factors", Pharmacopsychiatry, 39, pp.52~59 (2006)
  41. Zanardini R, "Effect of repetitive transcranial magnetic stimulation on serum brain derived neurotrophic factor in drug resistant depressed patients", J Affect Disord, 91, pp.83~86 (2006)
  42. Okamoto T, "Efficacy of electroconvulsive therapy is associated with changing blood levels of homovanillic acid and brain-derived neurotrophic factor (BDNF) in refractory depressed patients: a pilot study", Prog Neuropsychopharmacol Biol Psychiatry, 32, pp.1185~1190 (2008)
  43. Hori H, "Effects of olanzapine on plasma levels of catecholamine metabolites, cytokines, and brain-derived neurotrophic factor in schizophrenic patients", Int Clin Psychopharmacol, 22, pp.21~27 (2007)

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