To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
It was repeatedly reported that low frequency rTMS diminishes treatment-resistant auditory hallucinations. The main drawback to rTMS in general, so far has been the impossibility of precise targeting of the rTMS coil at the given cortical area. Stereotactic neuronavigation is a unique technology utilising the ability of aiming the coil with a high degree of anatomic accuracy based on an evaluation of the structural or functional neuroimaging of the brain.
To prove the clinical effect of using rTMS neuronavigation in the therapy of treatment-resistant auditory hallucinations
Seventeen schizophrenic patients with predominantly symptoms of treatment-resistant auditory hallucinations were treated.
Using double-blind sham-controlled parallel design, we evaluated the effect rTMS neuronavigation focused over the left temporo-parietal area, direct to the place with the highest metabolic activity (SPM II analysed PET contrast).
Clinical effect was assessed using PANNS, AHRS and HCS.
We found a significant improvement in the total on scales of HCS and AHRS, representing more than 30% reduction of the symptoms after neuronavigated rTMS. Sham rTMS did not showed a trend for improvement over time. No side effects during rTMS were observed.
Our study shows the acute effect of rTMS neuronavigation in the therapy of auditory hallucinations in schizophrenia. We believe that using neuronavigation and respecting an individual brain parameters and metabolic changes, we can evaluate higher efficiency of the rTMS method.
The role of coccidian protozoa Toxoplasma gondii represents one of the most enigmatic and unexplained questions in the field of pathophysiology of schizophrenia. To address the role of latent Toxoplasma gondii (T. gondii) infection in pathophysiology of schizophrenia we studied the influence of latent toxoplasmosis on brain morphology in schizophrenia.
Magnetic resonance imaging was analyzed by an optimized voxel-based-morphometry (VBM) in 44 schizophrenic patients (12 T. gondii positive) and 56 controls (13 T. gondii positive). The full factorial model of analysis of variance with diagnosis and seropositivity for latent toxoplasmosis as factors was used to address the differences in gray and white matter.
VBM analyses showed the grey matter (GM) volume reduction in schizophrenia patients compared with controls bilaterally in the neocortical regions, hippocampus, middle and posterior cingulate and in the caudate. In the subgroup of patients and controls seropositive to T. gondii the reduction of GM was located in the same regions as in the whole sample and consisted of 11660 over-threshold voxels (p£0.05, FWR corrected). The differences between T. gondii negative patients and controls consisted only of 289 voxels in temporal and mediotemporal regions.
Our study is the first to document that latent toxoplasmosis reduces GM in schizophrenia but not in controls. The higher morphological vulnerability of patients but not controls to T. gondii infection represents an indirect support for the epidemiological evidence of the role of latent toxoplasmosis in schizophrenia.
It was repeatedly reported that low frequency (≤1 Hz) repetitive transcranial magnetic stimulation (rTMS) diminishes treatment-resistant auditory hallucinations.
To evaluate the distribution of neuronal electrical activity and the brain metabolism changes after low-frequency rTMS in patients with auditory hallucinations.
RTMS (0.9 Hz, 100% of MT, 20 min.) applied to the left temporo-parietal cortex was used for ten days in the treatment of medication-resistant auditory hallucinations in schizophrenia (N = 12). The effect of rTMS on the low resolution brain electromagnetic tomography (LORETA) and brain metabolism (18FDG PET) was measured before and after two weeks of treatment. In a subsequent double blind sham controlled cross-over study (N = 15), the low frequency rTMS was applied using i) “neuronavigation” according to an individual metabolic local maxima of 18FDG PET uptake; ii) “standard” positioning, and iii) inactive “sham”.
The rTMS decreased the brain metabolism in the left superior temporal gyrus and in interconnected regions and effected increases in the contralateral cortex. We detected a decrease of current densities (LORETA) for the beta-1 and beta-3 bands in the left temporal lobe whereas an increase was found for beta-2 band contralaterally. The PET neuronavigated rTMS compared to both standard and inactive rTMS, revealed better outcome.
The LORETA and PET indicate that the neuroplastic changes provide the substrate for a clinical effect. Congruently, 18FDG PET navigated rTMS allows an individual approach to therapy of patient with treatment-resistant acoustic hallucinations.
In this study we sought to explore patterns of neural activity related to the self/other-agency judgment in patients with first-episode schizophrenia spectrum disorders (FES) and healthy controls (HC).
Thirty-five FES patients and 35 age-, gender- and education-matched healthy controls.
Main Outcome Measures
A task-related functional connectivity analysis with the use of independent component analysis (ICA).
ICA revealed that the self/other-agency judgment was dependent upon anti-correlated default mode and central-executive networks (DMN/CEN) dynamic switching. This antagonistic mechanism was substantially impaired in FES during the task.
Time-courses of DMN/CEN activity has been analyzed by means of signal power and spectral coherence. There was statistically significant difference in the variable (anti-correlation index, AI) between FES and HC. AI correlated with self-agency judgment task performance in FES.
This finding suggests that the main site of pathology in schizophrenia-spectrum disorders may originate in higher-order regulatory mechanisms subserving DMN/CEN orchestration.
The study was supported by the IGA Ministry of Health, Czech Republic, grant NT/14291.