Transcranial Magnetic Stimulation for Schizophrenia


Dougall N; Maayan N; Soares-Weiser K; McDermott LM; McIntosh A. Institution Dougall,Nadine. NMAHP Research Unit, School of Health Sciences, Uni versity of Stirling, Stirling, UK; . Maayan,Nicola. Enhance Reviews Ltd, Wantage, UK; Soares-Weiser,Karla. Enhance Reviews Ltd, Wantage, UK; McDermott,Lisa M. Primary Care and Public Health Sciences, King’s Colleg e London, London, UK; McIntosh,Andrew. Division of Psychiatry, University of Edinburgh , Edinburgh, UK.


Transcranial Magnetic Stimulation for Schizophrenia. [Review]


Schizophrenia Bulletin. 41(6):1220-2, 2015 Nov. Abstract People with schizophrenia typically experience auditory hallucination s or delusions during acute episodes. Although effective drug treatments are available, many have intractable symptoms that do not recover between acute episodes. One proposed alternative to drug treatments is transcranial magnetic stimulation (TMS). To date, many research trials to assess effectiveness of TMS for people with symptoms of schizophrenia have been conducted worldwide. However, there is a lack of consensus on whether TMS should be recommended to be adopted in routine clinical practice. We conducted a systematic review of the literature for all relevant randomized controlled trials (RCTs) comparing TMS with sham or standard treatment. Forty-one trials (1473 participants) survived eligibility criteria and had extractable data. We found significant differences in favor of temporoparietal TMS compared with sham TMS for global state (7 RCTs, n = 224, MD: -0.5, 95% CI: -0.76 to -0.23) and for p ositive symptoms measured on the Positive and Negative Syndrome Scale (5 RCTs, n = 127, MD: -6.09, 95% CI: -10.95 to -1.22). However, we also found that the quality of trial reporting was frequently suboptimal and the risks of bias were strong or unascertainable for many trial aspects; this led to many results being graded as very low-quality evidence. On that basis, we were unable to definitively support or refute the routine use of TMS in clinical practice. Future definitive trials of TMS with rigorous processes and high-quality reporting are needed. **(hallucinations)Authors Nathou C; Simon G; Dollfus S; Etard O. Institution Nathou,Clement. CHU de Caen, Department of Psychiatry, Centre Esquirol, Caen F-14000, France; Unicaen, UFR of Medicine, Caen F-14000, France; Unicaen, UMR 6301, Centre Cyceron, Caen F-14000, France. Simon,Gregory. Unicaen, LaPsyDE, Caen F-14000, France; CNRS, UMR 8240 LaPsyDE, Paris F-75005, France. Dollfus,Sonia. CHU de Caen, Department of Psychiatry, Centre Esquirol, Caen F-14000, France; Unicaen, UFR of Medicine, Caen F-14000, France; Unicaen, UMR 6301, Centre Cyceron, Caen F-14000, France. Electronic address: . Etard,Olivier. Unicaen, UFR of Medicine, Caen F-14000, France; CHU de Caen Laboratory of Neurological Functional Exploratory, Caen F-14000, France. Title Cortical Anatomical Variations and Efficacy of rTMS in the Treatment of Auditory Hallucinations. Source Brain Stimulation. 8(6):1162-7, 2015 Nov-Dec. Abstract BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) shows high inter-subject variability in its efficacy for treating resistant auditory verbal hallucinations in schizophrenia. Currently, the response of an individual patient to rTMS treatment cannot be predicted. It is possibl e that cortical anatomical characteristics could affect the therapeutic response. OBJECTIVE: We hypothesized that rTMS efficacy is related to anatomical variations underlying the stimulation target in the left temporal cort ex. We investigated two regions of interest (ROIs) that have been implicated in rTMS: the left temporal cortex, where the stimulation is delivered, and the primary hand motor cortex, where the stimulation strength is determined by the resting motor threshold (rMT). METHODS: Fifteen patients with schizophrenia (DSM IV) underwent rTMS and magnetic resonance imaging. The scalp- to -cortex distance (SCD) and the grey matter density (GMD) were measured in both ROIs. Linear regression models were used to investigate the relationships between these measures and the clinical efficacy of rTMS. RESULTS: Treatment efficacy was highly predicted by the temporal SCD and the GMD in the temporal and primary hand motor cortex regions. In contrast, the rMT was not predicted by the primary hand motor cortex SCD or GMD. CONCLUSION: These results suggest that rTMS treatment efficacy could be related to the depth of the temporal target. The data raise the question of whether rMT is the best measure for assessing the stimulation intensity in treating patients with schizophrenia. Authors