Deep transcranial magnetic stimulationadd-on for treatment of negative symptomsand cognitive deficits of schizophrenia:a feasibility study

Background:

Treatment for negative symptoms and cognitive deficits, core elements of schizophrenia, remainsinadequate. Stimulation of the prefrontal cortex via transcranial magnetic stimulation (TMS) yields onlymoderate results, possibly due to limited stimulation depth. Deep-TMS(dTMS)enables deeper and widerstimulation than before.

Objective:

This preliminary study is the first to examine dTMS as a possible add-ontreatment for negative symptoms and cognitive deficits of schizophrenia.

Method:

15 patients received20 daily dTMSsessions (20 Hz, 120% motor threshold) over the prefrontal cortex(PFC) across 4 weeks.Follow-up assessments were conducted 2 weeks post-treatment. Clinical efficacy assessments were conducted at baseline, visits 5, 10, 15, 20, and follow-up). The primary outcome measures were defined as change in the scale for the assessment of negative symptoms (SANS) and cognitive performance (Cambrisge Neuropsychological Test Automated Battery –CANTAB) results from baseline (visit 1) to the primary efficacy time-point at the end of treatment (visit 20). Secondary outcomemeasures were negative symptomsand cognitiveperformance at follow-up.

Results:

An improvement in the SANSscores (a mean decrease of 16.82%-11.8+3.28 points, p=0.0025) wasobserved over time, as well as improvement in thepositive and negative syndrome scale(PANSS)negative subscale(p<0.0001). Seventy percent of patients who completed treatment were responders, having achieved a>20% improvement in negative symptoms.The cognitive assessments suggested an improvement in cognitive deficits in (p<0.001).Improvements were maintained at 2 weeks post-treatment follow-up.

Conclusions:

These findings suggest that excitatory dTMS to the PFC can induce a positive therapeutic effect on both negative symptoms andcognitive deficits of schizophrenia when used as an adjunct to antipsychotic medication.

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