A pilot double-blind sham-controlled trial of repetitive transcranial magnetic stimulation for patients with refractory schizophrenia treated with clozapine

Jesus, Danilo Rocha de; Gil, Alexei; Barbosa, Leonardo S.; Lobato, Maria Inês Rodrigues; Magalhães, Pedro Vieira da Silva; Favalli, Gabriela; Marcolin, Marco Antônio; Daskalakis, Zafiris J.; Belmonte-de-Abreu, Paulo

doi:10.1016/j.psychres.2010.11.022

Cited by 59 publications

(38 citation statements)

References 31 publications

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“…We speculate that this "intermittent stimulation" may have had a less beneficial effect than a "continuous stimulation design". Contrary to our conclusions, De Jesus et al [17] speculated that their negative results were due to their continuous train (without breaks), arguing that most positive publications used stimulation trains with breaks. The influence of breaks in rTMS trains on treatment outcome is not well known.…”

Section: Discussioncontrasting

confidence: 99%

Treatment of refractory auditory hallucinations in schizophrenia by rTMS: Positive impact of negative double blind controlled study

Bouaziz¹,

Sidhoumi²,

Braha³

et al. 2014

OJPsych

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Background: Several studies reported on the effectiveness of 1 Hz repeated transcranial magnetic stimulation (rTMS) over the temporoparietal cortex (TPC) on refractory auditory hallucinations (AH) in schizophrenia but little is known about the long-term therapeutic effect of this tool. Aim: The aim of this study was to evaluate rTMS' impact on auditory hallucinations (AH) and cognitive functions in patients with schizophrenia with a three-month follow-up. Methods: In a randomized double blind sham controlled study, 26 patients with refractory schizophrenia received 1 Hz rTMS applied on TPC for four weeks. rTMS was given to patients over one month with five rTMS sessions each week. Patients were evaluated via AHRS (Auditory Hallucination Rating Scale, Hoffman et al.), PANSS (Positive and Negative Syndrome Scale, Kay et al. 1988), and CGI (Clinical Global Impression) before treatment by rTMS every week during the first month, and every month until the third month. Results: Neither clinical nor cognitive differences were found between rTMS and placebo. Conclusion: 1 Hz rTMS using parameters mentioned above has no statistically significant effect on AH; although evidences about the potential benefit of rTMS in the treatment of AH negative results suggest the need for further studies in this area.

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Section: Discussioncontrasting

confidence: 99%

Treatment of refractory auditory hallucinations in schizophrenia by rTMS: Positive impact of negative double blind controlled study

Bouaziz¹,

Sidhoumi²,

Braha³

et al. 2014

OJPsych

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“…This was because it was only available as an abstract online, and we were unable to obtain original data from the author. Information regarding the six excluded studies before the last step is summarized in Table 2 (de Jesus et al, 2011; Huber et al, 2003; Jin et al, 2006; Oh and Kim, 2011; Rollnik et al, 2000; Stanford et al, 2011). …”

Section: Resultsmentioning

confidence: 99%

Revisiting the therapeutic effect of rTMS on negative symptoms in schizophrenia: A meta-analysis

Shi

Cheung

et al. 2014

Psychiatry Research

118

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This study sought to determine the moderators in the treatment effect of repetitive transcranial magnetic stimulation (rTMS) on negative symptoms in schizophrenia. We performed a meta-analysis of prospective studies on the therapeutic application of rTMS in schizophrenia assessing the effects of both low-frequency and high-frequency rTMS on negative symptoms. Results indicate that rTMS is effective in alleviating negative symptoms in schizophrenia. The effect size was moderate (0.63 and 0.53, respectively). The effect size of rTMS on negative symptoms in sham-controlled trials was 0.80 as measured by the SANS and 0.41 as measured by the PANSS. A longer duration of illness was associated with poorer efficacy of rTMS on negative symptoms. A 10 Hz setting, at least 3 consecutive weeks of treatment, treatment site at the left dorsolateral prefrontal cortex (DLPFC) and a 110% motor threshold (MT) were found to be the best rTMS parameters for the treatment of negative symptoms. The results of our meta-analysis suggest that rTMS is an effective treatment option for negative symptoms in schizophrenia. The moderators of rTMS on negative symptoms included duration of illness, stimulus frequency, duration of illness, position and intensity of treatment as well as the type of outcome measures used.

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“…In the earlier RCT involving 11 patients with clozapine-resistant schizophrenia, rTMS over the Lt TPC did not differ from sham stimulation on any outcome measure [50]. In the later trial involving 17 clozapine-resistant patients, low frequency rTMS over the Lt TPC resulted in significant improvement in general psychopathology; however, there was no difference in AVH outcomes between the 2 groups [51]. These authors suggested that the improvement in general psychopathology was because of distant cortical effects of rTMS and its effect of enhancing cortical inhibition.…”

Section: Combining Rtms With Clozapinementioning

confidence: 84%

“…Two sham-controlled RCTs have evaluated the efficacy of low frequency rTMS over the Lt TPC in clozapine-medicated patients with persistent AVH [50] [51]. In the earlier RCT involving 11 patients with clozapine-resistant schizophrenia, rTMS over the Lt TPC did not differ from sham stimulation on any outcome measure [50].…”

Section: Combining Rtms With Clozapinementioning

confidence: 99%

Efficacy and safety of combining clozapine with electrical or magnetic brain stimulation in treatment-refractory schizophrenia

Arumugham

Thirthalli

Andrade

2016

Expert Review of Clinical Pharmacology

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We conducted a systematic literature search through Pubmed and cross-references for relevant publications evaluating the safety and efficacy of combining BST with clozapine. Expert commentary: Evidence from a randomized controlled trial and open-label trials suggest that ECT is an effective intervention in clozapine-refractory schizophrenia. There is limited evidence that the combination is safe. However, until sufficient data accumulate, it would be prudent to be vigilant against adverse effects related to lowered seizure threshold, cognitive impairment, and cardiovascular events. Both high frequency rTMS over the dorsolateral prefrontal cortex and low frequency rTMS over the temporoparietal cortex have been safely administered in patients receiving clozapine. However, rTMS efficacy in clozapine-refractory patients remains uncertain. The evidence for tDCS-clozapine combination is in the form of case reports and needs to be evaluated in controlled trials. Newer methods of brain stimulation and refinement of existing BSTs hold promise for the future.

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A pilot double-blind sham-controlled trial of repetitive transcranial magnetic stimulation for patients with refractory schizophrenia treated with clozapine

Cited by 59 publications

References 31 publications

Treatment of refractory auditory hallucinations in schizophrenia by rTMS: Positive impact of negative double blind controlled study

Treatment of refractory auditory hallucinations in schizophrenia by rTMS: Positive impact of negative double blind controlled study

Revisiting the therapeutic effect of rTMS on negative symptoms in schizophrenia: A meta-analysis

Efficacy and safety of combining clozapine with electrical or magnetic brain stimulation in treatment-refractory schizophrenia

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