“Apathetic to hypomanic/manic”: A case series-illustration of emergent mood symptoms during intermittent theta burst stimulation (iTBS) of cerebellar vermis in schizophrenia with predominant negative symptoms

Basavaraju, Rakshathi; Ithal, Dhruva; Ramalingaiah, Arvinda Hanumanthapura; Thirthalli, Jagadisha; Mehta, Urvakhsh Meherwan; Muralidharan, Kesavan

doi:10.1016/j.schres.2020.05.037

Cited by 11 publications

(6 citation statements)

References 13 publications

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“…No significant difference in the reported adverse events was observed between the iTBS and sham control groups, although the incidences of headache, pain, dizziness, and nausea were slightly marked. Two patients with schizophrenia emergent hypomania/mania symptoms while receiving iTBS of cerebellar vermis were worth noticing ( Basavaraju et al, 2020 ). The reported adverse events are summarized in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of intermittent theta-burst stimulation in patients with schizophrenia: A meta-analysis of randomized sham-controlled trials

Goh

Chen²,

Wu³

et al. 2022

Front. Pharmacol.

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Theta-burst stimulation is a non-invasive brain stimulation technique that was introduced as a potential augmentation treatment for patients with schizophrenia. The purpose of this meta-analysis was to investigate the therapeutic efficacy and safety of intermittent theta-burst stimulation in patients with schizophrenia. Following the PRISMA guidelines, the MEDLINE, Embase, Cochrane, Scopus, Web of Science, and CNKI databases were searched for relevant studies from database inception to 9 January 2022. Change in symptom severity among patients with schizophrenia was the primary outcome, and changes in cognitive function and safety profiles, including the discontinuation rate and adverse events, were secondary outcomes. In total, 13 double-blind randomized sham-controlled trials with 524 patients were included. Intermittent theta-burst stimulation adjunct to antipsychotics was associated with significantly improved psychopathology in patients with schizophrenia, particularly for negative symptoms and general psychopathology but not for positive symptoms or cognitive function. The stimulation parameters influenced the effectiveness of intermittent theta-burst stimulation. A more favorable effect was observed in patients who received theta-burst stimulation at the left dorsolateral prefrontal cortex, with ≥1800 pulses per day, for ≥20 sessions, and using an inactive sham coil as a placebo comparison in the study. The intermittent theta-burst stimulation is well tolerated and safe in patients with schizophrenia. Intermittent theta-burst stimulation adjunct to antipsychotics treatment is associated with significant improvement in negative symptoms and favorable tolerability in patients with schizophrenia. This meta-analysis may provide insights into the use of intermittent theta-burst stimulation as an additional treatment to alleviate the negative symptoms of schizophrenia.

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Section: Resultsmentioning

confidence: 99%

Efficacy and safety of intermittent theta-burst stimulation in patients with schizophrenia: A meta-analysis of randomized sham-controlled trials

Goh

Chen²,

Wu³

et al. 2022

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…For more serious side effects, cerebellar stimulation (i.e., rTMS) was terminated for one patient due to increased frequency of auditory hallucinations and associated distress ( 92 ). Additionally, two participants exhibited increased mania/hypomania after iTBS ( 90 , 91 ).…”

Section: Resultsmentioning

confidence: 98%

“…Three studies observed non-specific iTBS effects on positive symptoms, with significant reductions for participants in the active and control study arms ( 82 , 83 , 90 ). Studies with only an active stimulation arm (rTMS, iTBS, or tDCS) reported mixed results, with some finding no change ( 86 , 87 ), others finding a reduction ( 84 , 88 , 91 ), and one case study noting an increase ( 92 ) in positive symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…As for location of the cerebellar target, most of the transcranial electric stimulation studies identified the cerebellar vermis as 1–2 cm below the inion, which is consistent with recommended practice and the majority of cerebellar stimulation studies ( 15 , 33 ). However, some studies used different methods to identify the cerebellar target, such as MRI-guided neuronavigation ( 87 , 89 – 91 ) and the 10–20 international EEG coordinate system ( 82 , 86 , 88 , 92 ). This distinction is relevant as neuronavigation helps maximize the precision of the stimulation location for a given individual.…”

Section: Discussionmentioning

confidence: 99%

“…Additional research is needed to understand who will most benefit from cerebellar stimulation ( 111 ). Many studies recruited individuals who were treatment-resistant ( 17 – 19 , 82 , 87 , 92 ) or who had at least moderate symptoms ( 20 , 90 , 91 ); however, it is not clear whether these individuals were more likely to benefit from treatment than those with fewer symptoms. Evaluating individuals across the psychosis spectrum can help elucidate whether less symptomatic individuals or those earlier in the illness course can similarly benefit from cerebellar stimulation.…”

Section: Discussionmentioning

confidence: 99%

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Cerebellar stimulation in schizophrenia: A systematic review of the evidence and an overview of the methods

2022

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BackgroundCerebellar structural and functional abnormalities underlie widespread deficits in clinical, cognitive, and motor functioning that are observed in schizophrenia. Consequently, the cerebellum is a promising target for novel schizophrenia treatments. Here we conducted an updated systematic review examining the literature on cerebellar stimulation efficacy and tolerability for mitigating symptoms of schizophrenia. We discuss the purported mechanisms of cerebellar stimulation, current methods for implementing stimulation, and future directions of cerebellar stimulation for intervention development with this population.MethodsTwo independent authors identified 20 published studies (7 randomized controlled trials, 7 open-label studies, 1 pilot study, 4 case reports, 1 preclinical study) that describe the effects of cerebellar circuitry modulation in patients with schizophrenia or animal models of psychosis. Published studies up to October 11, 2022 were identified from a search within PubMed, Scopus, and PsycInfo.ResultsMost studies stimulating the cerebellum used transcranial magnetic stimulation or transcranial direct-current stimulation, specifically targeting the cerebellar vermis/midline. Accounting for levels of methodological rigor across studies, these studies detected post-cerebellar modulation in schizophrenia as indicated by the alleviation of certain clinical symptoms (mainly negative and depressive symptoms), as well as increased frontal-cerebellar connectivity and augmentation of canonical neuro-oscillations known to be abnormal in schizophrenia. In contrast to a prior review, we did not find consistent evidence for cognitive improvements following cerebellar modulation stimulation. Modern cerebellar stimulation methods appear tolerable for individuals with schizophrenia, with only mild and temporary side effects.ConclusionCerebellar stimulation is a promising intervention for individuals with schizophrenia that may be more relevant to some symptom domains than others. Initial results highlight the need for continued research using more methodologically rigorous designs, such as additional longitudinal and randomized controlled trials.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022346667].

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Cerebellar Transcranial Magnetic Stimulation in Psychiatric Disorders: A Systematic Review

Basavaraju,

Kaur,

Mehta

2024

Curr Behav Neurosci Rep

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“Apathetic to hypomanic/manic”: A case series-illustration of emergent mood symptoms during intermittent theta burst stimulation (iTBS) of cerebellar vermis in schizophrenia with predominant negative symptoms

Cited by 11 publications

References 13 publications

Efficacy and safety of intermittent theta-burst stimulation in patients with schizophrenia: A meta-analysis of randomized sham-controlled trials

Efficacy and safety of intermittent theta-burst stimulation in patients with schizophrenia: A meta-analysis of randomized sham-controlled trials

Cerebellar stimulation in schizophrenia: A systematic review of the evidence and an overview of the methods

Cerebellar Transcranial Magnetic Stimulation in Psychiatric Disorders: A Systematic Review

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