Intermittent theta burst stimulation for negative symptoms of schizophrenia—A double-blind, sham-controlled pilot study

Abstract

Optimal noninvasive brain stimulation parameters for the treatment of negative symptoms of schizophrenia remain unclear. Here, we aimed to investigate the clinical and biological effects of intermittent theta burst transcranial magnetic stimulation (iTBS) in patients with treatment-resistant negative symptoms of schizophrenia (NCT00875498). In a randomized sham-controlled 2-arm study, 22 patients with schizophrenia and treatment-resistant negative symptoms received 20 sessions of either active (n = 12) or sham (n = 10) iTBS. Sessions were delivered twice a day on 10 consecutive working days. Negative symptom severity was assessed 5 times using the Scale for the Assessment of Negative Symptoms (SANS): before iTBS, after iTBS, and 1, 3, and 6 months after iTBS. As a secondary objective, we explored the acute effects of iTBS on functional connectivity of the left dorsolateral prefrontal cortex (DLPFC) using seed-based resting-state functional connectivity MRI (rsFC fMRI) images acquired before and after iTBS. Active iTBS over the left DLPFC significantly decreased negative symptoms severity compared to sham iTBS (F(3,60) = 3.321, p = 0.026). Post hoc analyses revealed that the difference between groups was significant 6 months after the end of stimulation sessions. Neuroimaging revealed an increase in rsFC between the left DLPFC and a brain region encompassing the right lateral occipital cortex and right angular gyrus and a right midbrain region that may encompass dopamine neuron cell bodies. Thus, iTBS over the left DLPFC can alleviate negative symptoms of schizophrenia. The effect might be driven by significant modulation of dopamine transmission.

Ten Sessions of 30 Min tDCS over 5 Days to Achieve Remission in Depression: A Randomized Pilot Study

“…Although no acute effects of tDCS were observed immediately after the 5 days of stimulation, we observed a superiority of the active over the sham stimulation at the follow up regarding the number of remitters, one month after the simulation sessions. This is in line with other NIBS studies that have reported a delayed clinical effect of tDCS in patients with MDD [14], as well as of repetitive transcranial magnetic stimulation (rTMS) over the left DLPFC, in both patients with MDD [15] and patients with negative schizophrenia [16], suggesting the delayed effect of NIBS-induced neural plasticity when applied over the DLPFC. The present results (see Figure 2) are also in line with current literature supporting a high inter-individual variability regarding the response to antidepressants treatment [17].…”

Intermittent Theta Burst Stimulation vs. High-Frequency Repetitive Transcranial Magnetic Stimulation in the Treatment of Methamphetamine Patients

“…The effectiveness of iTBS has been confirmed in psychiatry and neurology ( 27 – 30 ). Meanwhile, iTBS has the advantages of short treatment time, high feasibility, and good economic benefits.…”

Recent advances in noninvasive brain stimulation for schizophrenia

“…Considerable effort has been made to reduce the financial and time burdens associated with noninvasive brain stimulation treatments, including the development of shorter protocols such as TBS protocols [18 ▪ ]. It was also proposed to provide a higher number of stimulation sessions per day, ranging from one per day in conventional use of HF-rTMS for depression to 2 per day with LF-rTMS or frontotemporal tDCS for hallucinations [37,38], and up to a higher number of sessions per day in the recent application of the so-called accelerated protocols [39].…”