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[Effectiveness and safety of high dose transcranial magnetic stimulation in schizophrenia with refractory negative
Objective:
To evaluate the efficacy and safety of high dose transcranial magnetic stimulation (rTMS) in patients with schizophrenia with refractory negative symptoms.
Methods:
From January 2013 to April 2014 at our institute, 70 hospitalized patients of schizophrenia, according to the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV), aged from 18 to 45 were randomly divided into study group (n = 33) and control group (n = 37). Both kinds and dosages of antipsychotics were preserved as before. All patients were treated with 10 Hz rTMS. rTMS was delivered to the left dorsolateral prefrontal cortex (DLPFC) with a figure-eight solid core coil at 100% motor threshold, 2 times daily for 10 days within 2 weeks. Sham stimulation was used in control group. In both groups, Positive and Negative Syndrome Scale (PANSS) and Treatment Emergent Symptom Scale (TESS) were used to evaluate the efficacy and safety before treatment, at week 1 and week 2, and subjective visual analogue scale (VAS) score was checked after each rTMS session. PANSS was performed 3 times at followup visits of week 4, week 8 and week 12.
Results:
Compared with before treatment the total score of PANSS and the score of negative symptoms at week 2 declined in study group (q = 3.780, 4.258, P < 0.05), especially the factors of blunted affect, emotional withdrawal and passive/apathetic social withdrawal (q = 3.829, 4.089, 4.072, P < 0.05). At the follow-up of week 4, week 8 and week 12 after treatment, none of the above factors got significant changes in study group (P > 0.05). After 2 weeks' treatment, the effective rates were 43.75% and 11.43% in study group and control group, respectively, and there was a significant difference between two groups (X2 = 8.888, P =0.003). The incidence of headache in study group was higher than that in control group(37.50% vs 8.57%, χ2 = 8.051, P = 0.005). The highest score of pain was (49 ± 14) in study group, which occurred after the first rTMS treatment. Along with the treatment, the score gradually become lower, and the lowest was (11 ± 5) after 20th treatment.
Conclusion:
Among schizophrenia patients with refractory negative symptoms, 10 Hz rTMS applied 2 times daily within 2 weeks is effective and safe, especially, may improve blunted affect, emotional withdrawal and passive/apathetic social withdrawal.
