Treatment of shizophrenic patients and rTMS.

EA 4166, University Of Lyon, Lyon 1, Institut fédératif des neurosciences de Lyon, CH le Vinatier 95 boulevard Pinel, 69 677 Bron Cedex, France.
Psychiatria Danubina (Impact Factor: 0.65). 11/2010; 22 Suppl 1:S143-6.
Source: PubMed

ABSTRACT schizophrenia (SCH) is a heterogeneous syndrome characterized by positive and negative symptoms. Despite appropriate medication, about 1/4 of patients suffer for refractory positive and/or negative symptoms, which are associated with functional handicap, increase of duration and of the number of hospitalizations. Numerous studies have suggested that the pathophysiology of auditory hallucinations (AH) is related to a hyper activity of the left temporoparietal cortex (TPC). On the other hand, negative symptoms are associated with a prefrontal hypoactivity and the efficiency of pharmacological treatments is frequently partial. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool with excellent tolerability and safety. Given its hypothesized mechanisms of action and the clinical beneficial effects obtained in several types of pathology (Aleman et al. 2007), the efficacy of rTMS has been investigated for drug-resistant SCH symptoms.
our objective is to expose the knowledge concerning the rTMS use in the treatment of these symptoms and to purpose a critical analysis of these data.
a systematic review of the literature has been conducted using NIH Pubmed. The following search terms were used: TMS - rTMS - Schizophrenia - negative symptoms - hallucinations.
concerning the treatment of AH, 16 publications and 4 meta analyses were selected. For the negative symptoms, we retained 16 studies and 3 meta analyses. The most extensively investigated application for rTMS in SCH is the use of low-frequency stimulation to the left TPC with the aim to improve AH symptomatology. When compared to sham, this type of acute course of rTMS has been proven to induce a substantial and significant reduction in AH. But this effect does not seem long-lasting and maintenance protocols must be developed. Concerning negative symptoms, the results are less solid but we find some works which demonstrate an improvement of these symptoms while various stimulation parameters were used. Recently, new parameters of stimulation in particular the theta burst stimulation have permitted us to obtain larger effects with longer duration. The interest of these new parameters will be discussed here.
overall, rTMS studies have demonstrated some promise in the treatment of SCH. However, more research is required to enhance rTMS efficacy and increase its beneficial effect duration and to test new therapeutic strategies in this topic.


Available from: Frédéric Haesebaert, Oct 02, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. Auditory hallucinations are a common symptom experience of individuals with psychotic disorders and are often experienced as persistent, distressing, and disruptive. This case series examined the lived experiences of four individuals treated (successfully or unsuccessfully) with low-frequency (1 Hz) rTMS for auditory hallucinations. Methods. A phenomenological approach was used and modified to involve some predetermined data structuring to accommodate for expected cognitive impairments of participants and the impact of rTMS on auditory hallucinations. Data on thoughts and feelings in relation to the helpful, unhelpful, and other effects of rTMS on auditory hallucinations, on well-being, functioning, and the immediate environment were collected using semistructured interviews. Results. All four participants noted some improvements in their well-being following treatment and none reported a worsening of their symptoms. Only two participants noted an improvement in the auditory hallucinations and only one of them reported an improvement that was sustained after treatment completion. Conclusion. We suggest that there are useful findings in the study worth further exploration, specifically in relation to the role of an individual's acceptance and ownership of the illness process in relation to this biomedical intervention. More mixed methods research is required to examine rTMS for auditory hallucinations.
    06/2013; 2013:183582. DOI:10.1155/2013/183582
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Following the early studies of Moniz and Lima, psychosurgery had considerable scientific credibility until the advent of modern antipsychotics in the mid 1950s. Thereafter, psychosurgery was almost abandoned in large medical centers as a common treatment for schizophrenia, although is still used for some affective and anxiety disorders. We reviewed relevant papers cited in the Medline/Index Medicus, Cochrane, and Scielo databases from 1930 to 2012. In our review of the literature, we show from recent studies that there are still many patients with schizophrenia who have serious deficits even after being treated with current noninvasive therapies. The value of psychosurgery remains controversial. There are no data available to support the use of stereotactic procedures for schizophrenia. Well designed controlled trials are needed to establish the effectiveness of psychosurgery in patients with schizophrenia.
    Neuropsychiatric Disease and Treatment 04/2013; 9:509-15. DOI:10.2147/NDT.S35823 · 2.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obsessive-compulsive disorder (OCD) is a chronic, often resistant neuropsychiatric disorder leading to severe social impairment. Neurophysiological theories suggest an imbalance between the frontal-striatal circuits involved in goal directed behavior. Repetitive transcranial magnetic stimulation (rTMS) has been suggested as a therapeutic option. Various targets of stimulation have been tested based on neurophysiological theories. The first studies, stimulating the dorsolateral prefrontal cortex, did not show an efficacy but the more recent ones, stimulating the supplementary motor area or the orbitofrontal cortex, seem to be promising. Further studies with larger sample should be conducted in order to propose rTMS as a therapeutic tool for OCD.
    Revue Neurologique 08/2012; 168(s 8–9):655–661. DOI:10.1016/j.neurol.2012.05.006 · 0.60 Impact Factor