Therapeutic Effects of Individualized Alpha Frequency Transcranial Magnetic Stimulation ( TMS) on the Negative Symptoms of Schizophrenia

Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 08/2006; 32(3):556-61. DOI: 10.1093/schbul/sbj020
Source: PubMed


Previous research in clinical electroencephalography (EEG) has demonstrated that reduction of alpha frequency (8-13 Hz) EEG activity may have particular relevance to the negative symptoms of schizophrenia. Repetitive Transcranial Magnetic Stimulation (rTMS) was utilized to investigate this relationship by assessing the therapeutic effects of stimulation set individually at each subject's peak alpha frequency (alphaTMS). Twenty-seven subjects, with predominantly negative symptom schizophrenia, received 2 weeks of daily treatment with either alphaTMS, 3 Hz, 20 Hz, or sham stimulation bilaterally over the dorsolateral prefrontal cortex. Individualized alphaTMS demonstrated a significantly larger (F (3,33) = 4.7, p = .007) therapeutic effect (29.6% reduction in negative symptoms) than the other 3 conditions (< 9%). Furthermore, these clinical improvements were found to be highly correlated (r = 0.86, p = .001) with increases (34%) in frontal alpha amplitude following alphaTMS. These results affirm that the resonant features of alpha frequency EEG play an important role in the pathophysiology of schizophrenia and merit further investigation as a particularly efficacious frequency for rTMS treatments.

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Available from: Gustavo Alva, Feb 18, 2014
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    • "Recently, novel rTMS paradigms, such as individualized alpha frequency TMS (αTMS) (Jin et al., 2006), theta burst stimulation (TBS) (Demirtas-Tatlidede et al., 2010) or the modulation of gamma oscillations (Barr, Farzan, Arenovich, et al., 2011; Farzan, Barr, Sun, Fitzgerald, and Daskalakis, 2012) have been tried. Considering the heterogeneity of symptoms in schizophrenia and the neural basis of the disease, the combined assessment of both target areas (frontal and temporal region) can be clinically useful (Oh and Kim, 2011) but the evidence from the structured clinical trials are still insufficient. "
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    DESCRIPTION: Transcranial magnetic stimulation (TMS) was introduced as a novel method of brain stimulation in 1985, and now it is widely used in research of cortical excitability, neuronal connectivity and plasticity, and also is applied to the treatment of various neurological and psychiatric conditions. This review is written with the purpose of introducing the brief conspectus and area of therapeutic application of TMS. The techniques, equipment and treatment modalities of TMS are continuously developing, and its area of therapeutic application is being extended. For determining the form of the optimal therapeutic application of TMS in various clinical conditions, more data from controlled studies should be obtained.
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    • "Res. (2015), individual alpha peak frequency (α-TMS) to increase alpha-range oscillations as a treatment modality (Jin et al., 2006, 2012). Notably, improvement in symptoms correlated with alpha EEG normalization after treatment with α-TMS. "
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    ABSTRACT: Deficits in both resting alpha-range (8-12Hz) electroencephalogram (EEG) activity and steady state evoked potential (SSVEP) responses have been reported in schizophrenia. However, the topographic specificity of these effects, the relationship between resting EEG and SSVEP, as well as the impact of antipsychotic medication on these effects, have not been clearly delineated. The present study sought to address these questions with 256 channel high-density EEG recordings in a group of 13 schizophrenia patients, 13 healthy controls, and 10 non-schizophrenia patients with psychiatric diagnoses currently taking antipsychotic medication. At rest, the schizophrenia group demonstrated decreased alpha EEG power in frontal and occipital areas relative to healthy controls. With SSVEP stimulation centered in the alpha band (10Hz), but not with stimulation above (15Hz) or below (7Hz) this range, the occipital deficit in alpha power was partially reverted. However, the frontal deficit persisted and contributed to a significantly reduced topographic relationship between occipital and frontal alpha activity for resting EEG and 10Hz SSVEP alpha power in schizophrenia patients. No significant differences were observed between healthy and medicated controls or between medicated controls and schizophrenia. These findings suggest a potential intrinsic deficit in frontal eyes-closed EEG alpha oscillations in schizophrenia, whereby potent visual stimulation centered in that frequency range results in an increase in the occipital alpha power of these patients, which however does not extend to frontal regions. Future research to evaluate the cortical and subcortical mechanisms of these effects is warranted. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 07/2015; 168(1). DOI:10.1016/j.schres.2015.06.012 · 3.92 Impact Factor
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    • "It has been suggested that a larger number of pulses are more effective (Gershon et al. 2003). In our study we applied a total amount of 60 000 pulses, which is at least twice the amount of any earlier published rTMS study for negative symptoms (Cohen et al. 1999; Klein et al. 1999; Hajak et al. 2004; Holi et al. 2004; Jandl et al. 2005; Sachdev et al. 2005; Jin et al. 2006; Novak et al. 2006; Goyal et al. 2007; Mogg et al. 2007; Prikryl et al. 2007, 2013; Fitzgerald et al. 2008; Schneider et al. 2008; Cordes et al. 2010; Barr et al. 2012). Negative symptoms were measured using the Scale for the Assessment of "
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    ABSTRACT: Background: Few studies have investigated the efficacy of repetitive transcranial magnetic stimulation (rTMS) treatment for negative symptoms of schizophrenia, reporting inconsistent results. We aimed to investigate whether 10 Hz stimulation of the bilateral dorsolateral prefrontal cortex during 3 weeks enhances treatment effects. Method: A multicenter double-blind randomized controlled trial was performed in 32 patients with schizophrenia or schizo-affective disorder, and moderate to severe negative symptoms [Positive and Negative Syndrome Scale (PANSS) negative subscale ⩾15]. Patients were randomized to a 3-week course of active or sham rTMS. Primary outcome was severity of negative symptoms as measured with the Scale for the Assessment of Negative Symptoms (SANS) and the PANSS negative symptom score. Secondary outcome measures included cognition, insight, quality of life and mood. Subjects were followed up at 4 weeks and at 3 months. For analysis of the data a mixed-effects linear model was used. Results: A significant improvement of the SANS in the active group compared with sham up to 3 months follow-up (p = 0.03) was found. The PANSS negative symptom scores did not show a significant change (p = 0.19). Of the cognitive tests, only one showed a significant improvement after rTMS as compared with sham. Finally, a significant change of insight was found with better scores in the treatment group. Conclusions: Bilateral 10 Hz prefrontal rTMS reduced negative symptoms, as measured with the SANS. More studies are needed to investigate optimal parameters for rTMS, the cognitive effects and the neural basis.
    Psychological Medicine 10/2014; 45(06):1-13. DOI:10.1017/S0033291714002360 · 5.94 Impact Factor
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