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rTMS for Schizophrenia

Posted on 1 Jun 2006
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This is the second of our Forum journal discussions, in which the editors of Schizophrenia Bulletin or Schizophrenia Research provide access to the full text of a new article. A short introduction by a journal editor, below, will get us started, and then it's up to our readers to share their ideas and insights, questions and reactions to the selected paper. So read on"

 

 

Therapeutic Effects of Individualized Alpha Frequency Transcranial Magnetic Stimulation (aTMS) on the Negative Symptoms of Schizophrenia Yi Jin, Steven G. Potkin, Aaron S. Kemp, Steven T. Huerta, Gustavo Alva, Trung Minh Thai, Danilo Carreon, and William E. Bunney, Jr.

Background

by Gunvant Thaker, Maryland Psychiatric Research Center, and Associate Editor, Schizophrenia Bulletin

Repeated transcranial magnetic stimulation (rTMS) provides a new and relatively noninvasive tool to manipulate brain circuitry. It has been widely used for cortical mapping of function by stimulating a region of interest extracranially and examining the effects on a particular function. The technique has been studied extensively as a treatment for depression, and investigators are just starting to examine its potential in schizophrenia therapeutics. A recent study noted improvement in auditory hallucinations in schizophrenia when rTMS was applied locally over the temporoparietal cortex (Hoffman et al., 2005). Scientists are just beginning to define treatment parameters, for instance, stimulation frequency, that are associated with superior efficacy for the target symptom. In this context, several investigators have observed impairments in brain oscillatory activity including reduced power and coherence of alpha activity and in gamma band in schizophrenia patients.

Yi Jin and colleagues, in a study reported recently in Schizophrenia Bulletin, set the rTMS stimulation frequency based on the individual subject"s peak alpha electroencephalography (EEG) frequency. The authors find significant improvements in negative symptoms that were highly correlated with the degree of individual"s alpha EEG enhancement. This is a very innovative study design, refining the methods of applying rTMS. The findings are particularly exciting since negative symptoms in schizophrenia are generally difficult to treat (see SRF Forum Discussion on The NIMH-MATRICS Consensus Statement on Negative Symptoms).

The findings reported by Jin et al., although interesting, raise several questions. For instance, what technique can one apply so that the treatment effects are long-term? Can rTMS induce changes in the neuronal activities such that subsequent drug treatments are more effective? There are likely to be other interesting questions/comments, and we encourage our readers to contribute to this discussion.

Reference:
Jin Y, Potkin SG, Kemp AS, Huerta ST, Alva G, Thai TM, Carreon D, Bunney WE Jr. Therapeutic Effects of Individualized Alpha Frequency Transcranial Magnetic Stimulation ({alpha}TMS) on the Negative Symptoms of Schizophrenia.Schizophr Bull. 2005 Oct 27; [Epub ahead of print] Abstract