Key clinical point: High-frequency repetitive transcranial magnetic stimulation (rTMS) may be associated with improvement of negative symptoms in patients with schizophrenia.

Major finding: The improvement in Scale for Assessing Negative Symptoms in schizophrenia scores in anhedonia, alogia, avolition, and attention impairment domains was statistically significant in patients who received active rTMS vs. those who received sham. The results from the Positive and Negative Syndrome Scale negative scale were similar.

Study details: A total of 100 patients with schizophrenia with predominantly negative symptoms were randomly assigned (1:1) to receive 20 sessions of rTMS, via either the active or the sham coil, over 4 weeks.

Disclosures: The study was funded by the Department of Science and Technology under the CSRI Initiative. The authors declared no conflict of interest.

Commentary

“Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation treatment which has shown positive effects for a variety of psychiatric disorders. However, previously reported studies on effects of rTMS on negative symptoms of schizophrenia are limited by small sample sizes, uncontrolled design, lack of a rigorous controlled treatment arm and short duration of follow-up. This report, which addresses several gaps in the existing literature, suggests that high frequency rTMS high frequency administered for 20 sessions over 4 weeks may be helpful in reducing negative symptom of schizophrenia. Given the very limited number of existing effective interventions for negative symptoms and relatively good tolerability of rTMS in this sample, additional investigation is needed to further characterize how rTMS should be applied in the treatment armamentarium for individuals with schizophrenia.”

Martha Sajatovic, MD

Professor of Psychiatry and of Neurology

Willard Brown Chair in Neurological Outcomes Research

Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center

Case Western Reserve University School of Medicine