Adjunctive treatment of bimodal repetitive transcranial magnetic stimulation (rTMS) in pharmacologically non-responsive patients with schizophrenia: A preliminary study

Objectives: We evaluated the efficacy of bimodal repetitive transcranial magnetic stimulation (rTMS) in treating pharmacologically non-responsive patients with schizophrenia. Methods: Ten patients with DSM-IV schizophrenia, unresponsive to pharmacological treatment, underwent treatment with 15 rTMS sessions, as an adjunctive therapy, for three weeks. Each session comprised 40 trains, beginning every 30 s: 20 trains of 10 Hz rTMS to the left dorsolateral prefrontal cortex (DLPFC) with a 3-s duration and 20 trains of 1 Hz rTMS to the left temporoparietal cortex (TPC) with a 30-s duration. We assessed patients via the Positive and Negative Syndrome Scale (PANSS) and Korean Version of the Calgary Depression Scale for Schizophrenia (K-CDSS), at five time points: baseline. Days 8, 15, and 22, and 1 week after final treatment (Day 29). Patients who agreed to take neurocognitive tests underwent neurocognitive function evaluations at baseline and 1 week after final treatment. Results: At Day 29, all PANSS subscale scores in had decreased significantly compared to baseline (Z = -2.214, p = 0.027, positive; Z = -2.132. p = 0.033, negative; Z = -2.023, p = 0.043, general pathology; Z = -2.371. p = 0.018, total). Effect over time was significant for the PANSS positive and negative subscale scores and total score (chi(2) = 13.35, p = 0.010;,chi(2) = 10.27, p = 0.036; and chi(2) = 16.50, p = 0.002, respectively) but not for the general pathology subscale. Among the neurocognitive tests, the fourth and fifth trials and total K-AVLT scores showed significant increases (Z = -2.041, p = 0.041; Z = -2.251, p = 0.024; and Z = -2.201, p = 0.028, respectively), suggesting improvement in short-term auditory verbal memory. Conclusions: Bimodal rTMS stimulation of left DLPFC and left TPC induced clinical improvement in pharmacologically non-responsive schizophrenia patients and may have improved their short-term verbal memories. (C) 2011 Elsevier Inc. All rights