LVR-Klinikum Düsseldorf Hospital of the Heinrich-Heine University ...

Effectiveness of rTMS in persons with schizophrenic
psychoses in partial remission: A randomised doubleblind,
two-arm, placebo-controlled study
J. Cordes, M. Arends, J. Thünker, M.W. Agelink,
A. Mobascher, G. Kotrotsios, S. J. Kim, W. Wölwer,
J. Brinkmeyer, U. Henning, A. Klimke, G. Winterer,
T. Wobrock, T. Schneider-Axmann, W. Gaebel
Project period: 2003–2010
Financing: Departmental research budget, Alpine Biomed
This extensive study primarily aims to investigate in a
placebo-controlled design the clinical effectiveness of
high-frequency 10 Hz rTMS on psychopathology (Clinical
Global Impression, PANSS Positive and Negative Scale)
and cognition as an add-on treatment in people with
schizophrenia in partial remission. In addition, against the
background of new reports relating to reduced cardio-vagal
modulation in patients with schizophrenia on the one hand
and a non-specific activation of the sympathetic modulations
following rTMS treatment in controls on the other, for the
first time the effects on the HPA axis, monoamine system
and the autonomous nervous system will be investigated.
This goes together with the investigation of the effects on
the diurnal cortisol profile before and after the series of
treatments, as well as the acute effects of rTMS treatment
on peripheral monoamine metabolites. In total, 10 serial
10 Hz rTMS treatments were applied via the dorsolateral
prefrontal cortex; parallel to this, before and during the
course of the treatment, serial measurements were taken,
in accordance with standardised guidelines, of the heartrate
variability (HRV), including spectrum analysis. As the
primary measurement of cognitive performance, facial affect
Improvement in CGI-S
1,2
1,0
0,8
0,6
0,4
0,2
0
Control group rTMS
Figure 24: Statistically significant (p=0.049) clinical improvement (measured
as improvement in the Clinical Global Impression Score, illness severity
subtest (CGI-S)) in patients with schizophrenia with pronounced negative
symptoms (score on the negative symptom scale of the Positive and
Negative Symptom Scale (PANSS) > 17) after treatment with repetitive
transcranial magnetic stimulation (rTMS) compared to a control group
(figure modified after: Cordes et al., Psychiatr. Res. 2009; DOI:10.1016/j.
psychres.2009.01.014)
ReseaRch
decoding was investigated, including its electrophysiological
correlates (P100, N170 and N240), by using a
32-channel EEG at the start and end of rTMS treatment.
Psychopathology was assessed by means of the PANSS
score both before the start and at the end of the tenth
session. The study involved 36 individuals with schizophrenia
and 16 healthy controls. Initial results show significant
improvements in the affect decoding capability under
verum conditions and corresponding electrophysiological
correlates.
Evaluation differences in medical interventions
(rTMS, depot antipsychotic application) in different
population groups
M. Arends, J. Cordes, U. Müller, J. Thünker
Project period: 2007–2010
Financing: Departmental research budget,
Janssen Cilag GmbH
With any new treatment method such as TMS, it is important
to take attributes and opinions into consideration, as these
are relevant to the outcome of the illness under this new
type of treatment. Whereas this was extensively investigated
for psychotropic drugs and ECT, it was found that, to
date, only one investigation has been published relating
to magnetic stimulation. Here, individuals who had been
treated with rTMS were asked about their opinions and
experience, with the majority assigning positive attributes to
rTMS. However, the study participants negatively assessed
the waiting time for rTMS and, in rare cases, headaches.
This project set itself the target of finding out about
attitudes, opinions and positions regarding rTMS. Initial
Improvement in
PANSS negative score
8
6
4
2
0
Control group rTMS
Figure 25: Statistically significant (p=0.022) improvement in the so-called
negative symptoms (such as lack of drive), measured as an improvement in
the subtest for negative symptoms on the Positive and Negative Symptom
Scale (PANSS) in patients with schizophrenia with pronounced negative
symptoms at the start of the study (score on the negative symptom scale
of the PANSS > 17) after treatment with repetitive transcranial magnetic
stimulation (rTMS) compared to a control group (figure modified after:
Cordes et al., Psychiatr. Res. 2009; DOI:10.1016/j.psychres.2009.01.014).
109