Case Study
Volume 9 Issue 3 - 2020
rTMS for Treatment Resistant Schizophrenia
Mikellides Georgios1* and Tantele Marianna2
1PhD Researcher, Maastricht University, Maastricht, Netherlands
2Consultant Psychiatrist, Cyprus Mental Health Services, Cyprus
*Corresponding Author: Georgios Mikellides, PhD Researcher, Maastricht University, Maastricht, Netherlands.
Received: January 30, 2020; Published: February 14, 2020




Abstract

Introduction: Schizophrenia presents with positive and negative symptoms which some of these symptoms are characterised by hearing voices (auditory hallucinations), reduced social engagement and emotional expression, and also lack of motivation. Around 20 percent of patients with Schizophrenia present with treatment resistance to medication where Clozapine treatment is indicated which may be more effective if it’s to be compared to other antipsychotics however Clozapine has more side effects and requires close monitoring due to the potential life threatening side effect of agranulocytosis which could present in less than 4 percent of patients receiving clozapine.

Method: In this case series study, five cases are presented which received the theta burst stimulation on the dorsolateral prefrontal cortex followed by combining an inhibition of the Wernicke’s area or inhibition of the right dorsolateral prefrontal cortex.

Results: This study explored the efficacy of rTMS on negative symptoms and auditory hallucinations by using high frequency rTMS to the dorso-lateral prefrontal cortex and low frequency rTMS stimuli on Wernicke’s area in the left temporo-parietal cortex or inhibition of the right dorsolateral prefrontal cortex. The cases described in this study, demonstrated excellent results.

Conclusion: It seems that rTMS could have a benefit in a variety of neuropsychiatric disorders and should be applied in treatment resistant schizophrenia too.

Our cases could perhaps stimulate the area of researching further and develop double blind RCTs in these treatment options.

Keywords: Schizophrenia; Clozapine

References

  1. Sims A. “Symptoms in the mind: an introduction to descriptive psychopathology”. Philadelphia: WB Saunders (2002).
  2. "Schizophrenia Fact sheet N°397". WHO (2015). 
  3. "Schizophrenia". National Institute of Mental Health (2016). 
  4. Taylor DM and Duncan-McConnell D. "Refractory schizophrenia and atypical antipsychotics". Journal of Psychopharmacology 14.4 (2000): 409-418. 
  5. van Os J and Kapur S. "Schizophrenia". Lancet 374.9690 (2009): 635-645. 
  6. Lin XD., et al. “Effects of Repetitive Transcranial Magnetic Stimulation Treatment on Event-Related Potentials in Schizophrenia”. Chinese Medical Journal 131.3 (2018): 301-306. 
  7. Cole JC., et al. “Efficacy of Transcranial Magnetic Stimulation (TMS) in the Treatment of Schizophrenia: A Review of the Literature to Date”. Innovations in Clinical Neuroscience 12.7-8 (2015): 12-19.
  8. Georgios Mikellides. “RTMS (Repetitive Transcranial Magnetic Stimulation) could be used as a First Line Treatment for Depression”. Global Journal of Intellectual and Developmental Disabilities 5.1 (2018): 555655.
  9. Georgios M and Marianna T. “A Case of Treatment Resistant Depression Who Did Not Respond to ECT (Electroconvulsive Therapy) and Responded to rTMS (Repetitive Transcranial Magnetic Stimulation)”. Biomedical Journal of Scientific and Technical Research 8.1 (2018): 001582.
  10. Mikellides G., et al. “rTMS for Migraine with a Generalised Anxiety Disorder-A Combination Treatment with Duloxetine”. Journal of Psychiatry 21.5 (2018): 458. 
Citation: Mikellides Georgios and Tantele Marianna. “rTMS for Treatment Resistant Schizophrenia. EC Psychology and Psychiatry 9.3 (2020): 01-04.

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