title: A randomized controlled trial of sequentially bilateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of negative symptoms in schizophrenia.
abstract: BACKGROUND
  Repetitive transcranial magnetic stimulation (rTMS) has been investigated for its treatment efficacy for the negative symptoms of schizophrenia. Previous studies have targeted the dorsolateral prefrontal cortex (DLPFC), which is associated with the pathophysiology of this disorder. Several rTMS parameters have been explored in the treatment of negative symptoms and include stimulating the left and bilateral DLPFC at several different frequencies and number of sessions. Results of such studies have been inconsistent, while high-frequency rTMS has shown greatest promise.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the efficacy of bilateral high-frequency rTMS in the treatment of negative symptoms in schizophrenia. It was hypothesized rTMS would alleviate negative symptoms in schizophrenia.
  
  
  METHODS
  Twenty-five patients were enrolled in this double-blind placebo-controlled randomized trial. Bilateral 20 Hz rTMS was MRI-targeted to the DLPFC at 90% RMT administered daily for 4 weeks for a total of 20 treatments. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative symptom scale (PANSS), and controlling for depression as measured with the Calgary Depression Scale (CDS) at baseline, 1, 2, 3, 4, and 2 weeks after the treatment course.
  
  
  RESULTS
  No significant group or time differences were found on negative symptoms or depressive symptoms after rTMS. Bilateral high-frequency rTMS did not alleviate negative symptoms in patients with schizophrenia.
  
  
  CONCLUSIONS
  These findings indicate that such symptoms are unresponsive to rTMS treatment or that more optimized parameters are needed to achieve improved therapeutic efficacy.
authors.affiliation: Schizophrenia Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mera S
authors.initials: MS
authors.lastname: Barr
authors.affiliation: Schizophrenia Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Faranak
authors.initials: F
authors.lastname: Farzan
authors.affiliation: Schizophrenia Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Tran
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Commercial Rd Melbourne, Victoria, Australia.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
authors.affiliation: Schizophrenia Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Electronic address: Jeff__Daskalakis@camh.net.
authors.forename: Zafiris J
authors.initials: ZJ
authors.lastname: Daskalakis
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009341:Negativism; D010324:Passive-Aggressive Personality Disorder / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D015990:Placebo Effect; D017397:Prefrontal Cortex; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome