Department of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttrakhand, 248001, India.
Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Raipur, India.
Cerebellum. 2021 Feb;20(1):116-123. doi: 10.1007/s12311-020-01193-9. Epub 2020 Sep 22.
Trans-cranial magnetic stimulation (TMS) can noninvasively modulate specific brain regions to dissipate symptoms in treatment-resistant schizophrenia (TRS). Citing impaired resting state connectivity between cerebellum and prefrontal cortex in schizophrenia, we aimed to study the effect of intermittent theta burst stimulation (iTBS) targeting midline cerebellum in TRS subjects on a randomized rater blinded placebo control study design. In this study, 36 patients were randomly allocated (using block randomization method) to active and sham iTBS groups. They were scheduled to receive ten iTBS sessions, two per day (total of 1200 pulses) for 5 days in a week. The Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Schizophrenia Cognition Rating Scale (SCoRS), Simpson-Angus Extrapyramidal Side Effects Scale (SAS), and Clinical Global Impression (CGI) were assessed at baseline, after last session, and at 2 weeks post-rTMS. Thirty patients (16 and 14 in active and sham groups) completed the study. Intention to treat analysis (ITT) using mixed (growth curve) model analysis was conducted. No significant group (active vs sham) × time (pretreatment-end of 10th session-end of 2 weeks post iTBS) interaction was found for any of the variable. No major side effects were reported. Our study fails to show a significant effect of intensive cerebellar iTBS (iCiTBS) on schizophrenia psychopathology, cognitive functions, and global improvement, compared with sham stimulation, in treatment resistant cases. However, we conclude that it is safe and well tolerated. Trials using better localization technique with large sample, longer duration, and better dosing protocols are needed.
经颅磁刺激（TMS）可无创性调节特定脑区，以消散治疗抵抗性精神分裂症（TRS）的症状。鉴于精神分裂症患者小脑与前额叶皮层之间静息状态连接受损，我们旨在研究针对中线小脑的间歇性 theta 爆发刺激（iTBS）对 TRS 患者的影响，这是一项随机、盲法、安慰剂对照研究设计。在这项研究中，36 名患者被随机分配（使用区组随机化方法）到活跃和假 iTBS 组。他们被安排接受十次 iTBS 治疗，每天两次（共 1200 个脉冲），每周五天。阳性和阴性综合征量表（PANSS）、简明精神病评定量表（BPRS）、精神分裂症认知评定量表（SCoRS）、辛普森-安格斯锥体外系副作用量表（SAS）和临床总体印象（CGI）在基线、最后一次治疗后和 rTMS 后 2 周进行评估。30 名患者（活跃组和假组各 16 名和 14 名）完成了研究。采用混合（生长曲线）模型分析进行意向治疗分析（ITT）。任何变量的活跃组与假组×时间（治疗前-第 10 次治疗结束-第 2 次 rTBS 治疗后）交互作用均无显著差异。未报告重大副作用。与假刺激相比，我们的研究未显示强化小脑 iTBS（iCiTBS）对治疗抵抗病例的精神病理学、认知功能和整体改善有显著影响。然而，我们得出的结论是它是安全且耐受良好的。需要使用更好的定位技术、更大的样本量、更长的持续时间和更好的给药方案进行试验。
