TOPLINE:
Inhibitory repetitive transcranial magnetic stimulation (rTMS) of the supplementary motor area (SMA) was associated with significant improvement in psychomotor slowing in psychosis — a condition for which there is currently no treatment — new data suggest.
METHODOLOGY:
- The double-blind, randomized, sham-controlled trial included 88 adult patients (mean age, 36 years) with schizophrenia spectrum disorders to receive 15 sessions of 1-Hz rTMS, intermittent theta burst stimulation (iTBS), or sham over a 3-week period. A fourth "waiting" group received no treatment (n = 22 per group).
- After 3 weeks, the waiting group received 15 sessions of 1-Hz rTMS over the SMA.
- Patients were assessed at 3, 6, and 24 weeks.
- Improvement was defined as a ≥ 30% reduction from baseline on the Salpêtrière Retardation Rating Scale.
TAKEAWAY:
- At the end of 3 weeks, individuals receiving rTMS reported the most SRSS improvement (68%), followed by iTBS (36%), sham (32%), and no treatment (18%) (P = .007).
- The rTMS group had more responders at 3 weeks compared to those who received sham (P = .03), iTBS (P = .02), and no treatment (P = .003), and 63% of the waiting group responded to 15 sessions of 1-Hz rTMS after conversion at 3 weeks.
- The improvements persisted at 6 months, with significant effects of time and a time-by-treatment interaction (P < .001 for both).
- There were no severe adverse events during the study period or follow-up and no differences between the groups in the number of reported adverse effects per treatment.
IN PRACTICE:
"This study suggests great potential of noninvasive brain stimulation interventions in the motor system," the authors wrote, who noted that the current findings should be replicated in larger, multicenter trials.
SOURCE:
Sebastian Walther, MD, of the Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland was the lead and corresponding author of the study. It was published online on February 28 in JAMA Psychiatry.
LIMITATIONS:
The authors cited a number of limitations, including a sample size too small to achieve sufficient power for the secondary outcomes. In addition, randomization was conducted before baseline assessments, so the intention to treat population included all patients with ≥1 rTMS session.
DISCLOSURES:
This study was funded by the Swiss National Science Foundation. Walther reported honoraria for medical education events from Mepha, Lundbeck, and Neurolite outside the submitted work. No other disclosures were reported.