Efficacy of repetitive transcranial magnetic stimulation for the treatment of negative symptoms in schizophrenia

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Schizophrenia is a major psychotic disorder that presents an enormous burden to the patients and their relatives. Despite treatment with second generation antipsychotics, negative symptoms and cognitive impairment often persist and determine an unfavourable course including reduction in life quality. Prefrontal repetitive transcranial magnetic stimulation (rTMS), a promising noninvasive biological technique, applied adjuvant to ongoing antipsychotic treatment was demonstrated to be safe and was associated with improvement in negative symptoms in the majority of the small placebo-controlled trials. However, the data on efficacy remain inconclusive. Controlled trials with larger sample sizes and longer treatment periods are required to reach level I evidence of efficacy (according to evidence based medicine criteria). The suggested study is a randomized, parallel-group, rater- and patients-blind design trial and compares real and placebo rTMS in 126 schizophrenic patients suffering from predominantly negative symptoms. All patients receive either real or placebo (sham-) rTMS as add-on treatment over a period of 3 weeks and will be assessed during a follow-up period of further 12 weeks. The results of the study will allow to answer the question whether rTMS is an effective evidence-based add-on intervention in the negative symptoms in schizophrenia, this treatment technique will be a therapeutic option to change the unfavourable course of schizophrenia and needs to be established in clinical practice.