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Repetitive transcranial magnetic stimulation for refractory symptoms in schizophrenia

Blumberger, Daniel Ma; Fitzgerald, Paul Bb; Mulsant, Benoit Ha; Daskalakis, Zafiris Ja

Current Opinion in Psychiatry: March 2010 - Volume 23 - Issue 2 - p 85–90
doi: 10.1097/YCO.0b013e3283366657
Schizophrenia: Edited by W. Wolfgang Fleischhacker

Purpose of review Schizophrenia is an illness associated with a substantial degree of treatment resistance and suboptimal therapeutic response. In recent years, novel brain stimulation technologies have been identified as potential treatments for schizophrenia and related disorders. Several published studies have assessed the use of repetitive transcranial magnetic stimulation (rTMS) in patients with schizophrenia.

Recent findings Most published studies have focused on the use of low-frequency rTMS to treat refractory auditory hallucinations. These studies support the efficacy of stimulation over the temporoparietal cortex. Several other studies have assessed high-frequency stimulation of the prefrontal cortex in the treatment of negative symptoms. Novel protocols to treat auditory hallucinations have been piloted and case reports are emerging on the use of maintenance rTMS to treat auditory hallucinations.

Summary Overall, rTMS studies have demonstrated some promise in the treatment of schizophrenia. However, more research is required to delineate the role of this technique in clinical practice and to explore novel stimulation techniques that may ultimately lead to improved therapeutic efficacy.

aDepartment of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada

bDepartment of Psychological Medicine, Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Victoria, Australia

Correspondence to Zafiris J. Daskalakis, MD, PhD, FRCP(C), 250 College Street, 7th Floor Toronto, ON M5T1R8, Canada Tel: +1 416 535 8501x4319; fax: +1 416 979 6936; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.