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Can Repetitive Transcranial Magnetic Stimulation Be Considered Effective Treatment Option for Negative Symptoms of Schizophrenia?

Prikryl, Radovan MD, PhD; Kucerova, Hana Prikrylova PhD

doi: 10.1097/YCT.0b013e318270295f

Objective Despite the development of second-generation antipsychotic drugs, treatment-resistant symptoms still represent a serious problem in schizophrenia. The aim of the present article was to review studies with repetitive transcranial magnetic stimulation for negative symptoms of schizophrenia and draw conclusions for clinical decision making.

Method Literature for this review was identified by searching MEDLINE and ISI Web of Science up to the year 2011.

Results Five open studies, 13 sham-controlled studies, and 2 meta-analysis and 2 review articles were included in the present paper. The effect size of the high frequency repetitive transcranial magnetic stimulation (rTMS) over the left prefrontal cortex in the treatment of negative symptoms of schizophrenia is thought to be mild to moderate (Cohen d = 0.43–0.68).

Conclusion Despite the promising results of some rTMS studies, the potential of rTMS for the treatment of negative symptoms is currently relatively unclear. Large clinical studies are therefore needed, especially large multicentric studies such as depression rTMS studies.

Clinical Recommendations 
  • There is an evidence showing that rTMS can be considered the effective treatment option for negative symptoms of schizophrenia.
  • Based on the results of current meta-analyses, the effect size of high-frequency rTMS in the treatment of negative symptoms of schizophrenia seems to be mild to moderate (Cohen d = 0.43–0.63).
  • Despite limited evidence base, the associations between efficacy and stimulation approaches (higher stimulation intensity, higher number of sessions or 10 Hz stimulus frequency) appear.
Additional Comments 
  • Neither the European Medicines Agency nor the Food and Drug Administration has approved rTMS for the treatment of negative symptoms of schizophrenia.
  • Furthermore, large clinical studies are necessary to verify the natural benefit of rTMS for general clinical practice.

From the Central European Institute of Technology (CEITEC), Masaryk University, and Department of Psychiatry Medical Faculty, Masaryk University Hospital, Brno, Czech Republic.

Received for publication December 21, 2011; accepted August 14, 2012.

Reprints: Radovan Prikryl, MD, PhD, Department of Psychiatry, University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic (e-mail:

This work was supported by the project “CEITEC (Central European Institute of Technology)” (CZ.1.05/1.1.00/02.0068) from European Regional Development Fund and by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 65269705 (University Hospital Brno, Brno, Czech Republic).

The authors have no conflicts of interest or financial disclosures to report.

© 2013 Lippincott Williams & Wilkins, Inc.