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Cited by 57Transcranial Magnetic Stimulation StudiesSchizophrenia research and treatmentElectroconvulsive Therapy Studies

Efficacy of Intensive Cerebellar Intermittent Theta Burst Stimulation (iCiTBS) in Treatment-Resistant Schizophrenia: a Randomized Placebo-Controlled Study

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Chauhan, Preeti, Garg, Shobit, Tikka, Sai Krishna, Khattri, Sumit·2021·The Cerebellum
DOI 10.1007/s12311-020-01193-9PMC PMC7508243
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Abstract

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.

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  • Other TMS depression trials have experienced similarly robust placebo responses, including CBM-iTBS trials.

    “Other TMS depression trials have experienced similarly robust placebo responses, including CBM-iTBS trials (Basavaraju et al., 2021; Chauhan et al., 2021)”

    From A double-blind, randomized, sham-controlled clinical trial of cerebellar intermittent theta burst stimulation for bipolar disorder: Safety, tolerability, mood and cognitive effects (2025) · cites this paper as Chauhan et al., 2021

    The Results > Outcome Measures section (page unavailable) reports statistically significant improvement in the sham group of this cerebellar iTBS trial. But the participants had treatment-resistant schizophrenia, not depression, and the authors say the improvement was not clinically significant. This source therefore does not establish a robust placebo response in a TMS depression trial. (LLM, conf=0.88)

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Authors
Chauhan, P., Garg, S., Tikka, S. K., & Khattri, S.
Affiliations
  • Shri Guru Ram Rai Institute of Medical & Health Sciences (IN)
  • All India Institute of Medical Sciences Raipur (IN)
Corresponding author
Garg, Shobit
ORCID
Venue
The Cerebellum
Publisher
Springer Science and Business Media LLC
Published
2020-09-22
Volume
20
Issue
1
Pages
116-123
ISSN
  • 1473-4222 (ISSN-L)
  • 1473-4230
DOI
10.1007/s12311-020-01193-9
PMC
PMC7508243
OpenAlex
W3088858253
Cited by
57
References
46
Citations by year
2026: 9 · 2025: 12 · 2024: 12 · 2023: 11 · 2022: 10 · 2021: 3
FWCI
2.32
Type
journal article
Language
en
Open access
Licence
Locations
  • The Cerebellum (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
treatment-resistant schizophrenia, intermittent theta burst stimulation, cerebellum, repetitive transcranial magnetic stimulation, sham stimulation, cognitive function, extrapyramidal symptoms, treatment efficacy
MeSH terms
Adolescent, Adult, Basal Ganglia Diseases, Cerebellum, Cognition, Double-Blind Method, Drug Resistance, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Theta Rhythm, Treatment Outcome, Transcranial Magnetic Stimulation, Young Adult

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