Transcranial Magnetic Stimulation (TMS) for Motor Symptoms in Psychiatric Disorders

Effects of Transcranial Magnetic Stimulation on Motor Symptoms of Patients With Psychiatric Disorders

Psychomotor slowing may occur in major psychiatric disorders, such as major depressive disorders or schizophrenia spectrum disorders. It refers to slowing of fine motor skills, motor planning and gross motor behavior. In major depression and schizophrenia, psychomotor slowing is associated with alterations of premotor cortex, dorsolateral prefrontal cortex and basal ganglia. This randomized, sham-controlled, prospective trial will test, whether 15 sessions of repetitive transcranial magnetic stimulation (rTMS) may ameliorate psychomotor slowing in schizophrenia or major depression.

Psychomotor slowing may occur in major psychiatric disorders, such as major depressive disorders or schizophrenia spectrum disorders. It refers to slowing of fine motor skills, motor planning and gross motor behavior. In major depression and schizophrenia, psychomotor slowing is associated with alterations of premotor cortex, dorsolateral prefrontal cortex and basal ganglia. This randomized, sham-controlled, prospective trial will test, whether 15 sessions of rTMS in 3 weeks may ameliorate psychomotor slowing in schizophrenia or major depression. Eligible participants will be randomized to one of four arms:

Psychomotor Retardation, Psychomotor Slowing, Schizophrenia and Related Disorders, Major Depressive Disorder

repetitive transcranial magnetic stimulation (rTMS) of 15 Hz over left DLPFC usually effective in depression treatment, probably no specific effect on psychomotor slowing

repetitive transcranial magnetic stimulation (rTMS) of 1 Hz over preSMA/SMA should inhibit overactive premotor cortices

intermittend theta burst stimulation (iTBS) over preSMA/SMA should facilitate neural activity within premotor cortices

sham rTMS with a placebo coil over occipital cortex should have no effect at all (no transcranial magnetic stimulation, only sound)

15 Hz stimulation of left dorsolateral prefrontal cortex (DLPFC)(15 sessions/3weeks, 1500 stimuli per session, stimulation intensity 100% of the individual active motor threshold; in total 22500 stimuli

1 Hz stimulation of preSMA/SMA (15 sessions/3weeks, 1500 stimuli per session, stimulation intensity 100% of the individual active motor threshold; in total 22500 stimuli

Three pulses of stimulation at 50 Hz of preSMA/SMA, repeated every 200 ms. 2 s trains are repeated every 10 s for a total of 190 s (600 pulses, 200 seconds). intensity 80% of individual active motor threshold; in total 9000 stimuli

Determination of active motor threshold and subsequent stimulation with the placebo coil, with the same sounds but without effects. 15 sessions in three weeks, duration of 20 mins per session

Number of participants with >30% reduction from baseline in the Salpetriere Retardation Rating Scale, last observation carried forward method applied

observer based rating scale of the severity of psychomotor slowing, assessment blind to intervention Scores may range from 0 - 60, higher scores indicate worse outcome

actigraphically (wrist of the non-dominant arm) assessed motor activity during the wake periods of one day, given in counts/h

observer based rating of catatonia severity with the Bush Francis Catatonia Rating Scale, assessment blind to intervention

Fingertapping test with the dominant and nondominant index finger for 10 sec, video-taped and blind assessment

test of manual dexterity in both hands, rotation of a specified coin for 10 seconds, video-taped and blinded evaluation

videotaped performance of hand gestures according to the Test of Upper Limb Apraxia (TULIA), blind evaluation and rating

scale for the assessment of negative symptoms, applies to schizophrenia spectrum disorder patients, assessment blind to intervention

Hamilton Rating Scale for Depression, 21-item version, applies to depression patients, assessment blind to intervention

the positive and negative syndrome scale, interview to assess severity of schizophrenia symptoms, applies to schizophrenia spectrum disorder patients, assessment blind to intervention

Inclusion Criteria: suffering from major depressive disorder or schizophrenia spectrum disorder according to DSM-5 criteria right handedness normal or corrected-to-normal vision and hearing Exclusion Criteria: epilepsy history of severe head trauma current abuse of drugs or alcohol; past addiction to drugs or alcohol pregnancy incompatibility to cerebral MRI