Centre for Advance Research and Excellence (CARE) in Neuromodulation

Centre for Advance Research and Excellence (CARE) in Neuromodulation

care Project

Schizophrenia is a disorder of the brain that affects thought, perception, reality testing, motor movements and ability to express oneself.  It can affect anyone but occurs commonly in men in their early to mid 20’s and in women in the late 20’s to early 30’s.

The symptoms of Schizophrenia can be categorised into positive, negative and cognitive symptoms, that impacts the overall quality of life of the patient.

Schizophrenia has a variable clinical presentation and the symptoms have broadly been divided into –

  1. Positive symptoms: The symptoms most commonly associated with this disease are positive symptoms marked by the presence of grossly abnormal behaviour, such as presence of hallucinations and delusions.
  2. Negative symptoms: The symptoms less obvious than positive symptoms but equally serious are the negative symptoms, characterised by a lack or a deficit in the ability to socialise or express oneself. Some evidence of these are reduces selfcare, emotional non-responsiveness, decrease in motivation, lack of interest in previously enjoyable activities, inability to get out of bed, etc.
  3. Cognitive symptoms: Diminished ability to think clearly and logically. These symptoms express themselves as difficulty in recalling things, use of nonsensical language, etc.

Medications, especially antipsychotics are often helpful in improving the positive symptoms.  However, the negative symptoms and cognitive symptoms of schizophrenia are often difficult to treat through traditional treatment approaches.

The results from our previous study using traditional TMS intervention for these patients indicated towards the effectiveness of traditional TMS along with medication or negative symptoms of schizophrenia (Sample-100); the findings were published in the journal “Brain Stimulation.”

DOI: 10.1016/j.brs.2020.02.016

The promising results from this study further encouraged the principal investigator Dr. Nand Kumar to conduct the present research in order to test the effectiveness of high frequency iTBS which is shorter in time duration than the traditional TMS intervention.

Therefore, we are currently investigating the efficacy of iTBS as an adjunct to medication for the treatment of negative and cognitive symptoms of schizophrenia, with the hope that it will provide relief to patients as well as their family members.

The intervention is:

  1. Out-patient Procedure
  2. Free of cost
  3. Painless
  4. Non-invasive
  5. Does not require anaesthesia

The intervention has certain limitations to its application in certain individuals and TMS is to be used with caution in patients with history of Seizure, ECT (in the past 1 years), Cardiac pacemakers, or any other MRI incompatible metallic implant in the body, or to those unwilling to give consent for the study.

Before the treatment  

The patient undergoes a screening procedure to assess for symptom severity, presence of any comorbid condition and to determine their eligibility for iTBS intervention.

If the patient meets the criteria, a record file is created and they are asked for written consent to participate in the research project, and a date and time for the first session is set.

A battery of tests are applied to assess for baseline functioning, symptom severity and any associated symptoms of depression.

The patient is seated in a comfortable chair, and the MEP (Motor Evoked Potential) is calculated before the first session.

The technician positions the TMS coil on the patient’s scalp according to the treatment protocol during the session. 

When the session begins, the patient feels tapping sensation on the stimulated area for 5-6 minutes.

Following the session, the patient is observed for about 15 minutes to check for any side effects such as headaches or seizures. 

This procedure is repeated for 15 days. (5 days per week for 3 weeks) 

Following the completion of all sessions, the patient is called once a month for the next six months for follow-up assessments to monitor their progress.