Journal of Neural Transmission

, Volume 126, Issue 2, pp 183–191 | Cite as

Repetitive transcranial magnetic stimulation for treatment of tardive syndromes: double randomized clinical trial

  • Eman M. KhedrEmail author
  • Bastawy Al Fawal
  • Ahmed Abdelwarith
  • Mostafa Saber
  • John C. Rothwell
Psychiatry and Preclinical Psychiatric Studies - Original Article


Tardive syndromes (TDS) typically manifest 3 months or later after exposure to antipsychotic drugs, and unfortunately have no satisfactory medical treatment. We explored the possibility of using therapeutic repetitive transcranial magnetic stimulation (rTMS). Twenty-six patients were allocated to receive real or sham rTMS over the hand/arm area of motor cortex (M1). Each received a daily total of 2000 rTMS pulses (20 Hz at 100% rMT: 1000 stimuli per hemisphere) for 10 consecutive days. Outcome was assessed using the Abnormal Involuntary Movement Scale (AIMS) and TMS measures of M1 excitability. Three patients in the sham group failed to complete the study. At baseline, there was no significant difference between the groups in age, sex distribution, duration of illness, AIMS score and drug treatment. rTMS improved symptoms in both groups. However, there was a greater reduction in the AIMS score of the real rTMS group compared with the sham group (real, 8.3 ± 1.7 points; sham 1.2 ± 3.3; repeated measure analysis ANOVA Time X Group interaction P = 0.001). The same trends were observed in the clinical subscales. Following treatment, MEP amplitudes at higher intensities (140, and 150%) increased more in the real treatment group than in the sham group. This is the first clinical trial study of bilateral hemispheric rTMS in patients with TDS and suggests that 20 Hz rTMS might be a feasible treatment option in patients unresponsive to “first-line” treatment.

Clinical trial registration Identifier: NCT03145311.


rTMS Tardive syndromes Tardive dyskinesia Motor threshold Cortical excitability Drug induced extrapyramidal. 


Compliance with ethical standards

Conflict of interest

All authors have no conflict of interests and there was no fund.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Eman M. Khedr
    • 1
    • 2
    Email author
  • Bastawy Al Fawal
    • 2
  • Ahmed Abdelwarith
    • 2
  • Mostafa Saber
    • 2
  • John C. Rothwell
    • 3
  1. 1.Department of Neuropsychiatry, Faculty of Medicine, Assiut University HospitalAssiut UniversityAssuitEgypt
  2. 2.Department of Neuropsychiatry, Faculty of Medicine, Aswan University HospitalAswan UniversityAswanEgypt
  3. 3.Sobell Department of Motor Neuroscience and Movement DisordersNational Hospital for Neurology and NeurosurgeryLondonUK

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