BRIEF COMMUNICATION
Cognitive effects of bilateral high frequency repetitive transcranial
magnetic stimulation in early phase psychosis: a pilot study
Michael M. Francis
1,2
&
Tom A. Hummer
1
&
Jenifer L. Vohs
1,2
&
Matthew G. Yung
1
&
Andrew C. Visco
1,2
&
Nikki F. Mehdiyoun
1,2
&
Teresa C. Kulig
1,2
&
Miji Um
3
&
Ziyi Yang
4
&
Mehrdad Motamed
4
&
Emily Liffick
1,2
&
Ying Zhang
4
&
Alan Breier
1,2
#
Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
Cognitive dysfunction is a core facet of schizophrenia that is present early in the course of the illness and contributes to
diminished functioning and outcomes. Repetitive transcranial magnetic stimulation (rTMS) is a relatively new neuropsychiatric
intervention. Initially used in treatment resistant depression, investigators are now studying rTMS for other psychiatric diseases
such as schizophrenia. In this study we examined the effect of high frequency rTMS on cognitive function in a group of
individuals with early phase psychosis. Twenty subjects were randomized (1:1) in double-blind fashion to rTMS or sham
condition. Over two weeks subjects underwent ten sessions of high frequency, bilateral, sequential rTMS targeting the dorsolat-
eral prefrontal cortex (DLPFC). Prior to beginning and following completion of study treatment, subjects completed a cognitive
assessment and magnetic resonance imaging. Subjects receiving rTMS, compared to sham treatment, displayed improvement on
a standardized cognitive battery both immediately following the course of study treatment and at follow-up two weeks later.
Imaging results revealed that left frontal cortical thickness at baseline was correlated with treatment response. The study treatment
was found to be safe and well tolerated. These results suggest that rTMS may hold promise for the treatment of cognitive
dysfunction in the early phase of psychosis, and that MRI may provide biomarkers predicting response to the treatment.
Keywords rTMS
.
Early phase psychosis
.
Schizophrenia
.
MRI
.
Cognition
Background
Cognitive dysfunction is a core facet of schizophrenia
(Galderisi et al. 2009) that is present early in the course of
the illness and contributes to profound social and vocational
impairments and overall poor outcomes (Harvey et al. 2001;
Sponheim et al. 2010). Currently available interventions for
schizophrenia have not shown consistent efficacy in amelio-
rating cognitive deficits associated with the illness (Green et
al. 2004). Clearly there is a significant need for therapeutic
agents that are efficacious for cognitive impairment in schizo-
phrenia, an effect which could result in significantly improved
long-term functioning and outcomes (Harvey et al. 2001).
Repetitive transcranial magnetic stimulation (rTMS) is a
non-invasive intervention that applies a repetitively pulsed
magnetic field over the scalp to induce an electric field within
a discrete area of the brain. This electric field modulates ion
flow across the neuronal cellular membrane with resultant
changes in neuronal polarization. The end result is altered
neuronal activity in the area where the rTMS is applied
(Baker and Freeston 1985). Additionally, it has been proposed
that effects of rTMS maintained after the treatment period may
result from treatment-induced changes in synaptic plasticity,
with long-term potentiation or depression of synaptic strength
being related to factors such as treatment duration or
* Michael M. Francis
mmfranci@iupui.edu
1
Department of Psychiatry, Indiana University School of Medicine,
355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA
2
Prevention and Recovery Center for Early Psychosis, Eskenazi
Health Midtown Community Mental Health Center, 720 Eskenazi
Avenue, Outpatient Care Center, Lower Level,
Indianapolis, IN 46202, USA
3
Department of Psychology, Indiana University-Purdue University
Indianapolis, 402 N. Blackford St, Indianapolis, IN 46202, USA
4
Department of Biostatistics, Richard M. Fairbanks School of Public
Health, Indiana University, 410 W. Tenth St., Suite 3000,
Indianapolis, IN 46202, USA
Brain Imaging and Behavior
https://doi.org/10.1007/s11682-018-9902-4
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