High-frequency neuronavigated rTMS effect on clinical symptoms and cognitive dysfunction: a pilot double-blind, randomized controlled study in Veterans with schizophrenia

Abstract

Cognitive impairment is a central aspect of schizophrenia (SCZ) that occurs at the onset of the disease and is related to poor social function and outcome in patients with SCZ. Recent literatures have revealed repetitive transcranial magnetic stimulation (rTMS) to be one of the efficient medical interventions for cognitive impairments. However, no study has been conducted to investigate the treatment effectiveness of 20 Hz rTMS with neuronavigation system administered to the left dorsolateral prefrontal cortex (DLPFC) in patients with schizophrenia. In this randomized, double-blind and sham-controlled study, 56 patients were enrolled in 20 Hz rTMS (n = 28) or sham stimulation (n = 28) over left DLPFC for 8 weeks. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was performed to measure the cognitive function at baseline and after 8 weeks of rTMS treatment. The positive and negative syndrome scales (PANSS) was performed to assess the clinical symptoms at baseline, after 2-week treatment, 4-week treatment, 6-week treatment, and 8-week treatment. Totally, 15 subjects (seven in active group and eight in sham group) dropped out during the trial and the main findings were from completed 41 patients. At 2 weeks, 4 weeks, and 6 weeks, there were no significant differences in PANSS total score and subscores between the sham and treatment groups. At 8 weeks, the 20 Hz rTMS significantly increased the immediate memory score compared with the sham. Furthermore, the improvement in the immediate memory score was correlated with the decrease in the excitement factor score of the patients with SCZ. Our results suggest that 20 Hz rTMS appears to be an effective treatment for improving the cognitive performance and reducing the clinical symptoms of patients with SCZ.

Recent Advances and Future Directions in Brain MR Imaging Studies in Schizophrenia: Toward Elucidating Brain Pathology and Developing Clinical Tools

“…93,94 Furthermore, in recent years, the therapeutic potential of TMS for schizophrenia has also been investigated in academic centers. Although a number of clinical trials indicated moderate therapeutic effect for this disorder, 95,96 its clinical efficacy remains controversial yet. 97,98 Moreover, the neurobiological mechanisms of action remain unclear.…”

Sex differences in association between cognitive impairment and clinical correlates in Chinese patients with first-episode drug-naïve schizophrenia

“…The shared and contradictory ndings of these studies show the sex differences in cognitive impairment of patients with rst-episode drug-naïve schizophrenia to worthy of further study. There are many explanations for these differences, most of which are related to genetic susceptibility and neurodevelopment, or bio-psycho-social factors [19][20][21][22]. In addition, culture may also play an important role in sex differences in schizophrenia [2,23,24].…”

Effects of High-Frequency rTMS on Negative Symptoms and Cognitive Function in Hospitalized Patients With Chronic Schizophrenia: A Double-Blind, Sham-Controlled Pilot Trial

“…An early study found that both 10 and 20 Hz rTMS improved memory in patients with schizophrenia, while another study found that both 10 and 20 Hz rTMS had delayed effects on cognitive function at the 6-month follow-up (55). Guan et al also found the effectiveness of high-frequency rTMS stimulation in improving the cognitive function of patients with schizophrenia (56). A recent meta-analysis also found that 10 Hz rTMS over the DLPFC significantly improved all indicators of working memory performance, including reaction time and accuracy (57).…”