The Efficacy of Adjunctives rTMS Over the Right Dorsolateral Prefrontal Cortex on Executive, Cognitive Functions and Psychopathology in Early Onset Schizophrenia

SOURCE: Indian Journal of Psychiatry. Conference: 69th Annual Conference of Indian Psychiatric Society, ANCIPS 2017. Raipur India. 59(Supplement 2) (pp S149), 2017. Date of Publication: January 2017.

AUTHORS: Gaikwad V.; Sinha V.K.

BACKGROUND: Early noninvasive electrical stimulation studies suggested that accentuation of non-dominant dorsolateral prefrontal (DLPFC) cortex activity might prove valuable in symptomatic treatment of refractory neuropsychiatric diseases and improvement of executive functioning via modulation of emotion and affect. This study aimed to test this hypothesis in early onset schizophrenia patients using high frequency noninvasive repetitive trans-cranial magnetic (rTMS) stimulation.

MATERIAL(S) AND METHOD(S): A 2-arm double-blind randomized controlled trial was conducted with 40 patients (20 active & 20 sham group) having early onset schizophrenia who underwent ten sessions (biweekly) of high frequency rTMS stimulation to the right DLPFC. Assessments included Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Symptom Scale (PANSS), Mini Mental State Examination (MMSE), N-Back and Trail making Test A and B (TMT A &B), Wisconsin Card Sorting Test (WCST) at Baseline, after 1st session of rTMS, later at 2nd week (completion of 10 sessions) and 4th week after the last session of rTMS.

RESULT(S): Overall, there was significant reduction in severity of positive symptoms, general psychopathology and total score (PANSSPS {p=.000}, GP {p=.020}, T {p=.000}); depressive symptoms (CDSS {p=.012}); improvement in cognitive (MMSE {p=.000}) and executive functioning (N-Back {p=.001}; TMT A {p=.001} and B {p=.007} and WCST {p=.019}) in the active patient’s v/s sham group.

CONCLUSION(S): Excitatory stimulation of right sided DLPFC using rTMS could induce cortical neural modulation to bring functional and neurochemical changes in frontal lobe to improve negative symptoms, mood, and executive functioning in patients suffering from early onset schizophrenia.