Schizophrenia Clinical Trial
Official title:
Treating Working Memory Deficits in Patients With Schizophrenia Using Repetitive Transcranial Magnetic Stimulation (rTMS)
Deficits in working memory (WM) performance are the most significant cognitive impairments
in schizophrenia (SCZ). It has also been shown that WM performance is contingent on the
cortex synchronization, a process that relies on brain inhibition. Repetitive Transcranial
Magnetic Stimulation (rTMS) has been demonstrated as an effective treatment for patients
with SCZ and has been shown to increase brain inhibition and improve cognitive performance.
In this study the investigators intend to:
- evaluate rTMS as a treatment for WM deficits in SCZ
- evaluate rTMS as a method to increase WM performance in healthy individuals
- determine if improvements in WM performance are related to enhanced synchronization of
brain networks
- determine whether genetic polymorphisms predict cortical function and treatment
response
- evaluate the influence of rTMS treatment on brain structure.
To directly investigate whether enhanced gamma synchrony mediates rTMS enhancement of WM in
patients with SCZ, and in healthy individuals the investigators propose the following study.
The relationship between the improvements in WM performance and increased gamma synchrony
following rTMS over the DLPFC will be investigated. Moreover, using statistical models, the
investigators will further examine whether increased gamma synchrony mediates WM improvement
in these patients. Therefore, in this study the investigators hope to clarify the
neurophysiological mechanisms through which rTMS exerts its therapeutic effects on WM
performance and develop rTMS as a novel therapeutic tool to enhance the treatment options
available for one of the core cognitive deficits in this disorder.
There is considerable evidence to support the fact that WM deficits in schizophrenia are
heritable and have a strong genetic component. This evidence emerges from genetic
association studies, and studies demonstrating that unaffected relatives of schizophrenia
patients also suffer WM deficits. Therefore, treatment response to rTMS may be at least
partly contingent on genetic variation within each individual. In particular, GABAergic
genes that code for GABAergic proteins which largely determine cortical inhibition may play
a key role in treatment response to rTMS over the DLPFC. However, several other gene systems
that interact with the GABAergic system may also play a role, and would also merit
investigation. Similarly brain structure may also determine treatment response. For
instance, volume or thickness of the DLPFC and DLPFC related circuitry has been shown to
play a role in WM performance, and therefore, may be a biomarker of treatment response.
Objective 1: To improve WM in patients with SCZ, and in healthy individuals using rTMS.
Hypothesis 1:20 Hz rTMS over the DLPFC will be superior to sham stimulation in improving WM
performance in patients with SCZ, and healthy individuals.
Objective 2: To evaluate if high frequency rTMS results in enhanced gamma synchrony SCZ and
healthy individuals.
Hypothesis 2: 20 Hz rTMS over the DLPRC will be superior to sham stimulation at increasing
gamma synchrony in patients with SCZ, and healthy individuals.
Objective 3: To determine if the rTMS induced increase in gamma band synchrony mediates the
therapeutic effects of rTMS on WM performance in patients with SCZ and healthy individuals.
Hypothesis 3: Increased gamma band synchrony will be shown to mediate the therapeutic
effects of rTMS on WM performance in SCZ and healthy individuals.
Objective 4: To test whether key polymorphisms in the GABAergic system, and related gene
systems determine γ oscillatory activity and WM improvement following rTMS.
Hypothesis 4: GABAergic gene and related gene polymorphisms will determine variation in γ
oscillatory activity and WM performance following rTMS treatment.
Objective 5: To examine whether brain structure is a biomarker of treatment response to rTMS
Hypothesis 5: Increase in cortical thickness at DLPFC and in microstructural integrity in
cortico-cortical white matter tracts connecting to DLPFC will correlate with n-back task
performance after rTMS treatment.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment
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