Schizophrenia Clinical Trial
Official title:
The Effects of Bimodal Anodal Transcranial Direct Current Stimulation Over Bilateral Prefrontal Cortex on Illness Severity, Insight, Functional Outcomes, Quality of Life, Neurocognition and Heart Rate Variability (HRV) in Schizophrenia
The study aimed to investigate the effects of bimodal anodal transcranial direct current stimulation (tDCS) over bilateral dorsolateral prefrontal cortex (DLPFC) on psychopathological symptoms, insight, psychosocial functioning, neurocognitive function and heart rate variability (HRV) in schizophrenia patients
Transcranial direct current stimulation encompasses the induction of a relatively weak
constant current flow through the cerebral cortex via scalp electrodes . Dependent on
stimulation polarity, this results in a modulation of cortical excitability and spontaneous
neural activity.The technique was established in the 1950s and 1960s primarily in animals. In
these early studies it was shown that subthreshold DC stimulation increases spontaneous
neuronal activity if the anode is placed above or within the cortex, while exposure to
cathodal polarity results in reduced activity. This is caused by a subthreshold membrane
depolarization by anodal and a hyperpolarization by cathodal stimulation. It was demonstrated
in humans that the after-effects of tDCS depend on modifications of N-methyl-D-aspartate
(NMDA) receptor-efficacy. The after-effects of tDCS are blocked by the NMDA receptor
antagonist dextromethorphan, and prolonged by the partial NMDA receptor-agonist
D-cycloserine. This tDCS polarity-dependent alteration of NMDA receptor function seems to be
initiated by the respective membrane potential shift and probably by the accompanying
cortical activity modification,because it is prevented by the sodium channel blocker
carbamazepine. Intraneuronal calcium concentration also contributes, because calcium channel
antagonists eliminate the excitability-enhancing after-effects of anodal tDCS. Recently,
unimodal anodal tDCS over left dorsolateral prefrontal cortex (DLPFC) has been found to
improve psychopathological symptoms, cognitive deficits and insight of schizophrenia and also
strengthen cardiac autonomic function in healthy subjects. Further studies using bimodal
anodal tDCS over bilateral dorsolateral prefrontal cortex (DLPFC) and prefrontal cortex are
needed.
Study design: randomized double-blind, sham-controlled study design.
Participants: 60 patients having a diagnosis of schizophrenia or schizoaffective were
randomly allocated to receive 20 minutes of active 2-mA tDCS or sham stimulation twice a day
on 5 consecutive weekdays. These participants were assessed at baseline, after intervention
and in a three-months follow-up.
Active or sham stimulation: The present study used bimodal anodal tDCS over bilateral
dorsolateral prefrontal cortex (DLPFC) and prefrontal cortex. One anode was placed with the
middle of the electrode over a point midway between International 10-20 electrode positions
F3 and Fp1 (left dorsolateral prefrontal cortex and left prefrontal cortex). The other was
located over a point midway between F4 and Fp2 (right dorsolateral prefrontal cortex and left
prefrontal cortex). An extracephalic positions were used for the reference electrodes
(cathodes) in order to avoid confounding effects from inhibitory cathodal effects at other
cortical sites. The reference electrodes were placed on bilateral forearms.
Others: see Arms and Interventions, Eligibility Criteria or Outcome Measures.
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