title: Can repetitive magnetic stimulation improve cognition in schizophrenia? Pilot data from a randomized controlled trial.
abstract: BACKGROUND
  Working memory represents a core cognitive domain that is impaired in schizophrenia for which there are currently no satisfactory treatments. Repetitive transcranial magnetic stimulation (rTMS) targeted over the dorsolateral prefrontal cortex has been shown to modulate neurophysiological mechanisms linked to working memory in schizophrenia and improves working memory performance in healthy subjects and might therefore represent a treatment modality for schizophrenia patients. The objectives were to evaluate the effects of rTMS on working memory performance in schizophrenia patients and evaluate whether rTMS normalizes performance to healthy subject levels.
  
  
  METHODS
  In a 4-week randomized double-blind sham-controlled pilot study design, 27 medicated schizophrenia patients were tested at the Centre for Addiction and Mental Health (a university teaching hospital that provides psychiatric care to a large urban catchment area and serves as a tertiary referral center for the province of Ontario). Patients performed the verbal working memory n-back task before and after rTMS magnetic resonance image targeted bilaterally sequentially to left and right dorsolateral prefrontal cortex 750 pulses/side at 20 Hz for 20 treatments. The main outcome measure was mean magnitude of change in the n-back accuracy for target responses with active (n = 13) or sham (n = 12) rTMS treatment course.
  
  
  RESULTS
  The rTMS significantly improved 3-back accuracy for targets compared with placebo sham (Cohen's d = .92). The improvement in 3-back accuracy was also found to be at a level comparable to healthy subjects.
  
  
  CONCLUSIONS
  These pilot data suggest that bilateral rTMS might be a novel, efficacious, and safe treatment for working memory deficits in patients with schizophrenia.
authors.affiliation: Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mera S
authors.initials: MS
authors.lastname: Barr
authors.forename: Faranak
authors.initials: F
authors.lastname: Farzan
authors.forename: Tarek K
authors.initials: TK
authors.lastname: Rajji
authors.forename: Aristotle N
authors.initials: AN
authors.lastname: Voineskos
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blumberger
authors.forename: Tamara
authors.initials: T
authors.lastname: Arenovich
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
authors.forename: Zafiris J
authors.initials: ZJ
authors.lastname: Daskalakis
mesh_terms: D000328:Adult; D003071:Cognition / Q000502:physiology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D055909:Magnetic Field Therapy; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008875:Middle Aged; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012565:Schizophrenic Psychology