Does rTMS alter neurocognitive functioning in patients with panic disorder/agoraphobia? An fNIRS-based investigation of prefrontal activation during a cognitive task and its modulation via sham-controlled rTMS.
OBJECTIVE
Neurobiologically, panic disorder (PD) is supposed to be characterised by cerebral hypofrontality. Via functional near-infrared spectroscopy (fNIRS), we investigated whether prefrontal hypoactivity during cognitive tasks in PD-patients compared to healthy controls (HC) could be replicated. As intermittent theta burst stimulation (iTBS) modulates cortical activity, we furthermore investigated its ability to normalise prefrontal activation.


METHODS
Forty-four PD-patients, randomised to sham or verum group, received 15 iTBS-sessions above the left dorsolateral prefrontal cortex (DLPFC) in addition to psychoeducation. Before first and after last iTBS-treatment, cortical activity during a verbal fluency task was assessed via fNIRS and compared to the results of 23 HC.


RESULTS
At baseline, PD-patients showed hypofrontality including the DLPFC, which differed significantly from activation patterns of HC. However, verum iTBS did not augment prefrontal fNIRS activation. Solely after sham iTBS, a significant increase of measured fNIRS activation in the left inferior frontal gyrus (IFG) during the phonological task was found.


CONCLUSIONS
Our results support findings that PD is characterised by prefrontal hypoactivation during cognitive performance. However, verum iTBS as an "add-on" to psychoeducation did not augment prefrontal activity. Instead we only found increased fNIRS activation in the left IFG after sham iTBS application. Possible reasons including task-related psychophysiological arousal are discussed.
Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr 14, 72076 Tuebingen, Germany.
Saskia
0000-0002-0416-4534
S
Deppermann
Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
Nadja
0000-0002-9843-4936
N
Vennewald
Department of Clinical Psychology and Psychotherapy, Universitaetsstr 31, 93053 Regensburg, Germany.
Julia
0000-0002-5787-971X
J
Diemer
Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr 14, 72076 Tuebingen, Germany.
Stephanie
S
Sickinger
Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr 14, 72076 Tuebingen, Germany.
Florian B
FB
Haeussinger
Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
Swantje
0000-0001-8957-8578
S
Notzon
Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
Inga
I
Laeger
Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
Volker
V
Arolt
Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr 14, 72076 Tuebingen, Germany.
Ann-Christine
0000-0002-8142-9743
AC
Ehlis
Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany ; kbo-Inn-Salzach-Hospital, Gabersee 7, 83512 Wasserburg am Inn, Germany.
Peter
P
Zwanzger
Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr 14, 72076 Tuebingen, Germany ; Graduate School LEAD, University of Tuebingen, Europastr. 6, 72072 Tuebingen, Germany ; Cluster of Excellence CIN, University of Tuebingen, Otfried-Mueller-Str. 25, 72076 Tuebingen, Germany.
Andreas J
AJ
Fallgatter
D000293:Adolescent; D000328:Adult; D000368:Aged; D000379:Agoraphobia / Q000473:pathology / Q000503:physiopathology*; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D016584:Panic Disorder / Q000473:pathology / Q000503:physiopathology*; D017397:Prefrontal Cortex / Q000473:pathology / Q000503:physiopathology*