Neural plasticity in schizophrenia: an integrated approach for rehabilitation by means of TMS and cognitive remediation training

Schizophrenia is a severe and disabling psychiatric disorder probably based on complex pathophysiological mechanisms of reduced inhibition, impaired connectivity and reduced plasticity in neural networks. Beside clinical symptomatology, a core feature of schizophrenia is a global cognitive and social disability, which strongly affect patients’ lives and their quality of life. The cognitive impairment involves memory, attention, executive functions, language, facial emotion recognition and theory of mind abilities. Cognitive remediation strategies, in addition to pharmacological and psychological treatments, has received increasing attention in recent years , as well as the use of non-invasive brain stimulation techniques such as TMS, which have demonstrated promising therapeutic potential. In order to evaluate the efficacy of TMS to induce improvements in cognitive functioning in schizophrenia, 16 patients were submitted to effective or sham iTBS over the left dorsolateral prefrontal cortex during 3 consecutive weeks. In half of patients the neuromodulation was combined with daily cognitive remediation training (Cogpack software), administered immediately after the application of TMS. Clinical, cognitive and social functioning were tested at baseline and at different timepoints after conclusion of the rehabilitation protocol (immediately after the 3 weeks protocol, and after 1, 3 and 6 months). The preliminary results indicate that the proposed TMS protocol induced significant improvements in global cognition, in particular in the domains subserved by the prefrontal cortex and the interconnected regions. In addition, patients submitted to TMS showed major benefits after 1 month from brain stimulation, suggesting that TMS induced long-lasting plastic changes.