Theta Burst for Cognitive Remediation in Schizophrenia: A Case Series and Feasibility Study.

S chizophrenia is a psychiatric illness with a prevalence of 1.4 to 1.6 per 1000 persons in the United States. Studies show the prevalence of cognitive deficits in patients with schizophrenia, spanning multiple domains, such as working memory, processing speed, and verbal memory. Treatment modalities that have tried to address cognitive deficits in schizophrenia include medications, cognitive remediation, and cognitive behavioral therapy with limited success. The lack of treatments for cognitive deficits has led to the investigation of other possible interventions, such as noninvasive brain stimulation. Systematic reviews have shown that transcranialmagnetic stimulation (TMS) may be efficacious in remediating cognitive deficits in schizophrenia. A recently developed and potentially quite promising form of TMS, called theta burst stimulation (TBS), applies short bursts of TMS (typically 3 pulses) at 50 Hz (within the gamma range of endogenous brain oscillations). These short bursts occur every 200milliseconds, or at 5 Hz, which iswithin the theta oscillation range. Theta burst stimulation is more potent when compared with conventional repetitive TMS. Trials have shown utility for high-frequency TMS in ameliorating positive and negative symptoms in schizophrenia. We recruited 6 patients (4 inpatients and 2 outpatients) to apply one session of excitatory TBS (iTBS) stimulating the left dorsolateral prefrontal cortex (DLPFC), performing Positive and Negative Symptom Scale (PANSS) and Brief Assessment of Cognition in Schizophrenia (BACS) test battery at baseline before stimulation. Three of 6 patients completed iTBS session. Subjects