A pilot study to investigate the efficacy and tolerability of lesion network guided transcranial electrical stimulation in outpatients with psychosis spectrum illness

Nicolas Raymond; Robert M G Reinhart; Rebekah Trotti; David Parker; Shrey Grover; Bilge Turkozer; Dean Sabatinelli; Rachal Hegde; Deepthi Bannai; Dung Hoang; Swetha Gandu; Brett Clementz; Matcheri Keshavan; Paulo Lizano

doi:10.1016/j.ajp.2023.103750

A pilot study to investigate the efficacy and tolerability of lesion network guided transcranial electrical stimulation in outpatients with psychosis spectrum illness

Asian J Psychiatr. 2023 Oct:88:103750. doi: 10.1016/j.ajp.2023.103750. Epub 2023 Aug 22.

Authors

Affiliations

¹ Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
² Department of Psychological and Brain Science, Boston University, Boston, MA, USA.
³ Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
⁴ Department of Psychiatry, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital and McLean Hospital, MA, USA.
⁵ Department of Psychology, University of Georgia, Athens, GA, USA.
⁶ Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁷ Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: [email protected].

Abstract

Background: Transcranial electrical stimulation (tES) may improve psychosis symptoms, but few investigations have targeted brain regions causally linked to psychosis symptoms. We implemented a novel montage targeting the extrastriate visual cortex (eVC) previously identified by lesion network mapping in the manifestation of visual hallucinations.

Objective: To determine if lesion network guided High Definition-tES (HD-tES) to the eVC is safe and efficacious in reducing symptoms related to psychosis.

Methods: We conducted a single-blind crossover pilot study (NCT04870710) in patients with psychosis spectrum disorders. Participants first received HD-tDCS (direct current), followed by 4 weeks of wash out, then 2 Hz HD-tACS (alternating current). Participants received 5 days of daily (2×20 min) stimulation bilaterally to the eVC. Primary outcomes included the Positive and Negative Syndrome Scale (PANSS), biological motion task, and Event Related Potentials (ERP) from a steady state visual evoked potential (SSVEP) paradigm. Secondary outcomes included the Montgomery-Asperg Depression Rating Scale, Global Assessment of Functioning (GAF), velocity discrimination and visual working memory task, and emotional ERP.

Results: HD-tDCS improved PANSS general psychopathology in the short-term (d=0.47; p_fdr=0.03), with long-term improvements in general psychopathology (d=0.62; p_fdr=0.05) and GAF (d=-0.56; p_fdr=0.04) with HD-tACS. HD-tDCS reduced SSVEP P1 (d=0.25; p_fdr=0.005), which correlated with general psychopathology (β = 0.274, t = 3.59, p = 0.04). No significant differences in safety or tolerability measures were identified.

Conclusion: Lesion network guided HD-tES to the eVC is a safe, efficacious, and promising approach for reducing general psychopathology via changes in neuroplasticity. These results highlight the need for larger clinical trials implementing novel targeting methodologies for the treatments of psychosis.

Keywords: Lesion Network Mapping; Positive Symptoms; Transcranial Electrical Stimulation.

Publication types

Clinical Study

MeSH terms

Cross-Over Studies
Evoked Potentials, Visual
Humans
Memory, Short-Term / physiology
Outpatients
Pilot Projects
Psychotic Disorders* / therapy
Single-Blind Method
Transcranial Direct Current Stimulation* / methods

Abstract

Publication types

MeSH terms

Grants and funding