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BioMed Research International
Volume 2014, Article ID 542526, 12 pages
Clinical Study

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

1Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr 14, 72076 Tuebingen, Germany
2Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany
3Department of Clinical Psychology and Psychotherapy, Universitaetsstr 31, 93053 Regensburg, Germany
4kbo-Inn-Salzach-Hospital, Gabersee 7, 83512 Wasserburg am Inn, Germany
5Graduate School LEAD, University of Tuebingen, Europastr. 6, 72072 Tuebingen, Germany
6Cluster of Excellence CIN, University of Tuebingen, Otfried-Mueller-Str. 25, 72076 Tuebingen, Germany

Received 4 October 2013; Revised 10 January 2014; Accepted 11 January 2014; Published 18 March 2014

Academic Editor: Qiyong Gong

Copyright © 2014 Saskia Deppermann et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. 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. Conclusion. 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.