Left Dorsolateral Prefrontal Cortex Anodal tDCS Effects on Negative Symptoms in Schizophrenia

Cognitive functions maintained stable (20 at baseline and 24 at the final outcome) as assessed by MOCA, with improvement on memory tasks. MDD symptoms substantially improved during the 10day treatment course and remained stable after three months follow-up, and the patient reported significant global clinical gains (see the Fig. 1). The patient was followed on a monthly basis and no risk issues were observed, such as gestational diabetes or hypertension. Caesarean section was performed opted by the gynecology and obstetrics team due to be considered high-risk pregnancy because of the MDD treatment. No complications during child-birth occurred. The neonate was a healthy full-term, 8 pounds newborn, with APGAR 10/10 and no malformations. The TNS protocol is based on a “bottom up” mechanism [7]. The electric stimuli follows the peripheral nerves pathway through central structures [7] such as the amygdala and the hippocampus, toward higher cortical area such as the dorsolateral prefrontal cortex, previously demonstrated to be involved in MDDwith symptoms amelioration when stimulated with other neuromodulation techniques [8]. Data on the use of cranial nerve stimulation for MDD during pregnancy is scant. In fact, TNS was not evaluated before. Only one case of vagus nerve stimulation (VNS) for the treatment of MDD in pregnancy was performedwith no safety issues [9]. Safety evaluation on the use of VNS in an animal model (pilot study of the teratogenicity) was performed with 10 rabbits with no safety issues reported [10]. We present the first report using TNS in a pregnant patient with successful amelioration of MDD symptoms and no considerable side effects to the newborn. TNS is a focused electrical stimulation technique without likely electric stimulation propagation to the fetus. Our findings are based on a case study, thus having limited generalizability. Nonetheless, these encouraging results should be seen as hypothesis-driven for further controlled, randomized trials exploring the safety and impact of TNS in the treatment of MDD in pregnancy.