1 Hz rTMS over the right prefrontal cortex reduces vigilant attention to unmasked but not to masked fearful faces

Background: Recent repetitive transcranial magnetic stimulation (rTMS) research in healthy subjects suggests that the emotions anger and anxiety are lateralized in the prefrontal cortex. Low-frequency rTMS over the right prefrontal cortex (PFC) shifts the anterior asymmetry in brain activation to the left hemisphere and reduces anxiety. The same rTMS technique results in enhanced anger-related emotional processing, observed as elevations in attention for angry faces. The current study used low-frequency rTMS over the right PFC and indexed selective attention to fearful faces, hypothesizing a reduction in attention for fearful faces, i.e., a reversal of the latter effect. Methods: In a placebo-controlled design, 1 Hz rTMS at 130% of the individual motor threshold (MT) was applied continuously over the right PFC of eight healthy subjects for 20 minutes. Effects on motivated attention were investigated by means of an emotional Stroop task, indexing selective attention to masked and unmasked fearful faces. Results: Vigilant attention for masked and unmasked fearful faces was observed after placebo stimulation. As hypothesized, rTMS reduced the vigilant emotional response to the fearful face, but only in the unmasked task. Conclusions: These data provide further support for the lateralization of the emotions anger and anxiety in the prefrontal cortex. In addition, the absence of an effect for masked fearful faces suggests that changes in emotional processing after a single session of rTMS predominantly involve the cortical affective pathways. (C) 2002 Society of Biological Psychiatry.