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Mehta DD, Siddiqui S, Ward HB, Steele VR, Pearlson GD, George TP. Functional and structural effects of repetitive transcranial magnetic stimulation (rTMS) for the treatment of auditory verbal hallucinations in schizophrenia: A systematic review. Schizophr Res 2024; 267:86-98. [PMID: 38531161 DOI: 10.1016/j.schres.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Auditory verbal hallucinations (AVH) are a disabling symptom for people with schizophrenia (SCZ), and do not always respond to antipsychotics. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for medication-refractory AVH, though the underlying neural mechanisms by which rTMS produces these effects remain unclear. This systematic review evaluated the structural and functional impact of rTMS for AVH in SCZ, and its association with clinical outcomes. METHODS A systematic search was conducted in Medline, PsychINFO, and PubMed using terms for four key concepts: AVH, SCZ, rTMS, neuroimaging. Using PRISMA guidelines, 18 studies were identified that collected neuroimaging data of an rTMS intervention for AVH in SCZ. Risk of bias assessments was conducted. RESULTS Low frequency (<5 Hz) rTMS targeting left hemispheric language processing regions may normalize brain abnormalities in AVH patients at structural, functional, electrophysiological, and topological levels, with concurrent symptom improvement. Amelioration of aberrant neural activity in frontotemporal networks associated with speech and auditory processing was commonly observed, as well as in cerebellar and emotion regulation regions. Neuroimaging analyses identified neural substrates with direct correlations to post-rTMS AVH severity, propounding their use as therapeutic targets. DISCUSSION Combined rTMS-neuroimaging highlights the multidimensional alterations of rTMS on brain activity and structure in treatment-resistant AVH, which may be used to develop more efficacious therapies. Larger randomized, sham-controlled studies are needed. Future studies should explore alternate stimulation targets, investigate the neural effects of high-frequency rTMS and evaluate long-term neuroimaging outcomes.
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Affiliation(s)
- Dhvani D Mehta
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Salsabil Siddiqui
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Heather B Ward
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Vaughn R Steele
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Godfrey D Pearlson
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Tony P George
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
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Guan M, Xie Y, Li C, Zhang T, Ma C, Wang Z, Ma Z, Wang H, Fang P. Rich-club reorganization of white matter structural network in schizophrenia patients with auditory verbal hallucinations following 1 Hz rTMS treatment. Neuroimage Clin 2023; 40:103546. [PMID: 37988997 PMCID: PMC10701084 DOI: 10.1016/j.nicl.2023.103546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
The human brain comprises a large-scale structural network of regions and interregional pathways, including a selectively defined set of highly central and interconnected hub regions, often referred to as the "rich club", which may play a pivotal role in the integrative processes of the brain. A quintessential symptom of schizophrenia, auditory verbal hallucinations (AVH) have shown a decrease in severity following low-frequency repetitive transcranial magnetic stimulation (rTMS). However, the underlying mechanism of rTMS in treating AVH remains elusive. This study investigated the effect of low-frequency rTMS on the rich-club organization within the brain in patients diagnosed with schizophrenia who experience AVH using diffusion tensor imaging data. Through by constructing structural connectivity networks, we identified several critical rich hub nodes, which constituted a rich-club subnetwork, predominantly located in the prefrontal cortices. Notably, our findings revealed enhanced connection strength and density within the rich-club subnetwork following rTMS treatment. Furthermore, we found that the decreased connectivity within the subnetwork components, including the rich-club subnetwork, was notably enhanced in patients following rTMS treatment. In particular, the increased connectivity strength of the right median superior frontal gyrus, which functions as a critical local bridge, with the right postcentral gyrus exhibited a significant correlation with improvements in both positive symptoms and AVH. These findings provide valuable insights into the role of rTMS in inducing reorganizational changes within the rich-club structural network in schizophrenia and shed light on potential mechanisms through which rTMS may alleviate AVH.
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Affiliation(s)
- Muzhen Guan
- Department of Mental Health, Xi'an Medical College, Xi'an, China.
| | - Yuanjun Xie
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China; Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Chenxi Li
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Tian Zhang
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Chaozong Ma
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Zhongheng Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhujing Ma
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Peng Fang
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China.
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Gao Z, Xiao Y, Zhu F, Tao B, Yu W, Lui S. The whole-brain connectome landscape in patients with schizophrenia: a systematic review and meta-analysis of graph theoretical characteristics. Neurosci Biobehav Rev 2023; 148:105144. [PMID: 36990373 DOI: 10.1016/j.neubiorev.2023.105144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
The alterations of connectome in schizophrenia have been reported, but the results remain inconsistent. We conducted a systematic review and random-effects meta-analysis on structural or functional connectome MRI studies comparing global graph theoretical characteristics between schizophrenia and healthy controls. Meta-regression and subgroup analyses were performed to examine confounding effects. Based on the included 48 studies, Structural connectome in schizophrenia showed a significant decrease in segregation (lower clustering coefficient and local efficiency, Hedge's g= -0.352 and -0.864, respectively) and integration (higher characteristic path length and lower global efficiency, Hedge's g= 0.532 and -0.577 respectively). The functional connectome showed no difference between groups except γ. Moderator analysis indicated that clinical and methodological factors exerted a potential effect on the graph theoretical characteristics. Our analysis revealed a weaker small-worldization trend in structural connectome of schizophrenia. For the relatively unchanged functional connectome, more homogenous and high-quality studies are warranted to elucidate whether the change was blurred by heterogeneity or the presentation of pathophysiological reconfiguration.
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Xie Y, Guan M, He Y, Wang Z, Ma Z, Fang P, Wang H. The Static and dynamic functional connectivity characteristics of the left temporoparietal junction region in schizophrenia patients with auditory verbal hallucinations during low-frequency rTMS treatment. Front Psychiatry 2023; 14:1071769. [PMID: 36761865 PMCID: PMC9907463 DOI: 10.3389/fpsyt.2023.1071769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVH) are a core symptom of schizophrenia. Low-frequency (e.g., 1 Hz) repetitive transcranial magnetic stimulation (rTMS) targeting language processing regions (e.g., left TPJ) has been evident as a potential treatment for AVH. However, the underlying neural mechanisms of the rTMS treatment effect remain unclear. The present study aimed to investigate the effects of 1 Hz rTMS on functional connectivity (FC) of the temporoparietal junction area (TPJ) seed with the whole brain in schizophrenia patients with AVH. METHODS Using a single-blind placebo-controlled randomized clinical trial, 55 patients with AVH were randomly divided into active treatment group (n = 30) or placebo group (n = 25). The active treatment group receive 15-day 1 Hz rTMS stimulation to the left TPJ, whereas the placebo group received sham rTMS stimulation to the same site. Resting-state fMRI scans and clinical measures were acquired for all patients before and after treatment. The seed-based (left TPJ) static and DFC was used to assess the connectivity characteristics during rTMS treatment in patients with AVH. RESULTS Overall, symptom improvement following 1 Hz rTMS treatment was found in the active treatment group, whereas no change occurred in the placebo group. Moreover, decreased static FC (SFC) of the left TPJ with the right temporal lobes, as well as increased SFC with the prefrontal cortex and subcortical structure were observed in active rTMS group. Increased dynamic FC (DFC) of the left TPJ with frontoparietal areas was also found in the active rTMS group. However, seed-based SFC and DFC were reduced to a great extent in the placebo group. In addition, these changed FC (SFC) strengths in the active rTMS group were associated with reduced severity of clinical outcomes (e.g., positive symptoms). CONCLUSION The application of 1 Hz rTMS over the left TPJ may affect connectivity characteristics of the targeted region and contribute to clinical improvement, which shed light on the therapeutic effect of rTMS on schizophrenia with AVH.
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Affiliation(s)
- Yuanjun Xie
- School of Education, Xinyang College, Xinyang, China.,Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Muzhen Guan
- Department of Mental Health, Xi'an Medical University, Xi'an, China
| | - Ying He
- Department of Psychiatry, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Zhongheng Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhujing Ma
- Department of Clinical Psychology, Fourth Military Medical University, Xi'an, China
| | - Peng Fang
- Department of Military Medical Psychology, Fourth Military Medical University, Xi'an, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Wu Y, Yang Z, Cui S. Update Research Advances in the Application of Transcranial Magnetic Stimulation in the Treatment of Schizophrenia. SCANNING 2022; 2022:5415775. [PMID: 36160325 PMCID: PMC9484979 DOI: 10.1155/2022/5415775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
Schizophrenia presents a chronic progressive course and requires long-term treatment. The current treatment of schizophrenia is mainly based on antipsychotic drugs, but drugs are ineffective for the negative symptoms and cognitive dysfunction of schizophrenia, and long-term medication may increase the burden on the endocrine and circulatory systems of patients. Repetitive transcranial magnetic stimulation is a noninvasive, painless, safe, efficacious, and economical physical therapy measure that has achieved good results in the treatment of schizophrenia. This paper reviews the progress of research on the clinical application of transcranial magnetic stimulation in the treatment of schizophrenia.
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Affiliation(s)
- Yanhai Wu
- The Third People's Hospital of Fuyang, Fuyang 236000, China
| | - Zucheng Yang
- Anhui Province Veterans Hospital, Bengbu 233000, China
| | - Shu Cui
- The Third People's Hospital of Fuyang, Fuyang 236000, China
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