High frequency repetitive transcranial magnetic stimulation of dorsomedial prefrontal cortex for negative symptoms in patients with schizophrenia: A double-blind, randomized controlled trial

Gan, Hong; Zhu, Jun‐Juan; Zhuo, Kaiming; Zhang, Jianye; Tang, Yingying; Qian, Zhenying; Xiang, Qiong; Li, Xuan; Zhu, Yongjun; Wang, Jinhong; Wang, Jijun; Liu, Dengtang

doi:10.1016/j.psychres.2021.113876

Cited by 18 publications

(23 citation statements)

References 49 publications

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“…rTMS is a safe and non-invasive brain stimulation techniques for stimulating specific cortical regions and modulating neuronal activity ( 5 ). During the last decades, a great number of studies have demonstrated encouraging results about the utility of rTMS in neuropsychiatry ( 6 – 9 ). And the U.S. Food and Drug Administration has approved the rTMS applied over the dorsolateral prefrontal cortex (DLPFC) for MDD in 2008.…”

Section: Introductionmentioning

confidence: 99%

Increased Prefrontal Activation During Verbal Fluency Task After Repetitive Transcranial Magnetic Stimulation Treatment in Depression: A Functional Near-Infrared Spectroscopy Study

Huang

Zhang

et al. 2022

Front. Psychiatry

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BackgroundPrevious studies have shown the clinical effect of 2 Hz repetitive transcranial magnetic stimulation (rTMS) for depression; however, its underlying neural mechanisms are poorly understood. The aim of this study was to examine the effects of rTMS on the activity of the prefrontal cortex in patients with depression, using functional near-infrared spectroscopy (fNIRS).MethodsForty patients with major depressive disorder (MDD) and 40 healthy controls were enrolled in this study. Patients underwent 4 weeks of 2 Hz TMS delivered to the right dorsolateral prefrontal cortex (DLPFC). fNIRS was used to measure the changes in the concentration of oxygenated hemoglobin ([oxy-Hb]) in the prefrontal cortex during a verbal fluency task (VFT) in depressed patients before and after rTMS treatment. The severity of depression was assessed using the Hamilton Rating Scale for Depression-24 item (HAMD-24).ResultsPrior to rTMS, depressed patients exhibited significantly smaller [oxy-Hb] values in the bilateral prefrontal cortex during the VFT compared with the healthy controls. After 4 weeks of 2 Hz right DLPFC rTMS treatment, increased [oxy-Hb] values in the bilateral frontopolar prefrontal cortex (FPPFC), ventrolateral prefrontal cortex (VLPFC) and left DLPFC during the VFT were observed in depressed patients. The increased [oxy-Hb] values from baseline to post-treatment in the right VLPFC in depressed patients were positively related to the reduction of HAMD score following rTMS.ConclusionThese findings suggest that the function of the prefrontal cortex in depressed patients was impaired and could be recovered by 2 Hz rTMS. The fNIRS-measured prefrontal activation during a cognitive task is a potential biomarker for monitoring depressed patients’ treatment response to rTMS.

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Section: Introductionmentioning

confidence: 99%

Increased Prefrontal Activation During Verbal Fluency Task After Repetitive Transcranial Magnetic Stimulation Treatment in Depression: A Functional Near-Infrared Spectroscopy Study

Huang

Zhang

et al. 2022

Front. Psychiatry

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“…For instance, investigating new target of stimulation, the effects of targeting the dorsomedial prefrontal cortex bilaterally with HF-rTMS (10 Hz) were recently studied in an MRI-guided randomized-controlled trial including 15 patients who received active stimulation and 14 who received sham stimulation [15 ▪▪ ]. Targeting the dorsomedial prefrontal cortex was made possible by the use of a butterfly coil that consists of two large circular coils forming an obtuse angle and allows deeper brain targets to be reached.…”

Section: Recent Evidences For Clinical Efficacy Of Repetitive Transcr...mentioning

confidence: 99%

Recent advances in noninvasive brain stimulation for schizophrenia

Adam

Mondino

2022

Current Opinion in Psychiatry

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Purpose of reviewNoninvasive brain stimulation has emerged in the last three decades as a promising treatment for patients with antipsychotic-resistant symptoms of schizophrenia. This review updates the latest progress in the use of noninvasive brain stimulation to treat schizophrenia symptoms. Recent findingsSeveral recently published randomized-controlled trials support a long-lasting clinical effect of stimulation techniques on schizophrenia symptoms. In addition, efforts have been made in recent months to improve efficacy through several optimization strategies. Studies have tested new parameters of stimulation, such as theta burst stimulation, and alternative cortical or subcortical targets and have reported encouraging results. New forms of electrical stimulations such as alternating and random noise stimulation, have also been studied and have shown clinical and cognitive usefulness for patients. Accelerated stimulation protocols, and prospects could arise with deeper stimulation strategies.

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“…Therefore, the repeated TMS (rTMS) was considered as a novel and safe therapeutic option for the treatment of some refractory symptoms in schizophrenia that were not effectively controlled with antipsychotics, such as negative symptoms and cognitive impairment (Aleman et al, 2018). Evidence from previous studies has demonstrated that rTMS could effectively relieve the drug-refractory symptoms of schizophrenia, but the results were inconsistent (Wobrock et al, 2015;Li et al, 2016;Gan et al, 2021). For example, one study found that high-frequency rTMS alleviated the negative symptoms of schizophrenia and the effect lasted for at least 4 weeks (Gan et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Evidence from previous studies has demonstrated that rTMS could effectively relieve the drug-refractory symptoms of schizophrenia, but the results were inconsistent (Wobrock et al, 2015;Li et al, 2016;Gan et al, 2021). For example, one study found that high-frequency rTMS alleviated the negative symptoms of schizophrenia and the effect lasted for at least 4 weeks (Gan et al, 2021). Similarly, some researchers found that the negative symptoms in patients with schizophrenia were improved after 8 weeks of treatment with 10 Hz high-frequency rTMS, suggesting that high-frequency rTMS showed a delayed effect on the negative symptoms (Li et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Reconfiguration of Functional Dynamics in Cortico-Thalamo-Cerebellar Circuit in Schizophrenia Following High-Frequency Repeated Transcranial Magnetic Stimulation

Huang

Zhang

et al. 2022

Front. Hum. Neurosci.

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Schizophrenia is a serious mental illness characterized by a disconnection between brain regions. Transcranial magnetic stimulation is a non-invasive brain intervention technique that can be used as a new and safe treatment option for patients with schizophrenia with drug-refractory symptoms, such as negative symptoms and cognitive impairment. However, the therapeutic effects of transcranial magnetic stimulation remain unclear and would be investigated using non-invasive tools, such as functional connectivity (FC). A longitudinal design was adopted to investigate the alteration in FC dynamics using a dynamic functional connectivity (dFC) approach in patients with schizophrenia following high-frequency repeated transcranial magnetic stimulation (rTMS) with the target at the left dorsolateral prefrontal cortex (DLPFC). Two groups of schizophrenia inpatients were recruited. One group received a 4-week high-frequency rTMS together with antipsychotic drugs (TSZ, n = 27), while the other group only received antipsychotic drugs (DSZ, n = 26). Resting-state functional magnetic resonance imaging (fMRI) and psychiatric symptoms were obtained from the patients with schizophrenia twice at baseline (t1) and after 4-week treatment (t2). The dynamics was evaluated using voxel- and region-wise FC temporal variability resulting from fMRI data. The pattern classification technique was used to verify the clinical application value of FC temporal variability. For the voxel-wise FC temporary variability, the repeated measures ANCOVA analysis showed significant treatment × time interaction effects on the FC temporary variability between the left DLPFC and several regions, including the thalamus, cerebellum, precuneus, and precentral gyrus, which are mainly located within the cortico-thalamo-cerebellar circuit (CTCC). For the ROI-wise FC temporary variability, our results found a significant interaction effect on the FC among CTCC. rTMS intervention led to a reduced FC temporary variability. In addition, higher alteration in FC temporal variability between left DLPFC and right posterior parietal thalamus predicted a higher remission ratio of negative symptom scores, indicating that the decrease of FC temporal variability between the brain regions was associated with the remission of schizophrenia severity. The support vector regression (SVR) results suggested that the baseline pattern of FC temporary variability between the regions in CTCC could predict the efficacy of high-frequency rTMS intervention on negative symptoms in schizophrenia. These findings confirm the potential relationship between the reduction in whole-brain functional dynamics induced by high-frequency rTMS and the improvement in psychiatric scores, suggesting that high-frequency rTMS affects psychiatric symptoms by coordinating the heterogeneity of activity between the brain regions. Future studies would examine the clinical utility of using functional dynamics patterns between specific brain regions as a biomarker to predict the treatment response of high-frequency rTMS.

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High frequency repetitive transcranial magnetic stimulation of dorsomedial prefrontal cortex for negative symptoms in patients with schizophrenia: A double-blind, randomized controlled trial

Cited by 18 publications

References 49 publications

Increased Prefrontal Activation During Verbal Fluency Task After Repetitive Transcranial Magnetic Stimulation Treatment in Depression: A Functional Near-Infrared Spectroscopy Study

Increased Prefrontal Activation During Verbal Fluency Task After Repetitive Transcranial Magnetic Stimulation Treatment in Depression: A Functional Near-Infrared Spectroscopy Study

Recent advances in noninvasive brain stimulation for schizophrenia

Reconfiguration of Functional Dynamics in Cortico-Thalamo-Cerebellar Circuit in Schizophrenia Following High-Frequency Repeated Transcranial Magnetic Stimulation

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