The alternations of nucleus accumbent in schizophrenia patients with auditory verbal hallucinations during low-frequency rTMS treatment

Abstract

Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been shown to reduce the severity of auditory verbal hallucinations (AVH) and induce beneficial functional and structural alternations of the brain in schizophrenia patients with AVH. The nucleus accumbens (NAcc) as an important component of the ventral striatum is implicated with the pathology in AVH. However, the induced characteristic patterns of NAcc by low-frequency rTMS in schizophrenia with AVH are seldom explored. We investigated the functional and structural characteristic patterns of NAcc by using seed-based functional connectivity (FC) analysis and gray matter volume (GMV) measurement in schizophrenia patients with AVH during 1 Hz rTMS treatment. Although low-frequency rTMS treatment did not affect the volumetric changes of NAcc, the abnormal FC patterns of NAcc, including increased FC of NAcc with the temporal lobes and decreased FC of NAcc with the frontal cortices in the pretreatment patients compared to healthy controls, were normalized or reversed after treatment. These FC changes were associated with improvements in clinical symptoms and neurocognitive functions. Our findings may extend our understanding of the NAcc in the pathology of schizophrenia with AVH and might be a biomarker of clinical effect for low-frequency rTMS treatment in schizophrenia.

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

“…The results regarding alterations in clinical symptoms were fully consistent with the previous report ( 32 ). The results also agree with the meta-analysis studies ( 19 , 20 , 46 ) and confirmed the effectiveness of low-frequency rTMS treatment on AVH in schizophrenia with our previous studies ( 33 , 35 – 37 ). Moreover, rTMS treatment induced beneficial connectivity changes of the seed in the active treatment group, including increased static FC (SFC) with prefrontal regions (e.g., right superior frontal gyrus and right supplementary motor cortex) and decreased SFC with the temporal lobe (e.g., right inferior temporal gyrus and middle temporal gyrus).…”

“…Unlike our previous studies using case-control paradigm (33,(35)(36)(37), this study had a single-blind parallel design, only the rTMS administrator rather than researchers or raters knew the conditions to which patients were assigned. Stimulation was performed by a Magstim Rapid System (YIRUDE, Wuhan, China), using a 70 mm figure-of-eight coil.…”

Low‐frequency rTMS induces modifications in cortical structural connectivity ‐ functional connectivity coupling in schizophrenia patients with auditory verbal hallucinations

“…Also, rTMS has the potential to reshape the connectivity of functionally interconnected regions by entraining endogenous brain oscillations (Thut & Miniussi, 2009) and thereby improving neural synchrony. Our prior investigation demonstrated that functional network connectivity is enhanced in schizophrenia patients with AVH following treatment, as determined by low‐frequency rTMS (Xie, Guan, Cai, et al, 2023; Xie, Guan, Wang, et al, 2023). Moreover, it has been observed that low‐frequency rTMS modulates the somatomotor network, which is accountable for somatic movements and sensations (Oosterwijk et al, 2012), thereby coordinating its structural and functional attributes.…”

“…Specifically targeting the left temporoparietal junction (TPJ), which is implicated in inner speech perception and AVH (Bohlken et al, 2017; Nathou et al, 2015), low‐frequency rTMS has demonstrated significant reduction in AVH symptoms among s patients with schizophrenia (Poulet et al, 2005; Vercammen et al, 2009), although some findings are inconclusive (Slotema et al, 2011). Furthermore, rTMS has been shown to induce long‐term changes by altering connectivity between the stimulate site and other brain areas (Vercammen et al, 2010) and modulating cerebral blood flow (Homan et al, 2012; Xie, Guan, Wang, et al, 2023). Additionally, in brain regions linked to AVH, rTMS increases local neural activity (Giesel et al, 2012; Xie et al, 2021).…”

rTMS Shows Efficacy in Improving Negative Symptoms in Early Psychosis: A Systematic Review

“…Francis et al measured thickness of the prefrontal cortex and found that the improvements in cognitive impairment were correlated with a thicker left prefrontal cortex at baseline (Francis et al, 2019). Xie, Cai, et al examined changes in grey matter volume in the nucleus accumbens, but did not find any differences or association with rTMS treatment (Xie, Cai, et al, 2022).…”