Efficacy of rTMS on SCZ symptoms: Insights from connectome mapping

Area of Science:

• Neuroscience
• Psychiatry
• Medical Imaging

Background:

• Schizophrenia (SCZ) treatment efficacy and mechanisms for repetitive transcranial magnetic stimulation (rTMS) require further investigation.
• The right orbitofrontal cortex (OFC) is a potential target for rTMS in SCZ.
• Understanding the neural underpinnings of rTMS response is crucial for optimizing treatment.

Purpose of the Study:

• To evaluate the efficacy of rTMS targeting the right OFC in SCZ patients.
• To construct a connectome atlas correlating symptomatology and treatment response.
• To identify resting-state functional connectivity (rsFC) patterns associated with SCZ symptoms and rTMS effects.

Main Methods:

• Ninety-eight SCZ patients were randomized into rTMS (n=53) or sham (n=45) groups.
• rTMS involved 20 sessions (twice daily) of 1 Hz stimulation at 110% resting motor threshold over the right OFC (AF8 site).
• Symptom severity (PANSS, HAMD, HAMA) and rsfMRI/DWI data were collected pre-treatment and at 2 and 4 weeks post-treatment; machine learning analyzed rsFC.

Main Results:

• The rTMS group showed significant improvements in PANSS scores at 4 weeks compared to the sham group.
• Machine learning identified specific rsFC patterns linked to depression, anxiety, and SCZ symptoms.
• The Default Mode Network (DMN) and Central Executive Network (CEN) were highlighted for their involvement in rTMS effects.

Conclusions:

• rTMS targeting the right OFC demonstrates significant efficacy in reducing SCZ symptoms.
• This study provides a connectome atlas and identifies novel therapeutic targets within brain networks.
• The findings support an enhanced approach to rTMS for schizophrenia treatment.