Efficacy of rTMS on SCZ symptoms: Insights from connectome mapping

Repetitive transcranial magnetic stimulation (rTMS) is a potential treatment for schizophrenia (SCZ), yet its efficacy and underlying mechanisms remain uncertain. This study evaluates the impact of rTMS targeting the right orbitofrontal cortex (OFC) in SCZ patients and constructs a connectome atlas based on symptomatology and treatment responses. Ninety-eight SCZ patients were randomly assigned to rTMS (n = 53) or sham stimulation (n = 45) groups. rTMS was delivered at 1 Hz, 110 % of the resting motor threshold, targeting the AF8 site over the right OFC, with 720 pulses per session, administered twice daily for a total of 20 sessions. Symptom assessments were conducted using the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA) at baseline, 2 weeks, and 4 weeks post-treatment. Resting-state functional magnetic resonance imaging (rsfMRI) and diffusion-weighted imaging (DWI) scans were acquired pre-treatment. Machine learning analysis of resting-state functional connectivity (rsFC) patterns revealed significant improvements in PANSS scores in the rTMS group at 4 weeks compared to the sham group. Specific rsFC patterns associated with depression, anxiety, and SCZ symptoms were identified, emphasizing the impact of the Default Mode Network (DMN) and Central Executive Network (CEN). Overall, rTMS targeting the right OFC effectively reduced SCZ symptoms, showcasing new therapeutic targets and an enhanced approach to rTMS treatment.