Deep transcranial magnetic stimulation over the anterior cingulate cortex in treatment-resistant schizophrenia: A...

Treatment-resistant schizophrenia (TRS) remains a therapeutic challenge. Deep transcranial magnetic stimulation (dTMS) is a novel technique targeting deep brain regions like the anterior cingulate cortex (ACC). This double-blind, randomized controlled trial investigated the efficacy and safety of low-frequency ACC-targeted dTMS in TRS. Twenty-three patients with TRS were randomly allocated to receive either active or sham dTMS, undergoing 20 sessions of 1 Hz dTMS over 4 weeks. Symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline, 2 weeks and 4 weeks post-treatment. Cognitive and functional performance were measured with MATRICS Consensus Cognitive Battery (MCCB) and UCSD Performance-based Skills Assessment (UPSA-B) at baseline and 4 weeks. Final analyses were based on a modified intention-to-treat (mITT) population who completed at least one post-treatment assessment (active = 8, sham = 9). Six participants who dropped out before the first post-baseline assessment (two consent withdrawals, four symptom aggravations) were excluded. The results indicated a significantly greater reduction in PANSS scores over time (F = 4.591, p = 0.018). Further analysis of symptom domains revealed that the dTMS intervention primarily ameliorated positive symptoms (F = 3.738, p = 0.037), with significant improvement compared to the sham at the end of treatment (difference = -4.306, 95 %CI [-6.961, -1.650]; p = 0.002). No significant between-group difference was observed regarding the PANSS-N, PANSS-G, MCCB overall composite or UPSA-B after treatment. No serious adverse events were reported. This pilot study provided preliminary evidence that low-frequency dTMS over the ACC is a tolerable intervention with potential efficacy for TRS, particularly for refractory positive symptoms.