A systematic review of TMS and neurophysiological biometrics in patients with schizophrenia

Journal article


di Hou, Meng, Santoro, Viviana, Biondi, Andrea, Shergill, Sukhi S and Premoli, Isabella 2021. A systematic review of TMS and neurophysiological biometrics in patients with schizophrenia. Journal of psychiatry & neuroscience : JPN. 46 (6), pp. E675-E701. https://doi.org/10.1503/jpn.210006
Authorsdi Hou, Meng, Santoro, Viviana, Biondi, Andrea, Shergill, Sukhi S and Premoli, Isabella
AbstractTranscranial magnetic stimulation can be combined with electromyography (TMS-EMG) and electroencephalography (TMS-EEG) to evaluate the excitatory and inhibitory functions of the cerebral cortex in a standardized manner. It has been postulated that schizophrenia is a disorder of functional neural connectivity underpinned by a relative imbalance of excitation and inhibition. The aim of this review was to provide a comprehensive overview of TMS-EMG and TMS-EEG research in schizophrenia, focused on excitation or inhibition, connectivity, motor cortical plasticity and the effect of antipsychotic medications, symptom severity and illness duration on TMS-EMG and TMS-EEG indices. We searched PsycINFO, Embase and Medline, from database inception to April 2020, for studies that included TMS outcomes in patients with schizophrenia. We used the following combination of search terms: transcranial magnetic stimulation OR tms AND interneurons OR glutamic acid OR gamma aminobutyric acid OR neural inhibition OR pyramidal neurons OR excita* OR inhibit* OR GABA* OR glutam* OR E-I balance OR excitation-inhibition balance AND schizoaffective disorder* OR Schizophrenia OR schizophreni*. TMS-EMG and TMS-EEG measurements revealed deficits in excitation or inhibition, functional connectivity and motor cortical plasticity in patients with schizophrenia. Increased duration of the cortical silent period (a TMS-EMG marker of γ-aminobutyric acid B receptor activity) with clozapine was a relatively consistent finding. Most of the studies used patients with chronic schizophrenia and medicated patients, employed cross-sectional group comparisons and had small sample sizes. TMS-EMG and TMS-EEG offer an opportunity to develop a novel and improved understanding of the physiologic processes that underlie schizophrenia and to assess the therapeutic effect of antipsychotic medications. In the future, these techniques may also help predict disease progression and further our understanding of the excitatory/inhibitory balance and its implications for mechanisms that underlie treatment-resistant schizophrenia. [Abstract copyright: © 2021 CMA Joule Inc. or its licensors.]
KeywordsSchizophrenia; Treatment; TMS; Transcranial magnetic stimulation; Electromyography; Electroencephalography
Year2021
JournalJournal of psychiatry & neuroscience : JPN
Journal citation46 (6), pp. E675-E701
ISSN1488-2434
Digital Object Identifier (DOI)https://doi.org/10.1503/jpn.210006
Official URLhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8695525/
Publication dates
Online21 Dec 2021
Publication process dates
Accepted06 Sep 2021
Deposited12 Jan 2022
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