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

Yuanjun Xie; Muzhen Guan; Ying He; Zhongheng Wang; Zhujing Ma; Peng Fang; Huaning Wang

doi:10.3389/fpsyt.2023.1071769

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

Front Psychiatry. 2023 Jan 25:14:1071769. doi: 10.3389/fpsyt.2023.1071769. eCollection 2023.

Authors

Yuanjun Xie^{1

2}, Muzhen Guan³, Ying He⁴, Zhongheng Wang⁵, Zhujing Ma⁶, Peng Fang⁷, Huaning Wang⁵

Affiliations

¹ School of Education, Xinyang College, Xinyang, China.
² Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
³ Department of Mental Health, Xi'an Medical University, Xi'an, China.
⁴ Department of Psychiatry, Second Affiliated Hospital, Army Medical University, Chongqing, China.
⁵ Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
⁶ Department of Clinical Psychology, Fourth Military Medical University, Xi'an, China.
⁷ Department of Military Medical Psychology, Fourth Military Medical University, Xi'an, China.

Abstract

Background: Auditory verbal hallucinations (AVH) are a core symptom of schizophrenia. Low-frequency (e.g., 1 Hz) repetitive transcranial magnetic stimulation (rTMS) targeting language processing regions (e.g., left TPJ) has been evident as a potential treatment for AVH. However, the underlying neural mechanisms of the rTMS treatment effect remain unclear. The present study aimed to investigate the effects of 1 Hz rTMS on functional connectivity (FC) of the temporoparietal junction area (TPJ) seed with the whole brain in schizophrenia patients with AVH.

Methods: Using a single-blind placebo-controlled randomized clinical trial, 55 patients with AVH were randomly divided into active treatment group (n = 30) or placebo group (n = 25). The active treatment group receive 15-day 1 Hz rTMS stimulation to the left TPJ, whereas the placebo group received sham rTMS stimulation to the same site. Resting-state fMRI scans and clinical measures were acquired for all patients before and after treatment. The seed-based (left TPJ) static and DFC was used to assess the connectivity characteristics during rTMS treatment in patients with AVH.

Results: Overall, symptom improvement following 1 Hz rTMS treatment was found in the active treatment group, whereas no change occurred in the placebo group. Moreover, decreased static FC (SFC) of the left TPJ with the right temporal lobes, as well as increased SFC with the prefrontal cortex and subcortical structure were observed in active rTMS group. Increased dynamic FC (DFC) of the left TPJ with frontoparietal areas was also found in the active rTMS group. However, seed-based SFC and DFC were reduced to a great extent in the placebo group. In addition, these changed FC (SFC) strengths in the active rTMS group were associated with reduced severity of clinical outcomes (e.g., positive symptoms).

Conclusion: The application of 1 Hz rTMS over the left TPJ may affect connectivity characteristics of the targeted region and contribute to clinical improvement, which shed light on the therapeutic effect of rTMS on schizophrenia with AVH.

Keywords: auditory verbal hallucinations; fMRI; functional connectivity; left temporoparietal junction region; rTMS; schizophrenia.

Grants and funding

This study was funded by the Natural Science Foundation of China (Nos. 81971255 and 81571651), Postdoctoral Science Foundation (No. 2019M653963), and the Military Medical Science and Technology Youth Training Program of China (No. 20QNPY049).