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Transcranial Magnetic Stimulation for Schizophrenia: A Meta-Analysis

Dalia Hegazy Ali*, Marwa abdelrhaman Soltan, Rania Kasim, Mohamed Rafaat Elfeky

Background: Schizophrenia is a significant cause of morbidity, and current biologic treatments often fail to achieve remission. Repeated transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation therapy approved for major depression. Peer-reviewed literature suggests that rTMS may have efficacy for psychosis as well as negative and cognitive symptoms; however, holistic data regarding the use of rTMS for schizophrenia remains unclear.

Objective: We aim to synthesize published data of rTMS efficacy in treating schizophrenia and evaluate the most efficacious treatment parameters.

Methods: A meta-analysis was performed evaluating mean weighted effect sizes (Cohen’s d) and heterogeneity (Cochran’s I2).

Results: 24 studies were included for analysis (N=4091). rTMS demonstrated greater effect sizes over sham in Positive and Negative Syndrome Scale (PANSS) negative (d=0.40, p=0.007 I2=59), PANSS general (d=0.31, p=0.004, I2=0) and Global Assessment of Functioning (GAF) (d=0.470, p=0.020, I2=58.2) scores. rTMS also demonstrated significant effect sizes over sham in PANSS positive (d=0.207, p=0.017, I2=20.2) and MADRS (d=0.457, p=0.023, I2=54.1) Sub-group analyses indicated that the stimulation location and frequency did not statistically influence efficacy.

Conclusion: rTMS may have benefits for treating schizophrenia, particularly in reducing negative symptoms when targeting the dorsal lateral prefrontal cortex (DLPFC) with high frequency stimulation (≥ 10 Hz). There was no evidence to support the efficacy of rTMS on audiovisual hallucinations. Further large-scale clinical trials are necessary to verify these findings and evaluate the durability of treatment effects, as there is limited long-term outcome data for the use of TMS for schizophrenia.