Neural Noise

TMS electric-field modeling for symptom targets in schizophrenia

2 min read

  • Symptom-general and symptom-specific TMS targets in schizophrenia have been mapped via electric-field modeling meta-analysis (Nature).1
  • TMS electric-field modeling is methods-relevant for stimulation targeting.1 1

Gardner updates

  • An electric-field modeling meta-analysis mapped symptom-general and symptom-specific TMS targets in schizophrenia (Nature). 1

Weekly enrichment (2026-07-20)

  • The meta-analysis (Sinanaj et al., Molecular Psychiatry 31:1265–1275, 2026) pooled randomized, sham-controlled trials in 4,283 patients, including 107 studies screened from 4,311 records across PubMed, EMBASE, PsycINFO, and Web of Science (searched to March 5, 2025).2
  • Across all symptom domains and protocols, active TMS produced a small but significant benefit over sham, standardized mean difference (SMD) 0.44 (95% CI 0.30–0.57), with high heterogeneity (I²=77%) and no evidence of publication bias.2
  • Negative symptoms improved with SMD 0.48 (95% CI 0.31–0.65); high-frequency TMS to the left prefrontal cortex reached SMD 0.62 (95% CI 0.41–0.83), and iTBS at L-PFC the highest at SMD 1.01 (95% CI 0.44–1.58) — a value the authors note matches the reported clozapine effect (SMD 0.62), with the caveat that this is contextual, not head-to-head.2
  • Positive symptoms improved only with low-frequency TMS to the left temporoparietal cortex (SMD 0.49, 95% CI 0.12–0.86), comparable to the median antipsychotic effect (SMD 0.42).2
  • Finite-element E-field modeling on 59 studies computed a Clinical E-Field Correlation (CEC) per gray-matter tetrahedral element, tested with a two-sided 1,000-iteration permutation test (p<0.05).2
  • Symptom-general optimal sites (significant positive CEC) were the left motor cortex (CECmax 0.40, p=0.001), left dorsomedial prefrontal cortex (L-DMPFC, MNI −19,38,42; CECmax 0.40, p=0.002), and left orbitofrontal cortex (L-OFC, CECmax 0.31, p=0.02); left cerebellar crus II and right lobule IX showed significant negative CEC.2
  • Restricting to HF L-PFC studies (n=15) strengthened the L-DMPFC/L-OFC association to CECmax 0.83 (p=0.0001); the cognitive subgroup (n=10) localized to left DLPFC (CECmax 0.63, p=0.04), and positive-symptom LF L-TPC studies (n=8) implicated right cerebellar lobules VIIIA/VIIIB/IX (CECmax 0.72, p=0.04).2
  • Closer proximity of studies’ actual coil targets to the L-DMPFC site predicted larger effect sizes (across symptoms r=−0.34, p=0.006; negative symptoms r=−0.63, p=0.01), the core argument for E-field-guided, personalized neuromodulation.2
  • Methodologically the team used random-effects models, Hedges’ correction for the 61.8% of studies with <50 participants, bootstrapping, and Cochrane RoB 2.0; a key limitation is that all included trials were adjuncts to antipsychotics in medication-refractory patients.23

Footnotes

  1. https://news.google.com/rss/articles/CBMiX0FVX3lxTE5GQV9vaWlxS1NBVTY2SF90ZWMwdmtEVmpRUGxmVXV1anFSczlMQWVxOWFLS0t1ZVNQc01TZnY1cnBibVpySnhrdkkwc1F4NF8wTGNVcVZsaUpablFNY0lN?oc=5 ↩ ↩2 ↩3 ↩4

  2. https://doi.org/10.1038/s41380-025-03238-z ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8 ↩9

  3. https://doi.org/10.21203/rs.3.rs-5565115/v1 ↩

Graph View