Intermittent theta burst stimulation for negative symptoms in schizophrenia patients with mild cognitive impairment: a randomized controlled trail.

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This study aims to evaluate the intervention effect of intermittent Theta burst stimulation (iTBS) on bilateral dorsomedial prefrontal cortex (DMPFC) for negative symptoms in schizophrenia using functional near-infrared spectroscopy (fNIRS) to confirm the therapeutic significance of DMPFC in treating negative symptoms and provide new evidence for schizophrenia treatment and research. Thirty-nine schizophrenia patients with negative symptoms and mild cognitive impairment were randomly divided into a treatment group (n=20) and a control group (n=19). The treatment group received iTBS in bilateral DMPFC. The control group received the sham treatment. Negative symptoms, cognitive function, emotional state, and social function were assessed at pre-treatment, post-treatment, 4-, 8-, and 12-week follow-ups. Brain activation in regions of interest (ROIs) was evaluated through verbal fluency tasks. Changes in scale scores were analyzed by repeated measures ANOVA. After 20 sessions of iTBS, the Scale for the Assessment of Negative Symptoms (SANS) total and sub-scale scores significantly improved in the treatment group, with statistically significant differences. SANS scores differed significantly between pre- and post-treatment in both groups, with post-treatment scores markedly lower than pre-treatment and better efficacy in the treatment group. However, there was no significant difference in cognitive function, emotional state, and social function. ROIs did not differ significantly between groups before intervention. After treatment, prefrontal cortex activation was significantly higher in the treatment group than in controls, with a statistically significant difference. Regarding functional connectivity, the small-world properties Sigma and Gamma were enhanced. iTBS on bilateral DMPFC can effectively alleviate negative symptoms and enhance prefrontal cortex activation and the small-world properties in patients of schizophrenia.