Schizophrenia is a complex mental illness associated with symptoms such as hallucinations, delusions and cognitive deficits. Antipsychotic medications and psychotherapy are traditional treatments, but some patients remain poorly responsive. This is where TMS proves invaluable.

What is Transcranial Magnetic Stimulation (TMS)?

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that can modulate neuronal activity via an electromagnetic field. TMS is a non-invasive technique that can modulate cortical excitability and brain circuitry through the selective delivery of magnetic pulses to specific brain regions associated with psychiatric conditions.

The mechanism in which TMS acts in schizophrenia

The following are mechanisms of TMS actions that provide a window to what goes wrong in Schizophrenia on the Neurophysiology and Neural Network dynamics level :

1. Cortical Excitability Modulation

Studies have associated schizophrenia itself with increased cortical excitability abnormalities focused on the prefrontal cortex and temporoparietal regions. Firing Rates : The activity of a neuron as measured by the number of action potentials it produces per unit time So depending on how often you stimulate via TMS, you can actually either increase or decrease this frequency.

Spotlight (high-frequency TMS [≥5 Hz]: This is generally used to increase cortical excitability and is used to help activate areas of the brain that are underactive in a form of “activative” pathway.

Low frequency TMS (≤1 Hz): results in decreased cortical excitability and so is used to inhibit hyperactive areas

TMS rebalances the aberrant neural circuits in schizophrenia by modifying the stimulation parameters.

2. Impact on Neurotransmitter Systems

A demonstration of the effect of TMS on some neurotransmitters involved in schizophrenia:

Dopamine: Alterations of dopaminergic pathways are central to schizophrenia. TMS may effect a modulation of dopamine release assisting in symptom reduction.

Glutamate and GABA: TMS can modulate excitation or inhibition of motor cortex neurometabolicity.

3. Improved neuroplasticity

Neuroplasticity means the brain’s ability to restructure itself by developing new neural connections. TMS seems like an attractive candidate to induce neuroplastic changes that could ultimately lead to recovery of cognitive dysfunction in schizophrenia.

4. Change in Functional Connectivity

In schizophrenia, connectivity between different parts of the brain is damaged. TMS can control these connections, and so help the different brain areas in successfully coordinating with each other in their tasks.

The above limitations emphasize the possibility that TMS may be indicated in diagnosed cases of schizophrenia for which we do not as a guideline recommend routine use at this time.

Several researches have assessed the effectivity of TMS on symptoms of schizophrenia,

Auditory Hallucinations: Low-frequency TMS stimulation of the left temporoparietal cortex in reduces treatment-resistant auditory hallucinations.

Negative Symptoms: High-frequency TMS over the prefrontal cortex has demonstrated some promise in treating negative symptoms such as apathy and social withdrawal.

Cognitive Impairments: TMS may improve various cognitive functions such as working memory and executive functioning.

Conclusion

The story of TMS may thus represent a new eclectic tool for schizophrenia treatment in the future. That it targets specific neural circuits and neurotransmitter systems makes it a welcome companion to our current armamentarium. This is an area of research that has been used for a number of years, and ongoing research and clinical trials are working to better define its applications and protocols in order to get the best outcomes.

Technological advances such as TMS offer the many psychiatrists and other mental health providers who seek to further improve the quality of life for individuals with schizophrenia methods that have a high likelihood of achieving this goal.

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If you or someone close to you is affected by schizophrenia, speak with a psychiatrist in your area who can help you navigate options for possible TMS treatment.