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5 Schizophrenia
131
5.4 TMS vs. tDCS
5.4.1 Efficacy
NIBS has been proposed as an intervention strategy for mental disorders. NIBS
includes TMS and tDCS [186]. The stimulation frequency of TMS can either
increase or decrease cortical excitability and ranges from 1 to 50Hz. On the other
hand, tDCS is another noninvasive neurostimulation technique that uses direct electrical currents to stimulate specic cortical regions. Anodal tDCS (AtDCS) is generally thought to enhance the function of the underlying cortical areas, while cathodal
tDCS has a suppressive effect. The sustained effects of tDCS are thought to share a
similar neurobiological basis with TMS, involving the induction of long-term
potentiation like plasticity [186, 236, 237].
In patients with schizophrenia, tDCS and TMS show different treatment outcomes in reducing positive symptoms. For auditory hallucinations, tDCS produced
a small but highly heterogeneous positive effect, and TMS produced a negligible but
homogeneous positive effect. However, both TMS and tDCS protocols signicantly
improved negative symptoms with a medium effect size. It should be noted that
there was a high degree of heterogeneity in these results. Some caution is needed in
interpreting the results of NIBS for negative symptoms in schizophrenia. In terms of
the efcacy on cognitive impairments in schizophrenia, active TMS was not superior to sham for cognitive improvement. In contrast, tDCS proved effective in
enhancing attention and working memory in schizophrenia patients [186].
Furthermore, research indicates that tDCS may be more effective than TMS in
enhancing attention/vigilance [187]. In conclusion, it seems that neurostimulation
could be used in patients with schizophrenia, in particular for the negative symptoms and cognitive impairments of the disorder.
5.4.2 Safety
Both TMS and tDCS have been widely reported as safe techniques with minimal
adverse effects [209, 238]. In terms of safety, unilateral rTMS has been shown to be
a safe, NIBS technique with no serious adverse effects other than the well-known
side effects of mild headache and localized scalp discomfort observed in the majority of studies. The general impression is that tDCS is a safe technique, with adverse
effects that are mild and transient [188]. The most common adverse effects are
observed in the active group and include itching, tingling, headache, burning, and
discomfort.
132
H. Deng et al.
5.5 Conclusion
The diverse and complex nature of schizophrenia has hindered the establishment of
consensus regarding the efcacy of novel noninvasive neurostimulation techniques,
specically TMS and tDCS.Despite mixed ndings on their effectiveness, both
TMS and tDCS show promise as treatment options for patients with schizophrenia.
However, additional research is necessary to determine the optimal stimulation
parameters and identify key variables that may impact individual responses to either
TMS or tDCS.In the design of future clinical trials, a priority should be the examination of the efcacy of higher doses of tDCS in schizophrenia. These trials should
entail the administration of stimulation sessions twice, and potentially even three
times, per day or using larger current intensity. Moreover, conducting follow-up
assessments 1, 2, and 3months following the conclusion of treatment is imperative.
Furthermore, there is a need for further exploration into the potential of neuronavigation in conjunction with TMS, as this modication of TMS has shown promise in
the treatment of schizophrenia. It is anticipated that these methods will contribute
signicantly to enhancing our understanding of the underlying pathological mechanisms and treatment of schizophrenia, ultimately leading to the achievement of sustained and effective outcomes.
Acknowledgments None.
Disclosure/Conicts of Interest The authors declare no conicts of interest in conducting this
study or preparing the manuscript.
Financial Support This work was supported by the National Natural Science Foundation of
China, 82301693 and 31900751; the Capital’s Funds for Health Improvement and Research,
CFH2024-4-2132; Beijing Municipal Science & Technology Commission, Z221100007422047.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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