Abstract

Objectives: Maintenance treatment with electroconvulsive therapy (ECT) and adjunct antipsychotics can alleviate symptoms of treatment-resistant schizophrenia (TRS), although cognitive impairment is a side effect. Transcranial magnetic stimulation (TMS) has alleviated symptoms and improved cognitive impairment caused by maintenance ECT treatment. This study aimed to investigate long-term treatment effects of maintenance repetitive TMS combined with maintenance ECT and adjunct antipsychotics (MTEO) on TRS patients.
Methods: Eighty TRS patients underwent MTEO or sham-MTEO treatments for 24 months. Severity of illness and patient cognition were evaluated with Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB), respectively. Global functional connectivity density (gFCD) was used to assess alterations in brain activity.
Results: Compared to the sham-MTEO group, the MTEO group exhibited an increase in mean MCCB total score [140.8 ± 17.5 vs. 165.5 ± 10.2, respectively; P < 0.05]. Compared to baseline, reductions in PANSS scores were significant in both groups. Also compared to baseline, a marked increase in gFCD was only observed in the left prefontal lobe, parietal lobe, and insular lobe in the MTEO group (FWE correct, P < 0.01). The sham-MTEO group exhibited an increase in gFCD in the temporal lobe and anterior cingulated cortex at baseline. In the striatum, gFCD decreased in both groups.
Conclusions: This novel MTEO treatment for TRS patients improved cognitive ability based on PANSS and MCCB scores, and this improvement may be related to increased brain activity in the prefontal, parietal, and insular lobes. Thus, further study of this treatment approach is warranted.

Key words: TRS, rTMS, gFCD, Antipsychotics, PANSS, MCCB