The current review provides an overview of the existing literature on multimodal transcranial magnetic stimulation, and functional magnetic resonance imaging (TMS/fMRI) studies in individuals with schizophrenia and discusses potential future avenues related to the same. Multimodal studies investigating pathophysiology have explored the role of abnormal thalamic reactivity and have provided further evidence supporting the hypothesis of schizophrenia as a disorder of aberrant connectivity and cortical plasticity. Among studies examining treatment, low-frequency rTMS for the management of persistent auditory verbal hallucinations (AVH) was the most studied. While multimodal TMS/ fMRI studies have provided evidence of involvement of local speech-related and distal networks on stimulation of the left temporoparietal cortex, current evidence does not suggest the superiority of fMRI based neuronavigation over conventional methods or of active rTMS over sham for treatment of AVH. Apart from these, preliminary findings suggest a role of rTMS in treating deficits in neurocognition, social cognition, and self-agency. However, most of these studies have only examined medication-resistant symptoms and have methodological concerns arising from small sample sizes and short treatment protocols. That being said, combining TMS with fMRI appears to be a promising approach towards elucidating the pathophysiology of schizophrenia and could also open up a possibility towards developing personalized treatment for its persistent and debilitating symptoms.

中文翻译：

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多模态 TMS-fMRI 应用在精神分裂症病理生理学和治疗中的研究综述

本综述概述了关于精神分裂症患者多模式经颅磁刺激和功能磁共振成像 (TMS/fMRI) 研究的现有文献，并讨论了与之相关的潜在未来途径。研究病理生理学的多模式研究探索了异常丘脑反应性的作用，并提供了进一步的证据支持精神分裂症作为一种异常连接和皮质可塑性障碍的假设。在检验治疗的研究中，低频 rTMS 用于治疗持续性幻听 (AVH) 的研究最多。虽然多模态 TMS/fMRI 研究提供了局部言语相关网络和远端网络参与刺激左颞顶叶皮层的证据，但目前的证据并不表明基于 fMRI 的神经导航优于传统方法或主动 rTMS 优于假手术治疗AVH。除此之外，初步研究结果表明 rTMS 在治疗神经认知、社会认知和自我代理缺陷方面发挥着作用。然而，这些研究大多数只检查了耐药症状，并且由于样本量小和治疗方案短而存在方法学问题。话虽如此，将 TMS 与功能磁共振成像相结合似乎是阐明精神分裂症病理生理学的一种有前途的方法，也可能为开发针对其持续性和衰弱症状的个性化治疗开辟了可能性。