Excitation/inhibition imbalance in schizophrenia: a meta-analysis of inhibitory and excitatory TMS-EMG paradigms.

IF 3 Q2 PSYCHIATRY Schizophrenia (Heidelberg, Germany) Pub Date : 2024-06-15 DOI:10.1038/s41537-024-00476-y
Orsolya Lányi, Boróka Koleszár, Alexander Schulze Wenning, David Balogh, Marie Anne Engh, András Attila Horváth, Péter Fehérvari, Péter Hegyi, Zsolt Molnár, Zsolt Unoka, Gábor Csukly
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Abstract

Cortical excitation-inhibition (E/I) imbalance is a potential model for the pathophysiology of schizophrenia. Previous research using transcranial magnetic stimulation (TMS) and electromyography (EMG) has suggested inhibitory deficits in schizophrenia. In this meta-analysis we assessed the reliability and clinical potential of TMS-EMG paradigms in schizophrenia following the methodological recommendations of the PRISMA guideline and the Cochrane Handbook. The search was conducted in three databases in November 2022. Included articles reported Short-Interval Intracortical Inhibition (SICI), Intracortical Facilitation (ICF), Long-Interval Intracortical Inhibition (LICI) and Cortical Silent Period (CSP) in patients with schizophrenia and healthy controls. Meta-analyses were conducted using a random-effects model. Subgroup analysis and meta-regressions were used to assess heterogeneity. Results of 36 studies revealed a robust inhibitory deficit in schizophrenia with a significant decrease in SICI (Cohen's d: 0.62). A trend-level association was found between SICI and antipsychotic medication. Our findings support the E/I imbalance hypothesis in schizophrenia and suggest that SICI may be a potential pathophysiological characteristic of the disorder.

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精神分裂症的兴奋/抑制失衡:抑制性和兴奋性 TMS-EMG 范例的荟萃分析。
皮层兴奋-抑制(E/I)失衡是精神分裂症病理生理学的一个潜在模型。此前使用经颅磁刺激(TMS)和肌电图(EMG)进行的研究表明,精神分裂症患者存在抑制功能障碍。在这项荟萃分析中,我们按照 PRISMA 指南和 Cochrane 手册的方法学建议,评估了 TMS-EMG 范式在精神分裂症中的可靠性和临床潜力。该研究于 2022 年 11 月在三个数据库中进行了检索。纳入的文章报告了精神分裂症患者和健康对照组的短时皮质内抑制(SICI)、皮质内促进(ICF)、长时皮质内抑制(LICI)和皮质静默期(CSP)。元分析采用随机效应模型进行。分组分析和元回归用于评估异质性。36 项研究的结果表明,精神分裂症患者存在严重的抑制缺陷,SICI 显著下降(Cohen's d:0.62)。SICI与抗精神病药物之间存在趋势性关联。我们的研究结果支持精神分裂症的E/I失衡假说,并表明SICI可能是精神分裂症的一个潜在病理生理特征。
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