The Effect of Cerebellar Vermal rTMS with TBS Paradigm on Negative Symptoms，Cognitive Function and Serum Inflammatory Factors in Elderly Patients with Chronic Schizophrenia：Randomized Controlled Trial postprint

Abstract: Background  The cerebellar vermis is closely related to emotional regulation and cognitive function. There have been few reports on whether repeated transcranial magnetic stimulation（rTMS）of the cerebellar vermis can improve clinical symptoms in elderly patients with chronic schizophrenia（CSZ）. Objective  Observing the effects of cerebellar vermis rTMS with theta burst stimulation（TBS）paradigm on negative symptoms，cognitive function，and serum inflammatory cytokine levels in elderly CSZ patients. Methods  This study is a single blind randomized controlled trial. Fifty elderly CSZ patients in stable condition admitted to Shenyang Mental Health Center were selected between October 2022 and August 2023 as the subjects. Using a random number table method，CSZ patients were divided into an observation group and a control group，with 25 cases in each group. The patients in observation group were treated with rTMS with TBS paradigm，the stimulation site is the vermis of the cerebellum. The treatment was conducted 5 days a week，once a day，for 4 consecutive weeks. The patients in control group were intervention with pseudo stimulation，and the treatment time and parameters were the same as those in the observation group. Use the Positive and Negative Symptom Scale（PANSS）to evaluate overall psychiatric symptoms，and use the Negative Symptom Scale（SANS）to evaluate negative symptoms. Evaluate cognitive function using the MATRICS Recognized Cognitive Set Test （MCCB）. Detecting serum interleukin-1β（IL-1β），Interleukin-6（IL-6）and tumor necrosis factor α（TNF-α）.Results  Compared with the control group，the observation group had lower PANSS negative symptom scores ［（17.11±2.00）scores vs （19.21±2.76）scores］，general psychopathological symptom scores ［（17.11±2.00）scores vs 19.21±2.76）scores］，total scores after treatment ［（29.33±4.27）scores vs （58.99±5.53）scores］，and lower SANS scale scores ［（54.00±3.78）scores vs （57.83±4.15）scores］（P<0.05）. Compared with the control group，the observation group had higher post-treatment information processing speed scores ［（39.78±2.45）scores vs （37.24±1.10）scores］，attention alertness scores［（47.07±4.27）scores vs（40.01±2.17）scores］，working memory scores［（45.12±3.20）scores vs（41.89±4.11）scores］，and social cognitive scores ［（46.40±4.29）scores vs （41.42±7.45）scores］（P<0.05）. Compared with the control group，the observation group had lower levels of IL-1β ［（41.09±7.34）μg/L vs （47.03±12.45）μg/L］，IL-6［（35.03±10.23）μg/L vs （41.28±7.32）μg/L］，and TNF-α ［（53.28±14.15）μg/L vs （61.35±12.79）μg/ L］ after treatment（P<0.05）. During the rTMS treatment process，only 4 cases in the observation group experienced dizziness and headache symptoms during the first treatment，which gradually became tolerable with prolonged treatment time. All other patients have no complaints of discomfort. Conclusion  The rTMS with TBS paradigm can improve negative symptoms，cognitive function，and serum inflammatory factor levels in elderly patients with CSZ.