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Baseline neurophysiological markers predict clinical response to HD-tDCS in schizophrenia: A randomized clinical trial

Poster Session F - Tuesday, March 10, 2026, 8:00 – 10:00 am PDT, Fairview/Kitsilano Ballroom

Deyang Li^1,2 (), Meng Chen¹, Xiang-Yang Zhang¹, Dongmei Wang¹; ¹Institute of Psychology, Chinese Academy of Sciences, ²University of Alberta

Schizophrenia is a severe neuropsychiatric disorder affecting about 0.45% of adults, with negative symptoms often resistant to antipsychotic medications. Transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) enables direct assessment of cortical excitability and inhibition. High-definition transcranial direct current stimulation (HD-tDCS) has shown potential in improving schizophrenia symptoms. This study examined whether baseline TMS-EEG markers could predict the therapeutic effects of HD-tDCS on clinical symptoms. A total of 104 patients with schizophrenia and 90 healthy controls underwent single-pulse TMS-EEG targeting the left dorsolateral prefrontal cortex (DLPFC). Patients then participated in a randomized, double-blind, controlled trial of anodal HD-tDCS over the DLPFC (1.5 mA, 20 min/session, 10 sessions). Primary outcomes were changes in Positive and Negative Syndrome Scale (PANSS) and Scale for the Assessment of Negative Symptoms (SANS) scores from baseline to post-treatment. Compared with healthy controls, patients showed reduced N100 amplitude, lower theta and alpha power, and increased gamma power. HD-tDCS significantly decreased PANSS (F = 41.40, p < 0.001, η2 = 0.321) and SANS (F = 25.15, p < 0.001, η2 = 0.224) scores compared with sham stimulation. Baseline N100 amplitude positively correlated with SANS improvement, whereas beta and gamma power were negatively correlated with PANSS positive and negative symptom improvements, respectively. TMS-EEG findings indicate that cortical excitation–inhibition imbalance contributes to schizophrenia symptom severity. HD-tDCS may be an effective adjunctive treatment, and TMS-EEG markers such as N100 amplitude and beta/gamma power may predict treatment response.

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