Treating Auditory Hallucinations by Transcranial Magnetic Stimulation: A Randomized Controlled Cross-Over Trial

Abstract

Background: In a previous functional magnetic resonance imaging study, the authors succeeded in demonstrating the activation of Heschl’s gyrus during auditory hallucinations (AH). Objectives: This study aims to treat AH specifically by repetitive transcranial magnetic stimulation (rTMS). Methods: 16 patients with AH were included in a randomized, cross-over, sham-controlled trial. 1 Hz rTMS was administered over the left and right temporo-parietal cortex and sham position, respectively, on 5 consecutive days; 900 stimuli each, strength 100% of motor threshold. Using the Psychotic Symptom Rating Scales (PSYRATS), the hallucinations during the stimulation periods and 4-week follow-ups were quantified. Electroencephalograms (EEG) were acquired before and after each period. Results: Treatment responses were observed after left hemisphere rTMS only. The 5 patients who showed a response did so already after 2 days. However, group mean hallucination scores did not differ across treatment conditions. No significant changes were found in EEG after rTMS. Conclusions: A subgroup of patients suffering from AH benefits soon after treatment start from rTMS over the left superior temporal gyrus as revealed by the decrease of AH scores compared to right-sided and sham procedures.

Effect of Low-Frequency rTMS on Electromagnetic Tomography (LORETA) and Regional Brain Metabolism (PET) in Schizophrenia Patients with Auditory Hallucinations

“…These promising results were replicated with an extended duration of stimulation for 2 weeks [17] and with a higher intensity of magnetic field [18][19][20][21] . Conversely, the effect was not replicated by studies with a treatment period only up to 5 days [22,23] or when the magnetic field was administered in the subthreshold intensity [24,25] .…”

“…The PET and qEEG were investigated in the resting state within 4 days before and after rTMS treatment. 0.9 Hz of low-frequency rTMS at 100% of MT was administered over the left temporoparietal region defined as the midway between the T 3 and P 3 sites according to the international 10/20 EEG electrode system, as described in previous reports [16,[18][19][20][21] . In our study, we chose the frequency of 0.9 Hz instead of 1 Hz to ensure an inhibitory effect on the brain cortex.…”

Placebo Response in Repetitive Transcranial Magnetic Stimulation Trials of Treatment of Auditory Hallucinations in Schizophrenia: A Meta-Analysis

“…For this purpose we used the global AVH, which was evaluated in the majority of studies using the Auditory Hallucination Rating Scale (AHRS) total score [22][23][24][25][26][27][28][29][30][31] or otherwise evaluated by the 20 the Scale for Auditory Hallucinations, 19 or the Psychotic Symptom Rating Scales. 37 The mean gain in each study was computed using the Comprehensive Meta Analysis (version 2) in a random effects model. After computation of the individual effect sizes for each study, meta-analytic methods were applied to obtain a combined, weighted effect size, Hedges's g, for the entire sham group.…”

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“…In addition, in some of these studies, the stimulation site was not the left temporoparietal cortex: Some studies targeted the left auditory cortex, [49] some studies stimulated right temporal region [52] and the other studies used bilateral paradigm for stimulation. [51] Although some of the recent studies have reported negative findings, combining them with the studies with positive outcomes resulted in a relatively moderate weighted size effect (about 0.44) indicating promising outcomes which is still statistically significant.…”