Elsevier

Biological Psychiatry

Volume 58, Issue 2, 15 July 2005, Pages 97-104
Biological Psychiatry

Original article
Temporoparietal Transcranial Magnetic Stimulation for Auditory Hallucinations: Safety, Efficacy and Moderators in a Fifty Patient Sample

https://doi.org/10.1016/j.biopsych.2005.03.041Get rights and content

Background

Auditory hallucinations are often resistant to treatment and can produce significant distress and behavioral difficulties. A preliminary report based on 24 patients with schizophrenia or schizoaffective disorder indicated greater improvement in auditory hallucinations following 1-hertz left temporoparietal repetitive transcranial magnetic stimulation (rTMS) compared to sham stimulation. Data from the full 50-subject sample incorporating 26 new patients are now presented to more comprehensively assess safety/tolerability, efficacy and moderators of this intervention.

Methods

Right-handed patients experiencing auditory hallucinations at least 5 times per day were randomly allocated to receive either rTMS or sham stimulation. A total of 132 minutes of rTMS was administered over 9 days at 90% motor threshold using a double-masked, sham-controlled, parallel design.

Results

Hallucination Change Score was more improved for rTMS relative to sham stimulation (p = .008) as was the Clinical Global Impressions Scale (p = .0004). Hallucination frequency was significantly decreased during rTMS relative to sham stimulation (p = .0014) and was a moderator of rTMS effects (p = .008). There was no evidence of neurocognitive impairment associated with rTMS.

Conclusions

Left temporoparietal 1-hertz rTMS warrants further study as an intervention for auditory hallucinations. Data suggest that this intervention selectively alters neurobiological factors determining frequency of these hallucinations.

Section snippets

Subjects

Patients met diagnostic criteria for schizophrenia or schizoaffective disorder (using the Structural Clinical Interview for DSM-IV (SCID, Version 2.0, Spitzer et al 1995), and reported AHs at least 5 times per day based on pre-enrollment assessments using a written log or hand-held counter. Exclusion criteria included a prior history of a seizure not induced by drug withdrawal, first degree relative with epilepsy, significant neurological illness or head trauma, significant unstable medical

Primary Outcome Variables

Hallucination Change Scores for the active and sham groups over the course of the trial are illustrated in Figure 1. The Hallucination Change Score was significantly lower for active compared to sham groups for the day 6 assessment (t(44) = −2.53, p = .015) and the final (day 9) assessment (t(43) = −2.70, p = .01). Hallucination Change Score dependence over time was characterized using a random-time model. The time effect (F1,41.4 = 39.43, p < .0001) and the interaction between treatment and

Discussion

Active rTMS was associated with significant improvements in hallucination severity relative to sham stimulation as reflected by Hallucination Change Score, our primary outcome measure. These improvements primarily reflected reductions in hallucination frequency. Overall clinical state as assessed by CGI scores was also more improved following active rTMS relative sham stimulation. Group differences remain significant for these two secondary outcome measures after Bonferroni correction of the

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