Deep transcranial magnetic stimulation add-on for the treatment of auditory hallucinations: a double-blind study

A total of 18 schizophrenic patients with refractory auditory hallucinations were recruited, from Beer Yaakov MHC and other hospitals outpatient populations. Patients received 10 daily treatment sessions with low-frequency (1 Hz for 10 min) deep TMS applied over the left temporoparietal cortex, using the H1 coil at the intensity of 110% of the motor threshold. Procedure was either real or sham according to patient randomization. Patients were evaluated via the Auditory Hallucinations Rating Scale, Scale for the Assessment of Positive Symptoms-Negative Symptoms, Clinical Global Impressions, and Quality of Life Questionnaire.In all, 10 patients completed the treatment (10 TMS sessions). Auditory hallucination scores of both groups improved; however, there was no statistical difference in any of the scales between the active and the sham treated groups.Low-frequency deep TMS to the left temporoparietal cortex using the protocol mentioned above has no statistically significant effect on auditory hallucinations or the other clinical scales measured in schizophrenic patients.Clinicaltrials.gov identifier: NCT00564096.Auditory hallucinations are reported by 50% to 70% of patients with schizophrenia, most of whom are successfully treated with antipsychotic medications. However, 25% to 30% of hallucinating schizophrenic patients are refractory to antipsychotic medications, and these patients suffer associated distress, functional disability, lack of behavioral control [1], and violent behavior [2]. Auditory hallucinations have also been known in up to 25% of the cases to contribute to serious suicide attempts [3]. Overactivation of the left temporoparietal cortex, which is critical to speech perception and is easily accessed through transcranial magnetic stimulation (TMS), has been implicated in the onset of auditory hallucinations [4].The first report of repetitive TMS (rTMS) treatment for auditory hallucinations was described in 1999 by Hoffman [5]. Since then, several stu