Deep transcranial magnetic stimulation for the treatment of auditory hallucinations: a preliminary open-label study

Eight schizophrenic patients with refractory auditory hallucinations were recruited, mainly from Beer Ya'akov Mental Health Institution (Tel Aviv university, Israel) ambulatory clinics, as well as from other hospitals outpatient populations. Low-frequency deep TMS was applied for 10 min (600 pulses per session) to the left temporoparietal cortex for either 10 or 20 sessions. Deep TMS was applied using Brainsway's H1 coil apparatus. Patients were evaluated using the Auditory Hallucinations Rating Scale (AHRS) as well as the Scale for the Assessment of Positive Symptoms scores (SAPS), Clinical Global Impressions (CGI) scale, and the Scale for Assessment of Negative Symptoms (SANS).This preliminary study demonstrated a significant improvement in AHRS score (an average reduction of 31.7% ± 32.2%) and to a lesser extent improvement in SAPS results (an average reduction of 16.5% ± 20.3%).In this study, we have demonstrated the potential of deep TMS treatment over the temporoparietal cortex as an add-on treatment for chronic auditory hallucinations in schizophrenic patients. Larger samples in a double-blind sham-controlled design are now being preformed to evaluate the effectiveness of deep TMS treatment for auditory hallucinations.This trial is registered with clinicaltrials.gov (identifier: NCT00564096).Schizophrenia is usually accompanied by reality distortion followed by frequent delusions and hallucinations. Hallucinations may be both visual and auditory, while the latter is more frequent. Auditory hallucinations are usually expressed by voices speaking to or about the patient [1]. The biochemical mechanisms behind auditory hallucinations (AHs) remain elusive. Generally, AHs may be considered to stem from a default monitoring of inner states. As a result, the individual mislabels the inner speech as non-self [2].Auditory hallucinations are reported by 50% to 70% of patients with schizophrenia, and the majority of cases are successfully treated with antipsychotic medic