Background
Auditory/verbal hallucinations (AVHs) are accompanied by activation in Wernicke’s
and right homologous regions. Efficacy in curtailing AVHs via 1-Hz repetitive magnetic
stimulation (rTMS) targeting a site in each region (“W” and “rW”) was therefore studied.
Methods
Patients with schizophrenia and AVHs (N = 83) were randomly allocated to double-masked rTMS versus sham stimulation, with
blocks of five sessions given to W and rW in random order, followed by five sessions
to the site yielding greater improvement. The primary outcome measure was the Hallucination
Change Score (HCS). Hallucination frequency, total auditory hallucination rating scale
score, and clinical global improvement were secondary outcome measures. Attentional
salience of AVHs and neuropsychological measures of laterality were studied as predictors
of site-specific response.
Results
After 15 sessions, rTMS produced significant improvements relative to sham stimulation
for hallucination frequency and clinical global improvement but not for HCS. After
limiting analyses to patients whose motor threshold was detected consistently: 1)
endpoint HCS demonstrated significantly greater improvement for rTMS compared with
sham stimulation; 2) for high-salience AVHs, rTMS to rW after the first five sessions
yielded significantly improved HCS scores relative to sham stimulation, whereas for
low salience AVHs, rTMS to W produced this finding. Nondominant motor impairment correlated
positively with hallucination improvement following rW rTMS.
Conclusions
One-hertz rTMS per our site-optimization protocol produced some clinical benefit in
patients with persistent AVHs as a group, especially when motor threshold was consistently
detected. Level of hallucination salience may usefully guide selection of W versus
rW as intervention sites.
Key Words
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Article info
Publication history
Published online: March 01, 2013
Accepted:
January 11,
2013
Received in revised form:
December 4,
2012
Received:
May 26,
2012
Identification
Copyright
© 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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- Curtailing the Voices and the Need for PredictorsBiological PsychiatryVol. 73Issue 10
