Two-day treatment of auditory hallucinations by high frequency rTMS guided by cerebral imaging: a 6 month follow-up pilot study.
BACKGROUND
Recently, repetitive Transcranial Magnetic Stimulation (rTMS) has been introduced as an alternative treatment for auditory hallucinations in schizophrenic patients that fail to respond to antipsychotics. Until now, application of rTMS has been at low frequency, and most commonly applied to the left temporoparietal cortex. This 6-month follow-up pilot study was performed to demonstrate the efficacy of high frequency rTMS guided by anatomical and functional Magnetic Resonance Imaging (MRI).


METHODS
Eleven patients with schizophrenia (DSM-IV) were treated with high frequency (20 Hz) rTMS delivered over 2 days; they were then followed for 6 months. The target area was identified by fMRI as the highest activation cluster along the posterior part of the left superior temporal sulcus from the BOLD signal of each subject during a language task.


RESULTS
A significant reduction in global severity and frequency of auditory hallucinations between baseline and post-treatment day 12 was observed. Auditory hallucinations were entirely relieved at 6-month follow-up in 2 patients. The treatment was well tolerated in all patients.


CONCLUSIONS
This is the first study reporting successful treatment of auditory hallucinations with 20 Hz rTMS. The efficacy at short term, the strength of the clinical response, the persistence of therapeutic effect over a 6-month follow-up, the safety profile, and the short duration of treatment present a considerable therapeutic gain compared to low frequency rTMS.
Montagne-Larmurier
A
A
Département Universitaire de psychiatrie, centre Esquirol, Centre Hospitalier Universitaire de Caen, avenue côte de nacre, Caen, 14000, France.
Etard
O
O
Razafimandimby
A
A
Morello
R
R
Dollfus
S
S
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000098:blood supply* / Q000473:pathology* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004558:Electric Stimulation; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006212:Hallucinations / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D012559:Schizophrenia / Q000150:complications; D012720:Severity of Illness Index; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D055815:Young Adult
D014150:Antipsychotic Agents; D010100:Oxygen