title: Transcranial magnetic stimulation of Wernicke's and Right homologous sites to curtail "voices": a randomized trial.
abstract: 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.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. ralph.hoffman@yale.edu
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Hoffman
authors.forename: Kun
authors.initials: K
authors.lastname: Wu
authors.forename: Brian
authors.initials: B
authors.lastname: Pittman
authors.forename: John D
authors.initials: JD
authors.lastname: Cahill
authors.forename: Keith A
authors.initials: KA
authors.lastname: Hawkins
authors.forename: Thomas
authors.initials: T
authors.lastname: Fernandez
authors.forename: Jonas
authors.initials: J
authors.lastname: Hannestad
mesh_terms: D000293:Adolescent; D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006212:Hallucinations / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000150:complications; D013702:Temporal Lobe / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult