Slow transcranial magnetic stimulation can rapidly reduce resistant auditory hallucinations in schizophrenia

Background: Almost a quarter of patients with schizophrenia present with resistant auditory verbal hallucinations (AVH), a phenomenon that may relate to activation of brain areas underlying speech perception. Repetitive transcranial magnetic stimulation (rTMS) at 1 Hz reduces cortical activation, and recent results have shown that 1-Hz left temporoparietal rTMS may reduce AVH. The aim of this study was to replicate recent data and investigate whether low-frequency rTMS with a high total stimulation number delivered in a shorter 5-day block produces similar benefit. Methods. Ten right-handed schizophrenia patients with resistant AVH received 5 days of active rTMS and 5 days of sham rTMS (2,000 stimulations per day at 90% of motor threshold) over the left temporoparietal cortex in a double-blind crossover design. The two weeks of stimulation were separated by a 1-week washout period. Results: AVH were robustly improved (56%) by 5 days active rTMS, whereas no variation was observed after sham. Seven patient, were responders to active treatment five of whom maintained improvement for at least 2 months. frequency rTMS applied to the left temporoparietal cortex, compared with sham. Conclusions. These data confirm the efficiency of low stimulation, in reducing resistant AVH. This improvement can be obtained in only 5 days without serious initial adverse events.