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

Oded Rosenberg, Yiftach Roth, Moshe Kotler, Abraham Zangen, Pinhas Dannon, Oded Rosenberg, Yiftach Roth, Moshe Kotler, Abraham Zangen, Pinhas Dannon

Abstract

Background: Schizophrenia is a chronic and disabling disease that presents with delusions and hallucinations. Auditory hallucinations are usually expressed as voices speaking to or about the patient. Previous studies have examined the effect of repetitive transcranial magnetic stimulation (TMS) over the temporoparietal cortex on auditory hallucinations in schizophrenic patients. Our aim was to explore the potential effect of deep TMS, using the H coil over the same brain region on auditory hallucinations.

Patients and methods: 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).

Results: 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%).

Conclusions: 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.

Trial registration: This trial is registered with clinicaltrials.gov (identifier: NCT00564096).

Figures

Figure 1
Figure 1
Electric field distribution maps of the H1 coil when placed during stimulation over the left temporoparietal cortex, at an intensity of 110% of a typical abductor policis brevis (APB) motor threshold. The images are based on electric field measurements in a phantom head model filled with saline water at physiological concentration.
Figure 2
Figure 2
Average scores of Auditory Hallucinations Rating Scale (AHRS), Scale for the Assessment of Positive Symptoms (SAPS) and Scale for Assessment of Negative Symptoms (SANS) (with standard error of mean (SEM)) 1 day before treatment (baseline), 1 day after last session (end of treatment), 1 week after last session and at 1 month after last session in the 10-session group.
Figure 3
Figure 3
Average scores of Auditory Hallucinations Rating Scale (AHRS), Scale for the Assessment of Positive Symptoms (SAPS) and Scale for Assessment of Negative Symptoms (SANS) (with standard error of mean (SEM)) 1 day before treatment (baseline), 1 day after last session (end of treatment), 1 week after last session and at 1 month after last session in the 20-session group.

References

    1. Hugdahl K, Løberg EM, Jørgensen HA, Lundervold A, Lund A, Green MF, Rund B. Left hemisphere lateralization of auditory hallucinations in schizophrenia: a dichotic listening study. Cogn Neuropsychiatry. 2008;13:166–179. doi: 10.1080/13546800801906808.
    1. Tranulis C, Sepehry AA, Galinowski A, Stip E. Should we treat auditory hallucinations with repetitive transcranial magnetic stimulation? A metaanalysis. Can J Psychiatry. 2008;53:577–586.
    1. Poulet E, Brunelin J, Bediou B, Bation R, Forgeard L, Dalery J, d'Amato T, Saoud M. Slow transcranial magnetic stimulation can rapidly reduce resistant auditory hallucinations in schizophrenia. Biol Psychiatry. 2005;57:188–191. doi: 10.1016/j.biopsych.2004.10.007.
    1. Hoffman RE, Hawkins KA, Gueorguieva R, Boutros NN, Rachid F, Carroll K, Krystal JH. Transcranial magnetic stimulation of left temporoparietal cortex and medication-resistant auditory hallucinations. Arch Gen Psychiatry. 2003;60:49–56. doi: 10.1001/archpsyc.60.1.49.
    1. Shergill SS, Murray RM, McGuire PK. Auditory hallucinations: a review of psychological treatments. Schizophr Res. 1998;32:137–150. doi: 10.1016/S0920-9964(98)00052-8.
    1. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985;8437:1106–1107. doi: 10.1016/S0140-6736(85)92413-4.
    1. Fitzgerald PB, Daskalakis ZJ. A review of repetitive transcranial magnetic stimulation use in the treatment of schizophrenia. Can J Psychiatry. 2008;53:567–576.
    1. Hoffman RE, Boutros NN, Berman RM, Roessler E, Belger A, Krystal JH, Charney DS. Transcranial magnetic stimulation of left temporoparietal cortex in three patients reporting hallucinated "voices". Biol Psychiatry. 1999;46:130–132. doi: 10.1016/S0006-3223(98)00358-8.
    1. Thirthalli J, Bharadwaj B, Kulkarni S, Gangadhar BN, Kharawala S, Andrade C. Successful use of maintenance rTMS for 8 months in a patient with antipsychotic-refractory auditory hallucinations. Schizophr Res. 2008;100:351–352. doi: 10.1016/j.schres.2008.01.003.
    1. Poulet E, Brunelin J, Kallel L, Bediou B, Dalery J, D'amato T, Saoud M. Is rTMS efficient as a maintenance treatment for auditory verbal hallucinations? A case report. Schizophr Res. 2006;84:183–184. doi: 10.1016/j.schres.2006.02.014.
    1. Lee SH, Kim W, Chung YC, Jung KH, Bahk WM, Jun TY, Kim KS, George MS, Chae JH. A double blind study showing those two weeks of daily repetitive TMS over the left or right temporoparietal cortex reduces symptoms in patients with schizophrenia who are having treatment-refractory auditory hallucinations. Neurosci Lett. 2005;376:177–181. doi: 10.1016/j.neulet.2004.11.048.
    1. Rosenberg O, Shoenfeld N, Zangen A, Kotler M, Dannon PN. Deep TMS in a resistant major depressive disorder: a brief report. Depress Anxiety. 2010;27:465–469. doi: 10.1002/da.20689.
    1. Rosenberg O, Zangen A, Stryjer R, Kotler M, Dannon PN. Response to Deep TMS in depressive patients with previous electroconvulsive treatment. Brain Stimul. 2010;3:211–217. doi: 10.1016/j.brs.2009.12.001.
    1. Levkovitz Y, Harel EV, Roth Y, Braw Y, Most D, Katz LN, Sheer A, Gersner R, Zangen A. Deep TMS over prefrontal cortex: evaluation of antidepressant and cognitive effects in depressive patients. Brain Stimul. 2009;2:188–200. doi: 10.1016/j.brs.2009.08.002.
    1. Zangen A, Roth Y, Voller B, Hallett M. Transcranial magnetic stimulation of deep brain regions: evidence for efficacy of the H-coil. Clin Neurophysiol. 2005;116:775–779. doi: 10.1016/j.clinph.2004.11.008.
    1. Roth Y, Zangen A, Hallett M. A coil design for transcranial magnetic stimulation of deep brain regions. J. Clin Neurophysiol. 2002;19:361–370. doi: 10.1097/00004691-200208000-00008.
    1. Levkovitz Y, Roth Y, Harel EV, Braw Y, Sheer A, Zangen A. A randomized controlled feasibility and safety study of deep transcranial magnetic stimulation. Clin Neurophysiol. 2007;118:2730–2744. doi: 10.1016/j.clinph.2007.09.061.
    1. Chanpattana W, Sackeim HA. Electroconvulsive therapy in treatment-resistant schizophrenia: prediction of response and the nature of symptomatic improvement. J ECT. 2010;26:289–298. doi: 10.1097/YCT.0b013e3181cb5e0f.
    1. Loo CK, Sainsbury K, Mitchell P, Hadzi-Pavlovic D, Sachdev PS. A sham-controlled trial of left and right temporal rTMS for the treatment of auditory hallucinations. Psychol Med. 2009;6:1–6.
    1. Vercammen A, Knegtering H, Bruggeman R, Westenbroek HM, Jenner JA, Slooff CJ, Wunderink L, Aleman A. Effects of bilateral repetitive transcranial magnetic stimulation on treatment resistant auditory-verbal hallucinations in schizophrenia: a randomized controlled trial. Schizophr Res. 2009;14:172–179. doi: 10.1016/j.schres.2009.07.013.
    1. Schreiber S, Dannon PN, Goshen E, Amiaz R, Zwas TS, Grunhaus L. Right prefrontal rTMS treatment for refractory auditory command hallucinations - a neuroSPECT assisted case study. Psychiatry Res. 2002;116:113–117. doi: 10.1016/S0925-4927(02)00065-3.
    1. Sommer IE, de Weijer AD, Daalman K, Neggers SF, Somers M, Kahn RS, Slotema CW, Blom JD, Hoek HW, Aleman A. Can fMRI-guidance improve the efficacy of rTMS treatment for auditory verbal hallucinations? Schizophr Res. 2007;93:406–408. doi: 10.1016/j.schres.2007.03.020.

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