Magnetic Stimulation Reduced Auditory Hallucinations in Patients With Schizophrenia

For patients with schizophrenia, repetitive transcranial magnetic stimulation (rTMS) was effective and safe in treating auditory verbal hallucinations, according to a randomized sham-controlled trial.

A post-hoc analysis of a trial of 62 participants found that those who received active rTMS experienced a significantly greater reduction in Auditory Hallucination Rating Scale (AHRS) scores (difference 5.96, 95% CI 3.42-8.50, P

These clinical effects were sustained at week 6 (group difference 7.89, 95% CI 4.77-11.01, PJAMA Network Open.

Intention-to-treat analyses revealed significant time-by-group interactions for AHRS scores at week 2 and week 6 (P

They also noted that providing patients with a stronger TMS-induced electric field was associated with greater reductions in AHRS scores (P=0.002).

In the clinical setting, “rTMS with neuronavigation is an effective treatment for schizophrenia patients,” Ji told MedPage Today in an email, adding that “precise location of the target is quite important. To further improve clinical efficiency, the e-field induced by TMS should be optimized for each patient.”

Ji noted that efficiency of rTMS treatment for auditory verbal hallucination symptoms has been mixed in previous trials. He added that one critical issue with many of those studies was imprecise locations for targeted stimulation.

“We overcome this limitation by using a neuronavigation system to monitor the spatial alignment between a given target and TMS coil during treatment,” Ji said. “Thus, the take-home message is precise navigation is necessary to achieve significant efficiency of rTMS.”

Ji noted that they also found significant alleviation in Positive and Negative Syndrome Scale (PANSS) scores during secondary analyses, even though the treatment protocol was only designed for auditory verbal hallucination symptoms.

To conduct this 6-week, double-blind, sham-controlled, randomized clinical trial, the authors included 66 participants with both auditory verbal hallucination symptoms and schizophrenia from the Anhui Mental Health Center. The participants were recruited from September 2016 to August 2021.

There were 62 participants who completed treatment for 2 weeks. Among those individuals, 53% were women and mean age was 27.4 years.

Participants were randomized to an active rTMS group (n=32) and a sham treatment group (n=30). For the rTMS treatment, participants received three daily sessions for 2 weeks using a 70-mm air-cooled figure-of-8 coil. The sham treatment was delivered using equipment that was identical in appearance, but only generated sound and sensation on the participants’ scalp but no current.

The authors noted that there was no statistically significant difference between groups in terms of how many correctly guessed their treatment group.

Major limitations included that this was a single-center trial with a small sample size and that a longer follow-up period is needed to determine how long the treatment effect lasted. The authors also noted that they did not test the effects of the treatment on cognitive function during the trial.