Twice daily low frequency rTMS for treatment-resistant auditory hallucinations

• Jérôme Brunelin ^[1] ; Filipe Galvao ^[1] ; Marine Mondino ^[1]
  1. [1] Centre Hospitalier Le Vinatier

     Centre Hospitalier Le Vinatier

     Arrondissement de Lyon, Francia

     
• Localización: International journal of clinical and health psychology, ISSN 1697-2600, Vol. 23, Nº. 1, 2023, págs. 141-150
• Idioma: inglés
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• Resumen

  • Background Repetitive transcranial magnetic stimulation (rTMS) has emerged as a therapeutic solution in patients with treatment-resistant auditory verbal hallucinations. However, the optimal stimulation parameters remain unclear, especially for patients with clozapine-resistant symptoms.

    Method In an open label retrospective study, we investigated whether parameters of stimulation that were useful in patients with major depressive disorder would help schizophrenia patients with treatment-resistant auditory verbal hallucinations. Fourteen participants, including 9 under clozapine, received 30 sessions of 1 Hz rTMS over 3 weeks (360 pulses per sessions delivered with 60 s ‘on’ and 30 s ‘off’ at 110% of the resting motor threshold, 2 sessions per day). Stimulations were applied over the left temporoparietal junction (T3-P3 according to 10/20 system).

    Results After rTMS, a significant decrease of auditory verbal hallucinations was observed (−38.7% ± 31.8, p = 0.003) on the Auditory Hallucination Rating Scale. The beneficial effects were also significant in the 9 patients who were also receiving clozapine (−34.9% ± 28.4, p = 0.01).

    Conclusions Low frequency rTMS, 30 sessions over 3 weeks, appears to be a suitable approach to decrease treatment-resistant auditory verbal hallucinations, including in patients with clozapine-resistant symptoms. Results from the current retrospective study in the clinical settings need to be confirmed by large-scale randomized sham-controlled trials.