M-L Paillère-Martinot1,2,3,4, A Galinowski2,3,4,5, M Plaze2,3,5, J Andoh2,6, D Bartrés-Faz2,7, F Bellivier8,9, J-P Lefaucheur10,11, D Rivière12, T Gallarda3,5, J-L Martinot2,3,4, E Artiges2,3,4,13. 1. AP-HP, Department of Adolescent Psychopathology and Medicine, Maison de Solenn, Cochin Hospital, Paris, France. 2. INSERM, U 1000, Research unit 'Imaging & Psychiatry', Service Hospitalier Frédéric Joliot, Orsay, France. 3. Université Paris Descartes, Paris, France. 4. University Paris-Sud, and University Paris-Saclay, Orsay, France. 5. SHU Department of Psychiatry, Sainte-Anne Hospital, Paris, France. 6. Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 7. Department of Psychiatry and Clinical Psychobiology, Faculty of Medicine, University of Barcelona, Barcelona, Spain. 8. AP-HP, Department of Psychiatry, Henri Mondor-Albert Chenevier Hospital, Créteil, France. 9. INSERM, U1144, Université Paris Diderot, Paris, France. 10. AP-HP, Physiology Department, Henri Mondor - Albert Chenevier Hospital, Créteil, France. 11. Université Paris 12, Créteil, France. 12. CEA, LNAO, NeuroSpin, Gif-sur-Yvette, France. 13. Psychiatry Department 91G16, GH Nord Essonne, Orsay, France.
Abstract
OBJECTIVE:Repetitive transcranial magnetic stimulation (rTMS) over the left temporo-parietal region has been proposed as a treatment for resistant auditory verbal hallucinations (AVH), but which patients are more likely to benefit from rTMS is still unclear. This study sought to assess the effects of rTMS on AVH, with a focus on hallucination phenomenology. METHOD: Twenty-seven patients with schizophrenia and medication-resistant AVH participated to a randomized, double-blind, placebo-controlled, add-on rTMS study. The stimulation targeted a language-perception area individually determined using functional magnetic resonance imaging and a language recognition task. AVH were assessed using the hallucination subscale of the Scale for the Assessment of Positive Symptoms (SAPS). The spatial location of AVH was assessed using the Psychotic Symptom Rating Scales. RESULTS: A significant improvement in SAPS hallucination subscale score was observed in both actively treated and placebo-treated groups with no difference between both modalities. Patients with external AVH were significantly more improved than patients with internal AVH, with both modalities. CONCLUSIONS: A marked placebo effect of rTMS was observed in patients with resistant AVH. Patients with prominent external AVH may be more likely to benefit from both active and placebo interventions. Cortical effects related to non-magnetic stimulation of the auditory cortex are suggested.
RCT Entities:
OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) over the left temporo-parietal region has been proposed as a treatment for resistant auditory verbal hallucinations (AVH), but which patients are more likely to benefit from rTMS is still unclear. This study sought to assess the effects of rTMS on AVH, with a focus on hallucination phenomenology. METHOD: Twenty-seven patients with schizophrenia and medication-resistant AVH participated to a randomized, double-blind, placebo-controlled, add-on rTMS study. The stimulation targeted a language-perception area individually determined using functional magnetic resonance imaging and a language recognition task. AVH were assessed using the hallucination subscale of the Scale for the Assessment of Positive Symptoms (SAPS). The spatial location of AVH was assessed using the Psychotic Symptom Rating Scales. RESULTS: A significant improvement in SAPS hallucination subscale score was observed in both actively treated and placebo-treated groups with no difference between both modalities. Patients with external AVH were significantly more improved than patients with internal AVH, with both modalities. CONCLUSIONS: A marked placebo effect of rTMS was observed in patients with resistant AVH. Patients with prominent external AVH may be more likely to benefit from both active and placebo interventions. Cortical effects related to non-magnetic stimulation of the auditory cortex are suggested.
Authors: Stephen J Brandt; Halimah Y Oral; Carla Arellano-Bravo; Martin H Plawecki; Tom A Hummer; Michael M Francis Journal: Neurotherapeutics Date: 2021-04-12 Impact factor: 7.620