The efficacy of fMRI guided 1 Hz versus 20 Hz repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of Auditory Verbal Hallucinations (AVH)

Abstract

Despite treatment with pharmacotherapy, some patients continue to suffer from auditory verbal hallucinations (AVH). Several studies concluded that low and high frequency repetitive Transcranial Magnetic Stimulation (rTMS) could offer an alternative treatment for these patients. The aim of this study is to verify whether 1 Hz (low) or 20 Hz (high) fMRI guided rTMS is more effective in the treatment for AVH. 16 psychotic patients with treatment-resistant auditory verbal hallucinations were included and randomly allocated to one of the two treatment conditions, 1 Hz or 20 Hz fMRI guided rTMS. Three measures were used for determining the severity of AVH; the Auditory Hallucination Rating Scale (AHRS) total score, the Hallucinations Change Scale (HCS) and Positive and Negative Syndrome Scale (PANSS) item three. The AHRS total score and the HCS showed improvement in both groups after rTMS treatment. The HCS showed a trend towards significance indicating greater improvement after 20 Hz rTMS treatment compared to 1 Hz rTMS treatment. At last, the patients in the 20 Hz treatment condition had lower scores in general on the AHRS total score, and there was a trend towards significance for the same effect for the scores on the HCS. More placebo-controlled research with larger sample sizes is needed to investigate the potential of high frequency rTMS in the treatment of AVH.