Repetitive transcranial magnetic stimulation in the treatment of auditory hallucinations in schizophrenic patients.

PURPOSE OF REVIEW: Since 1999, most studies have confirmed the initial positive results in the treatment of auditory verbal hallucination (AVH) with repetitive transcranial magnetic stimulation (rTMS) targeted to the classical site in the left temporo-parietal region. However, recent literature has tempered the initial interest in this treatment, requiring a new review on this topic.

RECENT FINDINGS: From the four meta-analyses, the latest reported a moderate effect size of 0.54. Two recent controlled studies, not included in the meta-analyses, failed to observe a significant improvement of AVH after 1 Hz rTMS. While almost all trials have studied the effects of low-frequency rTMS (1Hz), two recent procedures using high-frequency (20 Hz) or continuous theta burst stimulation showed promising results. The interest in using cerebral imaging to increase the efficacy of rTMS in the treatment of AVH has not been clearly demonstrated.

SUMMARY: Using rTMS to treat auditory hallucinations now seems less promising than it did 10 years ago because of the variable clinical effects and the high level of placebo responders. Evidence is still lacking concerning the maintenance treatment and the neurobiological underpinnings of rTMS efficacy, underscoring the need for further studies.