Abstract
BackgroundRepetitive transcranial magnetic stimulation (rTMS) has been found to be effective in reducing frequency and duration of auditory verbal hallucinations (AVH). Priming stimulation, which involves high-frequency rTMS stimulation followed by low-frequency rTMS, has been shown to markedly enhance the neural response to the low-frequency stimulation train. However, this technique has not been investigated in recent onset schizophrenia patients. The aim of this randomized controlled study was to investigate whether the effects of rTMS on AVH can be enhanced with priming rTMS in recent onset schizophrenia patients.MethodsForty recent onset schizophrenia patients completed the study. Patients were randomized over two groups: one receiving low-frequency rTMS preceded by priming and another receiving low-frequency rTMS without priming. Both treatments were directed at the left temporo-parietal region. The severity of AVH and other psychotic symptoms were assessed with the auditory hallucination subscale (AHRS) of the Psychotic Symptom Rating Scales (PSYRATS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI).ResultsWe found that all the scores of these ratings significantly reduced over time (i.e. baseline through 1, 2, 4 and 6 weeks) in both the treatment groups. We found no difference between the two groups on all measures, except for significantly greater improvement on loudness of AVH in the group with priming stimulation during the follow-ups (F = 2.72; p < .05).ConclusionsWe conclude that low-frequency rTMS alone and high-frequency priming of low-frequency rTMS do not elicit significant differences in treatment of overall psychopathology, particularly AVH when given in recent onset schizophrenia patients. Add on priming however, seems to be particularly better in faster reduction in loudness of AVH.
Highlights
Auditory verbal hallucinations (AVH) are among the commonly presenting positive symptoms in patients of schizophrenia
Priming stimulation, which involves high-frequency (6 Hz) repetitive transcranial magnetic stimulation (rTMS) stimulation followed by low-frequency rTMS (1Hz), has been shown to markedly enhance the neural response to the lowfrequency stimulation train [5] and to have greater antidepressant effects than low-frequency rTMS alone when applied to right dorsolateral prefrontal cortex (DLPFC) [6,7]
As schizophrenia is associated with cortical hyperexcitability and deficits in cortical inhibition, it has been suggested that enhanced inhibition with priming stimulation would be more effective for refractory auditory verbal hallucinations (AVH) and better tolerated than higher frequency stimulation paradigms [8,9]
Summary
Auditory verbal hallucinations (AVH) are among the commonly presenting positive symptoms in patients of schizophrenia. Especially repetitive transcranial magnetic stimulation (rTMS) have been found to be effective in reducing frequency and duration of AVH. While both low and high-frequency (including theta burst), left and right temporo-parietal sites have been used as paradigms, low-frequency stimulation of left. Repetitive transcranial magnetic stimulation (rTMS) has been found to be effective in reducing frequency and duration of auditory verbal hallucinations (AVH). Priming stimulation, which involves high-frequency rTMS stimulation followed by low-frequency rTMS, has been shown to markedly enhance the neural response to the low-frequency stimulation train This technique has not been investigated in recent onset schizophrenia patients. The aim of this randomized controlled study was to investigate whether the effects of rTMS on AVH can be enhanced with priming rTMS in recent onset schizophrenia patients
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