Treatment of Auditory Hallucinations With Bilateral Theta Burst Stimulation: A Randomized Controlled Pilot Trial

Abstract

Auditory hallucinations (AH) are a core symptom of schizophrenia, often leading to distress [ [1] Oorschot M. Lataster T. Thewissen V. Bentall R. Delespaul P. Myin-Germeys I. Temporal dynamics of visual and auditory hallucinations in psychosis. Schizophr Res. 2012; 140: 77-82 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar ]. Repetitive transcranial magnetic stimulation (TMS) applied to the left temporoparietal cortex has been shown to ameliorate AH in patients with schizophrenia [ [2] Hoffman R.E. Gueorguieva R. Hawkins K.A. et al. Temporoparietal transcranial magnetic stimulation for auditory hallucinations: safety, efficacy and moderators in a fifty patient sample. Biol Psychiatry. 2005; 58: 97-104 Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar ]. However, the effect sizes are moderate and an optimization of stimulation parameters would be desirable [ [3] Slotema C.W. Aleman A. Daskalakis Z.J. Sommer I.E. Meta-analysis of repetitive transcranial magnetic stimulation in the treatment of auditory verbal hallucinations: update and effects after one month. Schizophr Res. 2012; 142: 40-45 Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar ]. Continuous theta burst stimulation (cTBS), a patterned form of rTMS with brief stimulation sessions [ [4] Huang Y.Z. Edwards M.J. Rounis E. Bhatia K.P. Rothwell J.C. Theta burst stimulation of the human motor cortex. Neuron. 2005; 45: 201-206 Abstract Full Text Full Text PDF PubMed Scopus (2514) Google Scholar ] has recently been put forward as a new option to induce a more effective and quicker modulation of cortical hyperactivity and associated auditory hallucinations [ 5 Eberle M.C. Wildgruber D. Wasserka B. Fallgatter A.J. Plewnia C. Relief from chronic intractable auditory hallucinations after long-term bilateral theta burst stimulation. Am J Psychiatry. 2010 Nov; 167: 1410 Crossref PubMed Scopus (32) Google Scholar , 6 Sidhoumi D. Braha S. Bouaziz N. Brunelin J. Benadhira R. Januel D. Evaluation of the therapeutic effect of theta burst stimulation on drug-resistant auditory hallucinations in a schizophrenic patient and its impact on cognitive function and neuronal excitability: a case study. Clin Neurophysiol. 2010; 121: 802 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 7 Rachid F. Vianin P. Besse C. Safety and efficacy of continuous theta burst stimulation at 30 Hz in a patient with chronic auditory hallucinations: a case study in a private practice setting. Brain Stimul. 2013; 6: 707-708 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar , 8 Kindler J. Homan P. Flury R. Strik W. Dierks T. Hubl D. Theta burst transcranial magnetic stimulation for the treatment of auditory verbal hallucinations: results of a randomized controlled study. Psychiatry Res. 2013; 209: 114-117 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar ]. Moreover, recent studies indicate an additional critical involvement of the right temporoparietal cortex in the generation of AH [ [9] Hoffman R.E. Wu K. Pittman B. et al. Transcranial magnetic stimulation of Wernicke's and Right homologous sites to curtail “voices”: a randomized trial. Biol Psychiatry. 2013; 73: 1008-1014 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar ]. With this sham-controlled two-armed pilot trial, we aimed to provide a first estimate of efficacy as a basis for further larger clinical studies with bilateral cTBS to treat AH.