by Justin Jackson , Medical Xpress

A, Illustration of stimulation target on the left temporoparietal junction (TPJ) (left), distribution of the transcranial magnetic stimulation (TMS)–induced e-field in 1 patient (middle), and the individualized auditory verbal hallucination (AVH) network (right). B, The Auditory Hallucination Rating Scale (AHRS) reductions were positively correlated with e-field strength within each patient’s individualized AVH network (r = 0.54; P = .001) but not with the e-field strength within the TPJ target (r = 0.14; P = .44). Solid line indicates the regression line; shading, 95% CI for the regression line. Credit: JAMA Network Open (2024). DOI: 10.1001/jamanetworkopen.2024.44215

Research led by Anhui Medical University, China, has found that auditory verbal hallucinations in patients with schizophrenia can be alleviated by magnetic resonance imaging-navigated repetitive transcranial magnetic stimulation (rTMS). The findings are based on a six-week, double-blind, sham-controlled, randomized clinical trial involving 62 participants.

Auditory verbal hallucinations (AVH) are defined as hearing nonexistent spoken voices, a common and debilitating symptom of schizophrenia affecting approximately 75% of patients at initial presentation. AVH can persist despite antipsychotic treatment in up to 30% of cases. This persistence significantly diminishes quality of life and increases risks of suicide and violence, leaving an urgent unmet need for alternative therapies.

In the study, “Repetitive Transcranial Magnetic Stimulation for Auditory Verbal Hallucinations in Schizophrenia: A Randomized Clinical Trial,” published in JAMA Network Open, the team investigated the effect of imaging-navigated rTMS on AVH in patients with schizophrenia.

The purpose of the magnetic resonance imaging (MRI) was to better target specific brain regions with rTMS. Previous studies and treatments typically rely on the international 10-20 system as a standardized method for positioning the TMS coil based on EEG electrode landmarks. The 10-20 system places the coil at set distances between specific landmarks on a subject’s head, whereas the MRI-navigated method allows for direct and precise placement over the interior target area.

Participants were randomly assigned to receive either active or sham rTMS for two weeks over the left temporoparietal junction, a brain region associated with the generation of AVH, based on prior neuroimaging studies. Primary outcomes were measured using the Auditory Hallucination Rating Scale (AHRS) at baseline, after the two-week treatment period (week two), and during a follow-up assessment at week six.

Among the 62 participants, those receiving active rTMS showed a significant reduction in AHRS scores compared to the sham group at week two. These clinical effects were sustained at week six, indicating a lasting benefit.

By week two, the active rTMS group experienced an average 26.8% decrease in AHRS scores from baseline, whereas the sham group showed only a 4.4% decrease. This resulted in a between-group difference of approximately 22.4%, which was statistically significant, indicating a large and meaningful impact.

At week six, the active rTMS group continued to show a significant reduction in AHRS scores compared to the sham group, with an average 33.3% decrease in the active group versus a 3.5% decrease in the sham group.

A stronger TMS-induced electric field within a predefined AVH brain network was associated with greater reductions in AHRS scores.

These stronger fields were not from an increased rTMS output by researchers but rather the way individual neuroanatomy and variability in subregions and functional networks are able to receive rTMS treatment.

No serious adverse events were observed during the study, indicating that imaging-navigated rTMS is a safe treatment option for AVH in patients with schizophrenia.

The study authors acknowledge the need for more extensive multisite trials to replicate the findings and explore the effects of additional clinical factors on treatment efficacy.

More information: Qiang Hua et al, Repetitive Transcranial Magnetic Stimulation for Auditory Verbal Hallucinations in Schizophrenia, JAMA Network Open (2024). DOI: 10.1001/jamanetworkopen.2024.44215

Journal information:JAMA Network Open

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