http://archpsyc.jamanetwork.com/ en-us Mon, 17 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:43:56 GMT Silverchair editor@archpsyc.jamanetwork.com webmaster@archpsyc.jamanetwork.com http://archpsyc.jamanetwork.com/article.aspx?articleID=207057 Wed, 01 Jan 2003 00:00:00 GMT Hoffman RE, Hawkins KA, Gueorguieva R, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>Neuroimaging studies suggest that auditory hallucinations (AHs) of speech arise, at least in part, from activation of brain areas underlying speech perception. One-hertz repetitive transcranial magnetic stimulation (rTMS) produces sustained reductions in cortical activation. Recent results of 4-day administration of 1-Hz rTMS to left temporoparietal cortex were superior to those of sham stimulation in reducing AHs. We sought to determine if a more extended trial of rTMS could significantly reduce AHs that were resistant to antipsychotic medication.<div class="boxTitle">Methods</div>Twenty-four patients with schizophrenia or schizoaffective disorder and medication-resistant AHs were randomly allocated to receive rTMS or sham stimulation for 9 days at 90% of motor threshold. Patients receiving sham stimulation were subsequently offered an open-label trial of rTMS. Neuropsychological assessments were administered at baseline and during and following each arm of the trial.<div class="boxTitle">Results</div>Auditory hallucinations were robustly improved with rTMS relative to sham stimulation. Frequency and attentional salience were the 2 aspects of hallucinatory experience that showed greatest improvement. Duration of putative treatment effects ranged widely, with 52% of patients maintaining improvement for at least 15 weeks. Repetitive transcranial magnetic stimulation was well tolerated, without evidence of neuropsychological impairment.<div class="boxTitle">Conclusions</div>These data suggest that the mechanism of AHs involves activation of the left temporoparietal cortex. One-hertz rTMS deserves additional study as a possible treatment for this syndrome.</span> 60 1 49 56 10.1001/archpsyc.60.1.49 http://archpsyc.jamanetwork.com/article.aspx?articleID=207057