Repetitive Transcranial Magnetic Stimulation Safely Treats Schizophrenia Symptoms

Repetitive transcranial magnetic stimulation (rTMS) safely and effectively alleviates auditory verbal hallucinations in patients with schizophrenia, according to findings published in JAMA Network Open.

Researchers conducted a single-site, 6-week double-blind, sham-controlled, randomized clinical trial (ClinicalTrials.gov Identifier: NCT02863094) at the Anhui Mental Health Center in Hefei, China between September 2016 and August 2021 to evaluate the efficacy and safety of imaging-navigated rTMS in the treatment of auditory verbal hallucinations among patients with schizophrenia.

Participants aged between 18 and 60 who were diagnosed with schizophrenia and medication-resistant auditory verbal hallucinations and had received a stable dosage of antipsychotic medication for at least 2 weeks prior to the study were randomly assigned 1:1 to receive either imaging-guided active or sham rTMS over the left temporoparietal junction for 2 weeks.

The primary outcome was change in Auditory Hallucination Rating Scale (AHRS) score from baseline to weeks 2 and 6. Linear mixed-effects models were used in statistical analysis.

A total of 62 participants (mean age, 27.4; women, 53%) were included in the study, of whom 32 (mean age, 26.9; women, 56%) were assigned to the active group and 30 (mean age, 27.8; women, 50%) to the sham group.

Participants in the active vs sham group demonstrated a greater reduction in AHRS scores at weeks 2 (between-group difference, 5.96; 95% CI, 3.42-8.50; P <.001) and 6 (between-group difference, 7.89; 95% CI, 4.77-11.01; P <.001).

Compared with participants in the sham group, those in the active group had higher response rates at weeks 2 (47% vs 13%; P =.004) and 6 (50% vs 6%; P =.002).

No significant difference in the rates of adverse events (AEs) between the active and sham treatment groups was reported. The most common AE was sleepiness. No serious AEs were observed. 

Study limitations include the single-center design and small sample size, inability to test the rTMS effect on cognition, short follow-up duration, and possible detection bias.

“Future studies should consider the role of individual e-fields in individualized symptom networks to improve treatment efficacy,” the researchers concluded.