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Letter to the Editor| Volume 7, ISSUE 2, P340-341, March 2014

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

Published:January 10, 2014DOI:https://doi.org/10.1016/j.brs.2014.01.001
Treatment of Auditory Hallucinations With Bilateral Theta Burst Stimulation: A Randomized Controlled Pilot Trial
Previous ArticleAfferent Inhibition of Infraspinatus Primary Motor Cortex by Stimulation of the Suprascapular Nerve
Next ArticleAwareness of Symptoms Amelioration Following Low-frequency Repetitive Transcranial Magnetic Stimulation in a Patient With Tourette Syndrome and Comorbid Obsessive-compulsive Disorder
      Auditory hallucinations (AH) are a core symptom of schizophrenia, often leading to distress [
      • 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
      ]. Repetitive transcranial magnetic stimulation (TMS) applied to the left temporoparietal cortex has been shown to ameliorate AH in patients with schizophrenia [
      • 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
      ]. However, the effect sizes are moderate and an optimization of stimulation parameters would be desirable [
      • 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
      ]. Continuous theta burst stimulation (cTBS), a patterned form of rTMS with brief stimulation sessions [
      • 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
      ] has recently been put forward as a new option to induce a more effective and quicker modulation of cortical hyperactivity and associated auditory hallucinations [
      • 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
      ,
      • 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
      ,
      • 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
      ,
      • 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
      ]. Moreover, recent studies indicate an additional critical involvement of the right temporoparietal cortex in the generation of AH [
      • 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
      ]. 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.
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      References

        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • Haddock G.
        • McCarron J.
        • Tarrier N.
        • Faragher E.B.
        Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS).
        Psychol Med. 1999; 29: 879-889
        View in Article

      Article info

      Publication history

      Published online: January 10, 2014
      Accepted: January 3, 2014
      Received in revised form: December 12, 2013
      Received: December 3, 2013

      Footnotes

      Financial disclosures: Dr. Plewnia received funding not related to this research from the German Research Council (DFG; 525 PL1-1) and speaker's honoraria by inomed Medizintechnik GmbH, Emmendingen, Germany and Dr. Willmar Schwabe GmbH & Co. KG, Ettlingen, Germany. Dr. Zwissler is supported by a research grant from the University Hospital Tübingen (fortüne research grant 2086-1-0). Dr. Fallgatter received funding not related to this research from the German Research Council (DFG, FA 361/21-1, FA 361/22-1, SFB-TRR 58, KFO-125-1/2, GSC 1028), the Federal Ministry of Education and Research (BMBF, Panic Net Subproject C4; EUROSTARS E!7675 PONS) and sponsoring for an Investigator Initiated Trial by Astra Zeneca. Dr. Klingberg received public grants not related to this research from the German Ministry of Education and Research (grant no. 01GV0618) and from the German Research Foundation (grant no. KL1179/3-1, KL1179/2-1). B. Wasserka reported no biomedical financial interests or potential conflicts of interest.

      Identification

      DOI: https://doi.org/10.1016/j.brs.2014.01.001

      Copyright

      © 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

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