Treatment of refractory auditory hallucinations in Schizophrenia with rTMS: A case series

Introduction: Persistent, distressing and disruptive auditory hallucinations are experienced in psychotic disorders frequently. Low-frequency (1Hz) repetitive transcranial magnetic stimulation on the left temporoparietal cortex has been used to successfully treat refractory auditory hallucinations. We report a case series concerning successful treatment of refractory auditory hallucinations with low-frequency rTMS on the left temporoparietal cortex. METHODOLOGY • The sample size consisted of three participants who had treatment- refractory auditory hallucinations. All participants had failed trials of two non-clozapine anti-psychotics. Low-frequency (1Hz) rTMS using the fgure-of-eight air-cooled coil from the Medistim Horizon machine was applied over the left temporoparietal cortex for 5 sessions per week (1600 pulses per session) for 2 weeks. The Hallucnations Change Scale (HCS) was used as an instrument for examining the outcome of rTMS treatment in the authors' institution. Results • On day 14 of rTMS, participants 1, 2 and 3 had an HCS score of 5, 2 and 10 respectively as compared to a baseline score of 10 in each of the participants on day 1 of rTMS. DISCUSSION AND CONCLUSION • All participants reported here were adult men aged between 23 and 5 years with a primary diagnosis of treatment-refractory schizophrenia and were on clozapine at the time of the study. • Two out of the three participants reported signifcant reduction in the degree of auditory hallucinations following low-frequency rTMS. • These changes were evident after a minimum of 12 sessions. • This case series confrms previous fndings of targeting left temporoparietal cortex in abolishing auditory hallucinations.