Efficacy of slow repetitive transcranial magnetic stimulation in the treatment of resistant auditory hallucinations in schizophrenia: A meta-analysis

Andre Aleman*, Iris E. Sommer, Rene S. Kahn

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

213 Citations (Scopus)

Abstract

Objective: Slow repetitive transcranial magnetic stimulation (rTMS), at a frequency of 1 Hz, has been proposed as a treatment for auditory hallucinations. Several studies have now been reported regarding the efficacy of TMS treatment, but results were inconsistent. Therefore, meta-analytic integration of the published trials is needed to evaluate the prospects of this new treatment.

Data sources: A literature search was conducted using PubMed and Web of Science for the years 1966 until February 2006. We used the search terms transcranial magnetic stimulation, TMS, rTMS, and hallucination*.

Study selection: From 15 treatment studies published since 1999, ten were sham-controlled trials and provided sufficient valid information to be included. All studies targeted the left temporoparietal cortex using I Hz rTMS.

Data extraction: Standardized mean gain effect sizes of real rTMS versus sham rTMS were computed based on pretreatment-posttreatment comparisons (computed from mean and SD values or t or F statistics).

Data synthesis: After calculation of treatment gain on hallucination ratings using standardized mean differences (sham vs. active rTMS), a mean weighted effect size was computed in the random effects model. We observed a significant mean weighted effect size for rTMS versus sham across the 10 studies, involving 212 patients, d = 0.76 (95% Cl = 0.36 to 1.17). When only studies were included that used continuous stimulation (9 studies), the mean effect size increased to d = 0.88 and heterogeneity disappeared. There was no significant effect of rTMS on a composite index of general psychotic symptoms.

Conclusions: The results of this meta-analysis provide evidence for the efficacy of rTMS as an intervention that selectively alters neurobiologic factors underlying auditory hallucinations.

Original languageEnglish
Pages (from-to)416-421
Number of pages6
JournalJournal of Clinical Psychiatry
Volume68
Issue number3
Publication statusPublished - Mar-2007

Keywords

  • LEFT TEMPOROPARIETAL CORTEX
  • FUNCTIONAL NEUROANATOMY
  • CONTROLLED-TRIAL
  • DEPRESSION
  • VOICES
  • BRAIN
  • TMS
  • ACTIVATION
  • SYMPTOMS
  • RTMS

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