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High-Frequency Neuronavigated rTMS in Auditory Verbal Hallucinations: A Pilot Double-Blind Controlled Study in Patients With Schizophrenia

Sonia Dollfus 1, 2, 3 Nemat Jaafari 4, 5 Olivier Guillin 6, 7, 8 Benoit Trojak 9 Marion Plaze 10 Ghassen Saba 11 Cecilia Nauczyciel 12 Aurélie Montagne Larmurier 1, 2 Nathalie Chastan 13, 14 Vincent Meille 9 Marie-Odile Krebs 10 Samar Ayache 15 Jean Pascal Lefaucheur 16 Annick Razafimandimby 3 Elise Leroux 17 Rémy Morello 18 Jean Marie Batail 12 Perrine Brazo 3, 1, 2 Nicolas Lafay 5 Issa Wassouf 5 Ghina Harika-Germaneau 19 Rémy Guillevin 19 Carole Guillevin 20 Emmanuel Gérardin 21, 7 Maud Rotharmel 8 Benoît Crépon 10 Raphaël Gaillard 10 Christophe Delmas 8 Gael Fouldrin 7 Guillaume Laurent 8 Clément Nathou 1, 2, 3, 8 Olivier Etard 22
Abstract : Introduction: Despite extensive testing, the efficacy of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of temporo-parietal targets for the treatment of auditory verbal hallucinations (AVH) in patients with schizophrenia is still controversial, but promising results have been reported with both high-frequency and neuronavigated rTMS. Here, we report a double-blind sham-controlled study to assess the efficacy of high-frequency (20 Hz) rTMS applied over a precise anatomical site in the left temporal region using neuronavigation. Methods: Fifty-nine of 74 randomized patients with schizophrenia or schizoaffective disorders (DSM-IV R) were treated with rTMS or sham treatment and fully evaluated over 4 weeks. The rTMS target was determined by morphological MRI at the crossing between the projection of the ascending branch of the left lateral sulcus and the superior temporal sulcus (STS). Results: The primary outcome was response to treatment, defined as a 30% decrease of the Auditory Hallucinations Rating Scale (AHRS) frequency item, observed at 2 successive evaluations. While there was no difference in primary outcome between the treatment groups, the percentages of patients showing a decrease of more than 30% of AHRS score (secondary outcome) did differ between the active (34.6%) and sham groups (9.1%) (P = .016) at day 14. Discussion: This controlled study reports negative results on the primary outcome but demonstrates a transient effect of 20 Hz rTMS guided by neuronavigation and targeted on an accurate anatomical site for the treatment of AVHs in schizophrenia patients.
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Submitted on : Monday, July 22, 2019 - 3:01:11 PM
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Sonia Dollfus, Nemat Jaafari, Olivier Guillin, Benoit Trojak, Marion Plaze, et al.. High-Frequency Neuronavigated rTMS in Auditory Verbal Hallucinations: A Pilot Double-Blind Controlled Study in Patients With Schizophrenia. Schizophrenia Bulletin, Oxford University Press (OUP), 2018, 44 (3), pp.505-514. ⟨10.1093/schbul/sbx127⟩. ⟨hal-02190488⟩



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