Efficacy of Slow Repetitive Transcranial Magnetic Stimulation in the Treatment of Resistant Auditory Hallucinations in Schizophrenia: A Meta-Analysis
J Clin Psychiatry 2007;68(3):416-421
© Copyright 2016 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
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 1 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% CI = 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.