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• W1967075787 abstract "Back to table of contents Previous article Next article Letters to the EditorFull AccessMaintenance Treatment With Transcranial Magnetic Stimulation in a Patient With Late-Onset SchizophreniaEMMANUEL POULET M.D., Ph.D.JEROME BRUNELIN Ph.D.LASSAD KALLEL M.D.THIERRY D’AMATO M.D., Ph.D.MOHAMED SAOUD M.D., Ph.D.,EMMANUEL POULET M.D., Ph.D.Search for more papers by this authorJEROME BRUNELIN Ph.D.Search for more papers by this authorLASSAD KALLEL M.D.Search for more papers by this authorTHIERRY D’AMATO M.D., Ph.D.Search for more papers by this authorMOHAMED SAOUD M.D., Ph.D.Search for more papers by this author,Published Online:1 Apr 2008https://doi.org/10.1176/appi.ajp.2007.07060868AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A recent meta-analysis (1) concluded that repetitive transcranial magnetic stimulation (rTMS) efficiently reduces resistant auditory hallucinations in patients with schizophrenia (effect size=0.76). Nevertheless, treatment is presently only provided over short periods of time, and little is known about longer-term impact. Maintenance treatment protocols have been developed, and we previously described a case report involving a maintenance protocol with a weekly, once-a-day stimulation (2) ; however, we failed to demonstrate long-term benefits. To our knowledge, the case presented below is the first report of a twice-daily transcranial magnetic stimulation as efficacious for auditory hallucinations, both in acute and maintenance treatment. “Ms. A,” a 55-year-old right-handed, postmenopausal woman who had DSM-IV late-onset schizophrenia with an illness duration of 2 years, was referred for transcranial magnetic stimulation treatment. She was noted to have benzodiazepine addiction involving the use of lorazepam (9 mg/day). She had been suffering from resistant auditory hallucinations for 2 years (very frequent and loud, with >5 critical and command voices). She was unresponsive to four antipsychotic medication trials lasting >4 months each, including haloperidol (5 mg/day), amisulpride (1200 mg/day), olanzapine (15 mg/day), and risperidone (8 mg/day). A detailed assessment did not reveal any other pathology or transcranial magnetic stimulation contraindications. Auditory hallucinations were assessed using the Auditory Hallucination Rating Scale (3) , and positive symptoms were assessed using the Scale for the Assessment of Positive Symptoms (SAPS). Lorazepam withdrawal was completed without exacerbation of the psychotic symptoms (Auditory Hallucination Rating Scale score: 34). Four months after her initial presentation, the patient gave informed consent and was included in a transcranial magnetic stimulation protocol. Twice-a-day, 1000 low-frequency repetitive stimulations (1 Hz) were administered to the temporoparietal cortex at 100% of motor threshold over a 5-day period. The patient’s current dose of risperidone was maintained during treatment with transcranial magnetic stimulation. After the first course, auditory hallucinations were moderately improved, with a 35% reduction in her Auditory Hallucination Rating Scale score, which did not change over the next several months, as observed in a follow-up assessment. However, the patient’s general SAPS score improved, with a 30% reduction in severity. Six months after the first course of transcranial magnetic stimulation therapy, the patient presented with a relapse of hallucinations. A new transcranial magnetic stimulation course, with the same parameters, was conducted. This second course was followed by a once-per-month, twice-daily maintenance protocol (one session in the morning, the other in the afternoon on the same day). The patient’s auditory hallucinations were greatly improved, by 80%, and her SAPS score decreased from 38 to 16. This maintenance course was associated with a remission of auditory hallucination symptoms, with a stabilization of SAPS scores at 10 over the next 6 months. Presently, more than 1 year later, Ms. A is not receiving any antipsychotic medication, and her Auditory Hallucination Rating Scale and SAPS scores remain at 0.Our case raises the question as to whether twice-daily transcranial magnetic stimulation may be useful in some patients as a possible maintenance intervention. Certainly, further research will help us to understand whether the benefits observed in this single case might also be evident in larger studies.Lyon, France and Bron, FranceThe authors report no competing interests.This letter (doi: 10.1176/appi.ajp.2007.07060868) was accepted for publication in October 2007.References1. Aleman A, Sommer IE, Kahn RS: Efficacy of slow repetitive transcranial magnetic stimulation in the treatment of resistant auditory hallucinations in schizophrenia: a meta-analysis. J Clin Psychiatry 2007; 68:416–421Google Scholar2. Poulet E, Brunelin J, Kallel L, Bediou B, Dalery J, D’amato T, Saoud M: Is rTMS efficient as a maintenance treatment for auditory verbal hallucinations? a case report. Schizophr Res 2006; 84:183–184Google Scholar3. Hoffman RE, Hawkins KA, Gueorguieva R, Boutros NN, Rachid F, Carroll K, Krystal JH: Transcranial magnetic stimulation of left temporoparietal cortex and medication-resistant auditory hallucinations. Arch Gen Psychiatry 2003; 60:49–56Google Scholar FiguresReferencesCited byDetailsCited byLetter to the editor: Safety of “accelerated” rTMS protocols with twice-daily sessions in patients with schizophrenia – A comment on Caulfield et al.Journal of Psychiatric Research, Vol. 156Reply to “Letter to the editor: Safety of “accelerated” rTMS protocols with twice-daily sessions in patients with schizophrenia – A comment on Caulfield et al.”Journal of Psychiatric Research, Vol. 156Assessment of treatment resistance criteria in non-invasive brain stimulation studies of schizophreniaSchizophrenia Research, Vol. 243The Use of rTMS in Other Psychiatric Disorders1 January 2022Theta-Burst Stimulation for Auditory-Verbal Hallucination in Very-Late-Onset Schizophrenia-Like Psychosis—A Functional Magnetic Resonance Imaging Case Study20 April 2020 | Frontiers in Psychiatry, Vol. 11Repetitive transcranial magnetic stimulation for psychiatric disorders other than depression5 March 2016Hearing Research, Vol. 295Treatment of auditory verbal hallucinations with transcranial magnetic stimulation in a patient with psychotic major depression: One-year follow-upNeurocase, Vol. 18, No. 1Stimulation magnétique transcrânienne répétée (rTMS) et symptômes négatifs de la schizophrénieAnnales Médico-psychologiques, revue psychiatrique, Vol. 168, No. 6Stimulation magnétique transcrânienne répétée (rTMS) et schizophrénie : vers de nouvelles opportunités thérapeutiques ?Annales Médico-psychologiques, revue psychiatrique, Vol. 168, No. 5Brain Stimulation, Vol. 3, No. 4Schizophrenia Bulletin, Vol. 36, No. 1Current Opinion in Psychiatry, Vol. 23, No. 2Acta Psychiatrica Scandinavica, Vol. 122, No. 5Brain Stimulation, Vol. 2, No. 2Neuropsychologia, Vol. 47, No. 1Schizophrenia Research, Vol. 108, No. 1-3Schizophrenia Research, Vol. 113, No. 1International Journal of Geriatric Psychiatry, Vol. 23, No. 9 Volume 165Issue 4 April, 2008Pages 537-538THE AMERICAN JOURNAL OF PSYCHIATRY April 2008 Volume 165 Number 4 Metrics PDF download History Published online 1 April 2008 Published in print 1 April 2008" @default.
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