Transcranial magnetic stimulation of left temporoparietal cortex and medication-resistant auditory hallucinations

Arch Gen Psychiatry. 2003 Jan;60(1):49-56. doi: 10.1001/archpsyc.60.1.49.


Background: Neuroimaging studies suggest that auditory hallucinations (AHs) of speech arise, at least in part, from activation of brain areas underlying speech perception. One-hertz repetitive transcranial magnetic stimulation (rTMS) produces sustained reductions in cortical activation. Recent results of 4-day administration of 1-Hz rTMS to left temporoparietal cortex were superior to those of sham stimulation in reducing AHs. We sought to determine if a more extended trial of rTMS could significantly reduce AHs that were resistant to antipsychotic medication.

Methods: Twenty-four patients with schizophrenia or schizoaffective disorder and medication-resistant AHs were randomly allocated to receive rTMS or sham stimulation for 9 days at 90% of motor threshold. Patients receiving sham stimulation were subsequently offered an open-label trial of rTMS. Neuropsychological assessments were administered at baseline and during and following each arm of the trial.

Results: Auditory hallucinations were robustly improved with rTMS relative to sham stimulation. Frequency and attentional salience were the 2 aspects of hallucinatory experience that showed greatest improvement. Duration of putative treatment effects ranged widely, with 52% of patients maintaining improvement for at least 15 weeks. Repetitive transcranial magnetic stimulation was well tolerated, without evidence of neuropsychological impairment.

Conclusions: These data suggest that the mechanism of AHs involves activation of the left temporoparietal cortex. One-hertz rTMS deserves additional study as a possible treatment for this syndrome.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Antipsychotic Agents / therapeutic use
  • Drug Resistance
  • Female
  • Functional Laterality / physiology
  • Hallucinations / diagnosis
  • Hallucinations / drug therapy
  • Hallucinations / therapy*
  • Humans
  • Male
  • Neuropsychological Tests
  • Parietal Lobe / physiology*
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / therapy
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy
  • Schizophrenia / therapy*
  • Schizophrenic Psychology
  • Temporal Lobe / physiology*
  • Transcranial Magnetic Stimulation / therapeutic use*
  • Treatment Outcome


  • Antipsychotic Agents