Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Prospective Multicenter Double Blind Randomized Controlled Trial to Explore the Tolerability, Safety and Efficacy of the H1-Coil Deep Transcranial Magnetic Stimulation (TMS) in Subjects With Schizophrenia Experiencing Auditory Hallucinations
Brief Summary: Until recently stimulation of nervous tissue deeper than approximately 2 cm from the scalp (will hence be called non-deep TMS) was not possible (3).A new coil ("H"-coil invented in Weizmann Institute of Science, Neurobiology Department, Rehovot, Israel ) capable of stimulating more than twice this depth (Up to 5 cm)was recently developed.Deep TMS is using this h-coil.

Auditory hallucinations are reported by 50% to 70% of patients with schizophrenia and generally consist of spoken speech or "voices." . Patients usually describe the hallucinatory experience as distressing, consistent with evidence that the most common hallucinated utterances are abusive terms,contributing in up to 25% of the cases to a serious suicide attempt.The neuroanatomical basis of auditory hallucinations is thought to involve increasing blood flow of the speech perception areas of the brain, such as the superior temporal cortex of the dominant hemisphere as well as right and left superior temporal cortex.Brain imaging studies of patients with auditory hallucinations have revealed an active area in the right and left superior temporal cortex, Broca's area, and the left temporoparietal cortex. Shergill et al. reported the presence of active areas in the anterior cingulate cortex, right thalamus, left hippocampus, and parahippocampal cortex when subjects were experiencing auditory hallucinations.

Magnetic Stimulation of Left Temporoparietal Cortex suggest that the mechanism of auditory hallucinations involves activation of the left temporoparietal cortex.Reasons to believe that right frontotemporal TMS stimulation cortex can ameliorate auditory hallucinations include evidence that right temporoparietal stimulation achieved significant changes in the frequency of auditory hallucinations,in the patients with auditory hallucinations an increase in blood flow is noted in the right superior temporal gyrus,right temporal lobe activation during auditory hallucination,effect of rTMS can spread to the opposite hemisphere through interhemispheric connections,some evidence that brain circuits involved in the production of auditory hallucinations and symptoms of schizophrenia are widespread and not confined in the left temporoparietal cortex.Deep TMS can reach brain structures as deep as 5 cm whereas non-deep TMS can reach structures less than half that distance. As deep brain structures such as thalamic, limbic and paralimbic regions have been shown to be activated during auditory hallucinations and suspected to play a role in the pathogenesis of auditory hallucinations, their stimulation may attenuate auditory hallucinations. Non-deep TMS can stimulate the cortex but not the neuronal pathways connecting it to deeper brain structures and which stimulation may be additive.


Options:
A: Arm Label: Real TMS; Type: ACTIVE_COMPARATOR; Interventions: Device: DEEP TMS H1 coil | Arm Label: Sham & real TMS; Type: PLACEBO_COMPARATOR; Interventions: Device: Deep H1 coil TMS | Intervention Type: DEVICE; Name: DEEP TMS H1 coil; Assigned to Arm(s): Real TMS | Intervention Type: DEVICE; Name: Deep H1 coil TMS; Assigned to Arm(s): Sham & real TMS
B: Arm Label: Active rTMS; Type: ACTIVE_COMPARATOR; Interventions: Device: repetitive Transcranial Magnetic Stimulation | Arm Label: Sham rTMS; Type: SHAM_COMPARATOR; Interventions: Device: repetitive Transcranial Magnetic Stimulation | Intervention Type: DEVICE; Name: repetitive Transcranial Magnetic Stimulation; Assigned to Arm(s): Active rTMS, Sham rTMS
C: Arm Label: 1; Type: EXPERIMENTAL; Interventions: Other: Repetitive transcranial magnetic stimulation | Arm Label: 2; Type: SHAM_COMPARATOR; Interventions: Other: Sham repetitive transcranial magnetic stimulation | Intervention Type: OTHER; Name: Repetitive transcranial magnetic stimulation; Assigned to Arm(s): 1 | Intervention Type: OTHER; Name: Sham repetitive transcranial magnetic stimulation; Assigned to Arm(s): 2
D: Arm Label: Low frequency left (LFL) sided rTMS; Type: EXPERIMENTAL; Interventions: Device: repetitive Transcranial Magnetic Stimulation | Arm Label: Priming stimulation; Type: EXPERIMENTAL; Interventions: Device: repetitive Transcranial Magnetic Stimulation | Arm Label: Sham Control; Type: SHAM_COMPARATOR; Interventions: Device: repetitive Transcranial Magnetic Stimulation | Intervention Type: DEVICE; Name: repetitive Transcranial Magnetic Stimulation; Assigned to Arm(s): Low frequency left (LFL) sided rTMS, Priming stimulation, Sham Control

Answer: A