Low and High Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Resistant Auditory Hallucination in Schizophrenia

Study Overview
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Brief Summary
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Auditory Hallucinations (AH) are experienced by 50 to 70% of subjects with schizophrenia. Almost a quarter of patients are medication resistant to such symptoms. The application of rTMS at low frequency in the left temporoparietal cortex reduces AH. A pilot study reported successful treatment of AH with high frequency rTMS. rTMS (20Hz) should be a shorter and an easier treatment for out-patients with schizophrenia compared to low stimulation treatment.

Detailed Description
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90 schizophrenia patients Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM IV-TR) criteria with persistent Auditory Hallucinations (AH) resistant to antipsychotic treatments will be recruited. A double blind sham-controlled randomized parallel study comparing three groups treated 10 session in 5 days with high frequency (20 Hz), low frequency (1Hz) and sham-controlled condition rTMS. They will be followed 3 month and evaluated using Auditive Hallucination Rating Scale (AHRS), Scale for the Assessment of Positive Symptoms Scores (SAPS), Scale for the Assessment of Negative Symptoms Scores (SANS) and Positive And Negative Symptom Scale (PANSS) global score and Global Assessment of Functioning (GAF) score.

Official Title
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Low and High Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Resistant Auditory Hallucination in Schizophrenia: a Double Blind Sham-controlled Randomised Study

Conditions
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Schizophrenia

Intervention / Treatment
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* Procedure: high frequency (20Hz)
* Procedure: low frequency (1Hz)
* Procedure: Sham Comparator


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with schizophrenia DSM IV-TR criteria and persistent AH resistant to antipsychotic treatments. Exclusion Criteria: Left handed patients lateralizes rTMS contraindications

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: low frequency (1Hz)<br>low frequency | Procedure: low frequency (1Hz)<br>* 10 session in 5 days with low frequency (1Hz)<br>|
| Sham Comparator: Sham Comparator<br>Sham Comparator | Procedure: Sham Comparator<br>* 10 session in 5 days with sham-controlled<br>|
| Experimental: high frequency (20Hz)<br>high frequency | Procedure: high frequency (20Hz)<br>* 10 session in 5 days with high frequency (20 Hz)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To evaluate the efficiency of high frequency (20Hz) repetitive Transcranial Magnetic Stimulation (rTMS) to the left temporoparietal cortex compared to sham controlled condition rTMS in term on Auditory Hallucinations reduction. | Auditory Hallucinations improvement at 5-day was evaluate with AHRS (Auditory Hallucination Rating Scale) score | 5 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To compare the efficiency of low frequency (1Hz) to sham-controlled condition repetitive Transcranial Magnetic Stimulation (rTMS) in term of Auditory Hallucination reduction. | Auditory Hallucinations improvement evaluated with Auditory Hallucination Rating Scale (AHRS) | 5 days | 
| To compare the efficiency of high frequency to low frequency (1Hz) in term of Auditory Hallucination reduction. | Auditory Hallucinations improvement evaluated with Auditory Hallucination Rating Scale (AHRS) | 5 days | 
| To compare the maintenance of therapeutic effect for one month of high frequency to low frequency (1Hz) in term of Auditory Hallucination reduction. | Auditory Hallucinations improvement evaluated with Auditory Hallucination Rating Scale (AHRS) | 1 month | 
| To evaluate the maintenance of therapeutic effect of high frequency compared to sham controlled condition for 15 days 1 month, 2 months and 3 months |  | 15 days 1 month, 2 months and 3 months | 
| To compare the side effects of each of the active treatment | Tolerance assessed with the UDVALG of KLINISKE UNDERSOGELSER scale (UKU ) | at Inclusion and 5 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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GAF, rTMS, Schizophrenia, high frequency rTMS, low frequency rTMS, AHRS, SAPS SANS PANSS, UKU