Auditory hallucinations—hearing voices without external stimuli—affect up to 70–80% of patients with schizophrenia. While antipsychotic medications are the first-line treatment, approximately 25–30% of patients continue to experience persistent symptoms despite adequate pharmacological therapy. For these individuals, Repetitive Transcranial Magnetic Stimulation (rTMS) offers a promising, non-invasive treatment alternative.
Repetitive Transcranial Magnetic Stimulation (rTMS) is a brain stimulation technique that uses magnetic pulses to modulate the activity of targeted cortical regions. In the case of schizophrenia with treatment-resistant auditory hallucinations, low-frequency rTMS (typically 1 Hz) is applied to the left temporoparietal cortex, an area consistently linked to speech perception and implicated in the genesis of hallucinations.
Low-frequency stimulation reduces cortical hyperactivity, disrupting aberrant activity in auditory processing networks and improving symptom control without affecting global psychotic symptoms.
Multiple randomized controlled trials and meta-analyses support the efficacy of 1-Hz Repetitive Transcranial Magnetic Stimulation (rTMS) over the left temporoparietal cortex:
- Meta-analysis of 10 sham-controlled studies involving 212 patients showed a significant reduction in the severity of auditory hallucinations, with a large effect size favoring real rTMS over sham stimulation.
- Further evidence from combined studies demonstrated the therapeutic effectiveness of 1 Hz stimulation in individuals with persistent hallucinations, highlighting the value of Repetitive Transcranial Magnetic Stimulation (rTMS) in cases resistant to standard antipsychotic treatment.
- Clinical trials confirmed that Repetitive Transcranial Magnetic Stimulation (rTMS) significantly reduces hallucination frequency and loudness while being well-tolerated, with minimal side effects and no cognitive impairments reported.
Neuroimaging studies demonstrate that patients with auditory hallucinations exhibit hyperactivity in the left temporoparietal cortex. By applying slow Repetitive Transcranial Magnetic Stimulation (rTMS)-1 Hz, clinicians can decrease cortical excitability in this region, reducing hallucination intensity and frequency.
The standard rTMS treatment protocol for auditory hallucinations in schizophrenia involves low-frequency stimulation at 1 Hz, which has an inhibitory effect on cortical activity. The target area is the left temporoparietal cortex, typically localized near the T3–P3 region of the scalp. Each session lasts approximately 15 to 20 minutes and is administered daily over a period of one to two weeks, with a total of around 10 sessions. In some cases, booster sessions may be recommended to maintain therapeutic effects. Repetitive Transcranial Magnetic Stimulation (rTMS) is generally well-tolerated, with most patients experiencing only mild scalp discomfort or transient fatigue during or after treatment.
Repetitive Transcranial Magnetic Stimulation (rTMS) may be especially useful for:
- Patients with treatment-resistant auditory hallucinations
- Individuals unable to tolerate antipsychotic side effects
- Patients seeking a non-pharmacological treatment option
- Individuals with residual symptoms despite stable medication regimens
Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe, targeted, and evidence-based approach for the treatment of persistent auditory hallucinations in schizophrenia. By reducing cortical hyperactivity in the left temporoparietal cortex, rTMS can significantly decrease hallucination severity and improve quality of life.