Hallucinations, Verbal Auditory Clinical Trial
Official title:
TMS for Treatment Resistant Auditory Verbal Hallucination in Schizophrenia
This study will evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) in schizophrenia with treatment resistant auditory verbal hallucination
Brief summary:
This study will evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) in
schizophrenia with treatment resistant auditory hallucination
Detailed description:
Auditory verbal hallucinations in schizophrenia disorders have been proposed to be associated
with a source- monitoring deficit. The improvement of the monitoring deficit will have major
impact on the improvement of hallucinatory symptoms and the social function. Brain network
considered to play a major role in source monitoring is the default mode (DM) network. An
increasing activity during the brain's resting phase and decreasing activity during
stimulus-induced brain activity, increased rest activity in the primary auditory cortex which
contributes to conditions, internal speech perceived as a tangible external sound, triggering
the occurrence of verbal auditory hallucinations in schizophrenic disorders.
This study will determine if
1-Hz low-frequency, transcranial repetitive magnetic stimulus could be used to inhibit
hyperconnectivity between these DM networks and other brain regions, allowing the
source-monitoring capability to function properly. This study will measure the oscillatory
strength and functional connectivity in the DM network via EEG resting-state activity in
schizophrenic with auditory hallucinations before and after rTMS administration. With a
seed-based analysis, using the region of interest (ROIs) in the posterior cortex area of the
cortex (PPC), precuneus area (PCu), the inferior parietal area (IPC), the medial temporal
(MT) area, the medial frontal area (MFC) and the singulatum cortex anterior (ACC) in
bilateral hemispheres to create an EEG-based brain activity mapping, measuring cortical
spectral power and functional connectivity in the ROIs.
Before starting rTMS, participants will undergo : (1) general and psychiatric assessment, (2)
neuropsychological test to evaluate hallucination and source-monitoring ability, (3) an EEG
recording (which takes about 1 hour). After these assessment are completed, participants will
be randomly assigned (by computer program) to receive either 1 Hz frequency rTMS or placebo
stimulation for 20 minutes per day over a 10-day period. During this time, the participants
will not know whether they received real or placebo TMS. For 10-days, stimulation will be
administered to an area of the left temporal lobe of the brain (temporo-parietal junction).
After trial is completed, participants will be told if they received real or placebo. If the
participants have receive only place stimulation, they will then be offered a trial of real
rTMS.
TMS is not causing pain, but it can be uncomfortable due to a tingling or knocking sensation,
contraction of scalp and facial muscles. There is also a small risk of seizure associated
with TMS, but because of the lower frequency of stimulation used in this study (1 stimulation
per second), this risk is significant only for participants who have a prior history of
seizures, epilepsy, or other neurological problem. Investigators are also concerned that TMS
may cause hearing problems. Therefore, investigators will carefully monitor participants for
early signs of such problem, using hearing-safety aid to every stimulation session. If
investigators suspect that a participant is experiencing problems with hearing, the trial is
stopped.
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