Reduced Neuronal Activity in Language-Related Regions After Transcranial Magnetic Stimulation Therapy for Auditory Verbal Hallucinations

Background: Transcranial magnetic stimulation (TMS) is a novel therapeutic approach, used in patients with pharmacoresistant auditory verbal hallucinations (AVH). To investigate the neurobiological effects of TMS on AVH, we measured cerebral blood flow with pseudocontinuous magnetic resonance-arterial spin labeling 20 +/- 6 hours before and after TMS treatment. Methods: Thirty patients with schizophrenia or schizoaffective disorder were investigated. Fifteen patients received a 10-day TMS treatment to the left temporoparietal cortex, and 15 received the standard treatment. The stimulation location was chosen according to an individually determined language region determined by a functional magnetic resonance imaging language paradigm, which identified the sensorimotor language area, area Spt (sylvian parietotemporal), as the target region. Results: TMS-treated patients showed positive clinical effects, which were indicated by a reduction in AVH scores (p <= .001). Cerebral blood flow was significantly decreased in the primary auditory cortex (p <= .001), left Broca's area (p <= .001), and cingulate gyrus (p <= .001). In control subjects, neither positive clinical effects nor cerebral blood flow decreases were detected. The decrease in cerebral blood flow in the primary auditory cortex correlated with the decrease in AVH scores (p <= .001). Conclusions: TMS reverses hyperactivity of language regions involved in the emergence of AVH. Area Spt acts as a gateway to the hallucination-generating cerebral network. Successful therapy corresponded to decreased cerebral blood flow in the primary auditory cortex, supporting its crucial role in triggering AVH and contributing to the physical quality of the false perceptions.