"We have had a large number who have spontaneously reported that their residual hallucinations (usually auditory) have remitted with treatment, which is not at all what we were looking at," he said. "This is clearly a different effect than has been seen in the direct stimulation of the temporoparietal cortex."
(In recent months, three studies [Chibbaro et al., 2005; Hoffman et al., 2005; Lee et al., 2005] have been published on the use of low-frequency rTMS applied to the temporoparietal cortex for patients reporting auditory hallucinations--Ed.)
Asked about patients' responses to treatment, Schneider told Psychiatric Times, "Their persistence is very interesting. These are schizophrenic patients who [by definition] are often poorly motivated. Yet our dropout rate is one on NARSAD and one on Stanley to date. It is very unusual in and of itself to get people to come in five days per week. Granted, most of these people are being transported. Nevertheless to get them up and moving at 8 a.m. is a feat."
The patients, Schneider said, report that with the treatment they subjectively feel clearer and that they can think better. He relayed an anecdote in which one patient who was quite negative at the start of the study came in later and told the staff about going to a family wedding and dancing. Another patient who according to Schneider was "one of the most slovenly people" he had ever seen, came in one day clean shaven and relatively well dressed for him. Two patients who were previously unemployed are now employed, and another is applying for work.
Transcranial magnetic stimulation is generally safe with minimal adverse effects, George said at the APA symposium. Both single-pulse TMS and rTMS, he said, can cause discomfort at the site of stimulation and muscle tension headache (<10%). Some data show a temporary increase in auditory threshold when the patient does not wear earplugs during the procedure.
"Obviously any metal in the brain could be affected. And right now, we are screening out people with pacemakers," George said.
With regard to neuropsychological deficits, George said there are no known adverse effects on cognition.