Zapping Those Voices in The Head
WebMD News Archive
March 23, 2000 (Atlanta) -- The voices sound real, and they won't go away.
From deep within a schizophrenic patient's head, they relentlessly repeat their
awful messages, which can urge suicide or even murder. Now help may be on the
way: A report in the journal Lancet suggests that an electromagnetic
device can zap the voices out of the head without hurting the brain.
The technique, rTMS, which stands for repetitive transcranial magnetic
stimulation, uses a handheld device to deliver a low-voltage electromagnetic
pulse to a specific area of the brain. TMS pulses -- experienced as a tingling
sensation -- do not damage the brain, although some patients report a minor
headache due to muscle contractions of the face and scalp. The experimental
devices have been able to help some patients with severe depression. Now Yale
researcher Ralph E. Hoffman, MD, reports that rTMS can hush the voices haunting
some schizophrenic patients -- one of the most difficult-to-treat symptoms
known to psychiatry.
"I thought it was pretty remarkable," Hoffman, medical director of
the Yale Psychiatric Institute, tells WebMD. "For a couple of patients, it
seems to have had some lasting benefits. We are seeing a response rate now of
up to 75%. For most of the patients who have a response, it seems to endure for
months. It's frequently not a total response, but there is at least a 50%
decrease in [auditory] hallucinations."
The voices technically are hallucinations, but this doesn't mean that they
aren't real. "It is not in their imagination," Hoffman says. "They
are having [the perception of hearing] in the same way we hear people around
us. ... We compared the loudness of the hallucinations with [a recording of a
person reading played at various volumes]. Some of these range up to 60 or 70
decibels -- really a loud sound."
During puberty, normal brain development goes through a process of
fine-tuning by getting rid of unnecessary connections between areas of the
brain. Hoffman's theory is that for some reason this process goes terribly
wrong in some people, and too many brain connections are lost. One result can
be a loss of proper function in the part of the brain that controls the way
sounds are translated into speech, and in schizophrenic patients this leads to
hearing voices in the head. If this is so, Hoffman says, then calming this part
of the brain should quiet the voices. The rTMS device appears to do just
In an interview with WebMD, rTMS developer Alvaro Pascual-Leone, MD, PhD,
says that the device originally was created as a way to map the language areas
of the brain without surgery. While testing the device, he found that it had
long-lasting effects on the brain. Depending on how, when, and where in the
brain it was used, the rTMS had either a stimulating or calming effect. Taking
advantage of these effects, he and other researchers began exploring whether
rTMS could be used as an alternative to electroconvulsive therapy (ECT),
sometimes called "shock therapy," in patients with severe depression.
They have since expanded their studies to try the technique in patients with
other psychiatric conditions, and Pascual-Leone finds the Hoffman results