***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Repetitive transcranial magnetic stimulation ( rTMS ) has shown promise as a treatment for refractory auditory hallucinations ( AH ) in Schizophrenia . Most previous studies have examined the effect of low frequency , left-sided stimulation ( LFL ) ( 1 Hz ) to the temporoparietal cortex ( TPC ) . Priming stimulation ( 6 Hz ) prior to LFL stimulation ( hereby simply referred to as priming ) has been shown to enhance the neurophysiological effects of LFL rTMS alone and , as such , may lead to greater attenuation of AH . OBJECTIVE Therefore , this study evaluated the efficacy of priming rTMS and LFL rTMS compared to sham rTMS using MRI targeting of Heschl 's gyrus ( HG ) within the TPC of subjects with SCZ experiencing refractory auditory hallucinations ( AH ) . METHODS Subjects between the ages of 18 and 65 were recruited from a tertiary care university hospital . Fifty-four subjects with medication resistant AH were r and omized to receive LFL , priming , or sham rTMS for 20 treatments . The primary outcome was reduction of hallucinatory symptoms as indexed by response rates on the Psychotic Symptoms Rating Scale ( PSYRATS ) . RESULTS The response rates did not differ among the three treatment groups using an intention to treat analysis . The response rates did not differ in any of the secondary outcome measures . The treatment was well tolerated with minimal adverse effects including no changes in cognition during the study . CONCLUSION These findings suggest that neither priming nor LFL rTMS of Heschl 's gyrus are effective at ameliorating refractory AH in schizophrenia . Clinical Trials.gov Identifier : NCT01386918 Auditory hallucinations have been associated with a disruption in monitoring one 's own speech suggesting an autonoetic agnosia in schizophrenia . This deficit can be measured by a source monitoring task . Low frequency transcranial magnetic stimulations ( rTMS ) applied to the left temporoparietal cortex can inhibit cortical areas involved both in autonoetic agnosia ( which means ' the inability to identify self-generated mental events ' ) and in auditory hallucinations ( AH ) phenomena . Although improvements in AH have been repeatedly reported following rTMS treatment , effects on autonoetic agnosia measured by source monitoring have never been investigated . We aim ed to investigate the relation between improvements in AH and source monitoring performance after rTMS treatment . Twenty four right-h and ed refractory schizophrenic patients with hallucinations r and omly received sham or active 10.0001-Hz rTMS to the left temporoparietal cortex and performed 2 source monitoring tasks requiring discrimination between silent- and overt-reading words before and after rTMS sessions . Compared to sham , active rTMS significantly improved AH . Source monitoring performances and the improvements tended to correlate , which would support a specific relation between autonoetic agnosia and auditory hallucinations In an open study , four subjects with a stable deficit syndrome of schizophrenia received high frequency repetitive transcranial magnetic stimulation ( 15 Hz at 90 % of motor threshold , 1800 pulses each session , daily for 20 sessions over 4 weeks ) over the left dorsolateral prefrontal cortex . Subjects showed a significant reduction in negative symptoms and improvement in function , with no change in positive symptoms . This improvement was maintained at the 1 month follow up . Repetitive transcranial magnetic stimulation as a treatment of the deficit syndrome of schizophrenia is feasible , safe and may be beneficial . A systematic study in r and omized control trials would be appropriate OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate BACKGROUND Almost a quarter of patients with schizophrenia present with  resistant auditory verbal hallucinations ( AVH )  , a phenomenon that may relate to activation of brain areas underlying speech perception . Repetitive transcranial magnetic stimulation ( rTMS ) at 1 Hz reduces cortical activation , and recent results have shown that 1-Hz left temporoparietal rTMS may reduce AVH . The aim of this study was to replicate recent data and investigate whether low-frequency rTMS with a high total stimulation number delivered in a shorter 5-day block produces similar benefit . METHODS Ten right-h and ed schizophrenia patients with resistant AVH received 5 days of active rTMS and 5 days of sham rTMS ( 2,000 stimulations per day at 90 % of motor threshold ) over the left temporoparietal cortex in a double-blind crossover design . The two weeks of stimulation were separated by a 1-week washout period . RESULTS AVH were robustly improved ( 56 % ) by 5 days active rTMS , whereas no variation was observed after sham . Seven patients were responders to active treatment , five of whom maintained improvement for at least 2 months . CONCLUSIONS These data confirm the efficiency of low-frequency rTMS applied to the left temporoparietal cortex , compared with sham stimulation , in reducing resistant AVH . This improvement can be obtained in only 5 days without serious initial adverse events Background About 25 % of schizophrenia patients with auditory hallucinations  are refractory to pharmacotherapy and electroconvulsive therapy . We conducted a deep transcranial magnetic stimulation ( TMS ) pilot study in order to evaluate the potential clinical benefit of repeated left temporoparietal cortex stimulation in these patients . The results were encouraging , but a sham-controlled study was needed to rule out a placebo effect . Methods A total of 18 schizophrenic patients with refractory auditory hallucinations were recruited , from Beer Yaakov MHC and other hospitals outpatient population s. Patients received 10 daily treatment sessions with low-frequency ( 1 Hz for 10 min ) deep TMS applied over the left temporoparietal cortex , using the H1 coil at the intensity of 110 % of the motor threshold . Procedure was either real or sham according to patient r and omization . Patients were evaluated via the Auditory Hallucinations Rating Scale , Scale for the Assessment of Positive Symptoms-Negative Symptoms , Clinical Global Impressions , and Quality of Life Question naire . Results In all , 10 patients completed the treatment ( 10 TMS sessions ) . Auditory hallucination scores of both groups improved ; however , there was no statistical difference in any of the scales between the active and the sham treated groups . Conclusions Low-frequency deep TMS to the left temporoparietal cortex using the protocol mentioned above has no statistically significant effect on auditory hallucinations or the other clinical scales measured in schizophrenic patients .Trial Registration Clinical trials.gov identifier : NCT00564096 BACKGROUND Repetitive transcranial magnetic stimulation ( rTMS ) has been investigated for its treatment efficacy for the negative symptoms of schizophrenia . Previous studies have targeted the dorsolateral prefrontal cortex ( DLPFC ) , which is associated with the pathophysiology of this disorder . Several rTMS parameters have been explored in the treatment of negative symptoms and include stimulating the left and bilateral DLPFC at several different frequencies and number of sessions . Results of such studies have been inconsistent , while high-frequency rTMS has shown greatest promise . OBJECTIVE /HYPOTHESIS The objective of this study was to evaluate the efficacy of bilateral high-frequency rTMS in the treatment of negative symptoms in schizophrenia . It was hypothesized rTMS would alleviate negative symptoms in schizophrenia . METHODS Twenty-five patients were enrolled in this double-blind placebo-controlled r and omized trial .  Bilateral 20 Hz rTMS was MRI-targeted to the DLPFC at 90 % RMT administered daily for 4 weeks for a total of 20 treatments . Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms ( SANS ) , the Positive and Negative symptom scale ( PANSS ) , and controlling for depression as measured with the Calgary Depression Scale ( CDS ) at baseline , 1 , 2 , 3 , 4 , and 2 weeks after the treatment course . RESULTS No significant group or time differences were found on negative symptoms or depressive symptoms after rTMS . Bilateral high-frequency rTMS did not alleviate negative symptoms in patients with schizophrenia . CONCLUSIONS These findings indicate that such symptoms are unresponsive to rTMS treatment or that more optimized parameters are needed to achieve improved therapeutic efficacy Background : Previous research suggests that repetitive transcranial magnetic stimulation ( rTMS ) applied to the temporoparietal cortex may have therapeutic benefits for patients with schizophrenia and treatment-resistant auditory hallucinations . We aim ed to test this hypothesis in a r and omized double-blind trial . Methods : Thirty-three patients with treatment-resistant auditory hallucinations entered a r and omized sham-controlled , double-blind trial . rTMS was applied for 10 consecutive weekdays , for 15 minutes at 1 Hz and 90 % of the resting motor threshold . We assessed clinical symptoms and cognitive function . Results : rTMS was safe with no adverse effects on memory and cognitive parameters assessed . Active treatment did not result in a greater therapeutic effect than sham on any measure except for the loudness of hallucinations where there was a significant reduction in the active versus the sham group over time . Conclusions : The study does not support the effectiveness of rTMS using the stimulation parameters provided . However , it does suggest that rTMS methods may have a therapeutic role and indicates the need for further exploration of alternative and more effective stimulation methods Objective : Auditory hallucinations are a characteristic symptom of schizophrenia and are usually resistant to treatment . The present study was conducted to further support the findings that repetitive transcranial magnetic stimulation ( rTMS ) reduces auditory hallucinations , and to evaluate the effect of low-frequency rTMS on auditory hallucinations in schizophrenia . Methods : Forty schizophrenia patients were included in the study . Patients were r and omized to control or experimental group .  Low-frequency rTMS ( 1 Hz , 90 % motor threshold ) was applied to the left temporoparietal cortex of patients in the experimental group for 10 days following the st and ard guidelines as an addition to antipsychotic treatment . The control group received only antipsychotics . The changes in the psychopathology scores for the auditory hallucinations were recorded using auditory hallucination recording scale . The rater was blind to the intervention procedure . Results : A significant improvement was found in auditory hallucinations in the experimental group as compared to the control group . Conclusion : Left temporoparietal rTMS warrants further study as an intervention for auditory hallucinations . Data suggest that this intervention selectively alters neurobiological factors determining frequency of these hallucinations Summary .The effects of repetitive transcranial magnetic stimulation ( rTMS ) on  schizophrenic negative symptoms ( NS ) and EEG topography were investigated in this pilot study .10 patients with predominant NS were treated with 10 Hz rTMS over the left dorsolateral prefrontal cortex for 5 days . For NS ratings , the Scale for the Assessment of Negative Symptoms ( SANS ) was used . Both ratings and EEG recordings were obtained pre- and post-rTMS .  Electrical activity changes were computed by Low Resolution Brain Electromagnetic Tomography . SANS showed an improvement after rTMS , from 49.0 ( SD : 10.7 ) to 44.7 ( SD : 11.8 ) ( means ) . EEG frequency b and s were changed fronto-temporally ( right ) and were mainly decreases in delta- and beta- and increases in alpha1-activity , as well as decreases in beta-activity in the temporal and parieto-occipital regions (left).Although we are aware of the limitations of this study , we assume a slight improvement in NS . The EEG find 
    Output:
    
Based on this review , there is insufficient evidence to support or refute the use of TMS to treat symptoms of schizophrenia .
Although some evidence suggests that TMS , and in particular temporoparietal TMS , may improve certain symptoms ( such as auditory hallucinations and positive symptoms of schizophrenia ) compared to sham TMS , the results were not robust enough to be unequivocal across the assessment measures used .
There was insufficient evidence to suggest any added benefit with TMS used as an adjunctive therapy to antipsychotic medication .