Purpose: This review reports the current perspectives of brain stimulation techniques in the treatment of auditory verbal hallucinations (AVH) in schizophrenia.
Methods: A systematic search of the literature in the PubMed database revealed that the most studied techniques are noninvasive techniques (NIBS), including electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS).
Results: The results showed that ECT could have great clinical efficacy but is currently underused in practice perhaps due to the costs associated with its limited implementation and potential associated risks. tDCS is still poorly studied and does not demonstrate sufficiently homogeneous or conclusive results yet to prove its efficacy in the treatment of AVH. However, its safe and simple implementation allows us to recommend it to patients who are refractory to other stimulation techniques. Finally, rTMS seems to be the most efficacious NIBS to offer patients with persistent AVH as an add-on therapeutic strategy. Its implementation has a non negligible cost but can be performed by a single practitioner. Great evolution in these techniques with technological progress, robotics and computer science are currently being tested and will undoubtedly improve the clinical efficacy of these procedures, particularly towards more personalized treatments such as individual rTMS targets and intensities. There are also new techniques for deep brain stimulation based on focused ultrasound that could provide much insight into the treatment of AVH in schizophrenia.
Conclusion: This review suggests that add-on brain stimulation treatments could play a key role among the therapeutic strategies for auditory hallucinations reduction in schizophrenia.
Keywords: auditory hallucinations; electroconvulsive therapy; repetitive transcranial magnetic stimulation; schizophrenia; transcranial direct current stimulation.
Conflict of interest statement
Prof. Dr. Sonia Dollfus reports personal fees and non-financial support from Janssen, Roche, Takeda, Gedeon, non-financial support from Otsuka, consulting and advisory board from Fabre and Gedeon outside the submitted work. The authors report no other conflicts of interest in this work.
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Efficacy of Fronto-Temporal Transcranial Direct Current Stimulation for Refractory Auditory Verbal Hallucinations in Schizophrenia: A Randomized, Double-Blind, Sham-Controlled StudyA Bose et al. Schizophr Res 195, 475-480. PMID 28866447. - Randomized Controlled TrialPersistent auditory verbal hallucinations (AVH) that are refractory to antipsychotic medications are reported in about 20-30% of schizophrenia patients. Transcranial Dire …
Should We Expand the Toolbox of Psychiatric Treatment Methods to Include Repetitive Transcranial Magnetic Stimulation (rTMS)? A Meta-Analysis of the Efficacy of rTMS in Psychiatric DisordersCW Slotema et al. J Clin Psychiatry 71 (7), 873-84. PMID 20361902. - Meta-AnalysisIt is time to provide rTMS as a clinical treatment method for depression, for auditory verbal hallucinations, and possibly for negative symptoms. We do not recommend rTMS …
High Frequency rTMS; A More Effective Treatment for Auditory Verbal Hallucinations?AD de Weijer et al. Psychiatry Res 224 (3), 204-10. PMID 25453990. - Randomized Controlled TrialThe great majority of studies on repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool for auditory verbal hallucinations (AVH) have used 1-Hz stimula …
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