Auditory verbal hallucinations in schizophrenia: current perspectives in brain stimulation treatments

Abstract

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:

• electroconvulsive therapy
• repetitive transcranial magnetic stimulation
• transcranial direct current stimulation
• auditory hallucinations
• schizophrenia

Acknowledgments

The authors would like to thank the DRCI of CHU de Caen for their valuable help with the editing process of the manuscript.

Disclosure

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.