3 AVH are characterized by the perception of voices without external stimuli, typically located outside of themselves by patients but also, and more and more described, from within of the subject’s head. In schizophrenia, the presence of hallucinations would largely drain patients’ attention and thus mobilize cognitive resources in a less productive manner. The hallucinatory phenomenon is to be distinguished from the illusion which is a misinterpretation of an existing external stimulus. Understanding auditory hallucinationsĪuditory hallucinations (AVH) have been described since antiquity, but have been identified as pathological only for the last 3 centuries. Here, we will focus on electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) techniques as they represent the largest use of brain stimulation in schizophrenia. The present review aims to summarize the current clinical use of brain stimulation techniques in the treatment of auditory hallucinations in schizophrenia and to propose some perspectives of use to improve the techniques efficacy. Therefore, the development of alternative approaches to alleviate these treatment-resistant/persistent symptoms is crucial. 2 Practitioners can then decide to attempt alternative solutions such as an add-on strategy or a complementary treatment. 1 Up to 30% of patients using antipsychotic medications still experience auditory verbal hallucinations (AVH), and although clozapine is considered the most efficacious antipsychotic agent in refractory patients, 40–70% of these patients achieve only poor or partial response to it. The treatment of auditory hallucinations with brain stimulation techniques has been continuously growing in recent years, with the need to help the large number of patients with schizophrenia who persistently experience this debilitating symptom despite well-conducted pharmacological treatments regimens.
Keywords: electroconvulsive therapy, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, auditory hallucinations, schizophrenia 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.Ĭonclusion: This review suggests that add-on brain stimulation treatments could play a key role among the therapeutic strategies for auditory hallucinations reduction in schizophrenia. 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. Its implementation has a non negligible cost but can be performed by a single practitioner. Finally, rTMS seems to be the most efficacious NIBS to offer patients with persistent AVH as an add-on therapeutic strategy. However, its safe and simple implementation allows us to recommend it to patients who are refractory to other stimulation techniques. tDCS is still poorly studied and does not demonstrate sufficiently homogeneous or conclusive results yet to prove its efficacy in the treatment of AVH. 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. 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). Purpose: This review reports the current perspectives of brain stimulation techniques in the treatment of auditory verbal hallucinations (AVH) in schizophrenia. Clément Nathou, 1,2 Olivier Etard, 2,3 Sonia Dollfus 1,2ġNormandie Univ, UNICAEN, CHU de Caen, Service de Psychiatrie Adulte, Caen, F-14000, France 2Normandie Univ, UNICAEN, ISTS, EA 7466, GIP Cyceron, Caen 14000, France 3Normandie Univ, UNICAEN, CHU de Caen, Service des Explorations Fonctionnelles du Système Nerveux, CHU de Caen, Caen, F-14000, France
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