Kubera Katharina M, Barth Anja, Hirjak Dusan, Thomann Philipp A, Wolf Robert C
Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany.
Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany ; Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University Homburg, Germany.
Front Syst Neurosci. 2015 Oct 12;9:131. doi: 10.3389/fnsys.2015.00131. eCollection 2015.
This mini-review focuses on noninvasive brain stimulation techniques as an augmentation method for the treatment of persistent auditory verbal hallucinations (AVH) in patients with schizophrenia. Paradigmatically, we place emphasis on transcranial magnetic stimulation (TMS). We specifically discuss rationales of stimulation and consider methodological questions together with issues of phenotypic diversity in individuals with drug-refractory and persistent AVH. Eventually, we provide a brief outlook for future investigations and treatment directions. Taken together, current evidence suggests TMS as a promising method in the treatment of AVH. Low-frequency stimulation of the superior temporal cortex (STC) may reduce symptom severity and frequency. Yet clinical effects are of relatively short duration and effect sizes appear to decrease over time along with publication of larger trials. Apart from considering other innovative stimulation techniques, such as transcranial Direct Current Stimulation (tDCS), and optimizing stimulation protocols, treatment of AVH using noninvasive brain stimulation will essentially rely on accurate identification of potential responders and non-responders for these treatment modalities. In this regard, future studies will need to consider distinct phenotypic presentations of AVH in patients with schizophrenia, together with the putative functional neurocircuitry underlying these phenotypes.
本综述聚焦于非侵入性脑刺激技术，将其作为治疗精神分裂症患者持续性幻听（AVH）的一种辅助方法。典型地，我们重点关注经颅磁刺激（TMS）。我们具体讨论了刺激的原理，并结合药物难治性和持续性AVH个体的表型多样性问题，思考了方法学问题。最终，我们对未来的研究和治疗方向给出了简要展望。总体而言，目前的证据表明TMS是治疗AVH的一种有前景的方法。颞上叶皮质（STC）的低频刺激可能会降低症状严重程度和发作频率。然而，临床效果持续时间相对较短，且随着更大规模试验的发表，效应大小似乎会随时间下降。除了考虑其他创新刺激技术，如经颅直流电刺激（tDCS），以及优化刺激方案外，使用非侵入性脑刺激治疗AVH本质上依赖于准确识别这些治疗方式的潜在反应者和无反应者。在这方面，未来研究需要考虑精神分裂症患者AVH不同的表型表现，以及这些表型背后假定的功能性神经回路。
