title: Review of the efficacy of transcranial magnetic stimulation for auditory verbal hallucinations.
abstract: With an increase of the number of studies exploring repetitive transcranial magnetic stimulation (rTMS) for the treatment of auditory verbal hallucinations (AVH), an update is provided on the efficacy of different paradigms. A literature search was performed from 1966 through April 2013. Twenty-five randomized controlled trials using the severity of AVH or psychosis as outcome measures were included. Standardized mean weighted effect sizes were computed; a qualitative review of the literature was performed to assess the effects of various rTMS paradigms. rTMS versus sham treatment for AVH yielded a mean weighted effect size of .44. No significant mean weighted effect size was found for the severity of psychosis (i.e., .21). For patients with medication-resistant AVH, the mean weighted effect size was .45. rTMS applied at the left temporoparietal area with a frequency of 1 Hz yielded a moderate mean weighted effect size of .63, indicating superiority of this paradigm. Various other paradigms failed to show superior effects. rTMS applied at the right temporoparietal area was not superior to sham treatment. rTMS, especially when applied at the left temporoparietal area with a frequency of 1 Hz, is effective for the treatment of AVH, including in patients with medication-resistant AVH. The results for other rTMS paradigms are disappointing thus far. A next step should be to explore the effects of rTMS in medication-free individuals, for example, during the initial phases of psychosis, and in patients with diagnoses other than schizophrenia who do not have comorbid psychotic symptoms.
authors: Parnassia Psychiatric Institute, The Hague. Electronic address: c.slotema@psyq.nl.
authors: Christina W
authors: CW
authors: Slotema
authors: Parnassia Psychiatric Institute, The Hague.
authors: Jan D
authors: JD
authors: Blom
authors: Department of Psychiatry and Rudolf Magnus Institute for Neuroscience University Medical Centre Utrecht, Utrecht.
authors: Remko
authors: R
authors: van Lutterveld
authors: Parnassia Psychiatric Institute, The Hague; Department of Psychiatry, University Medical Centre Groningen, University of Groningen, The Netherlands; Department of Epidemiology, Columbia University, New York, New York.
authors: Hans W
authors: HW
authors: Hoek
authors: Department of Psychiatry and Rudolf Magnus Institute for Neuroscience University Medical Centre Utrecht, Utrecht.
authors: Iris E C
authors: IE
authors: Sommer
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology*; D006212:Hallucinations / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: Auditory hallucinations; deep brain stimulation; meta-analysis; psychosis; review; transcranial magnetic stimulation