title: Musical hallucinations: review of treatment effects.
abstract: BACKGROUND
  Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare.
  
  
  OBJECTIVE
  To review the effects of published treatment methods for musical hallucinations.
  
  
  METHODS
  A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology.
  
  
  RESULTS
  Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication.
  
  
  CONCLUSIONS
  Treatments for musical hallucinations tend to yield favorable results when they target the main etiological factor of these phenomena. There is a need to establish the natural course of musical hallucinations, their response to non-pharmacological treatments, and their effects on the patient's quality of life. There is also a need to standardize the assessment of treatment responses, and document long-term follow up.
authors.affiliation: Department of Neurology, Haga Hospital The Hague, Netherlands ; Department of Neurology, Ashford/St. Peter's Hospital Chertsey, UK ; Department of Neurology, St. George's Hospital London, UK.
authors.forename: Jan A F
authors.initials: JA
authors.lastname: Coebergh
authors.affiliation: Parnassia Psychiatric Institute The Hague, Netherlands.
authors.forename: R F
authors.initials: RF
authors.lastname: Lauw
authors.affiliation: 'S Heeren Loo Noordwijk, Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Bots
authors.affiliation: Department of Psychiatry, University Medical Center Utrecht Utrecht, Netherlands ; Brain Centre Rudolf Magnus Utrecht, Netherlands.
authors.forename: I E C
authors.initials: IE
authors.lastname: Sommer
authors.affiliation: Parnassia Psychiatric Institute The Hague, Netherlands ; Department of Psychiatry, University of Groningen Groningen, Netherlands.
authors.forename: J D
authors.initials: JD
authors.lastname: Blom
keywords: Auditory Charles Bonnet syndrome; auditory hallucination; brain lesion; epilepsy; intoxication/pharmacology; psychiatric disorder