The Use of Repetitive Transcranial Magnetic Stimulation (rTMS) in Auditory Verbal Hallucinations (AVH)

Up to one-third of all schizophrenic patients suffer from auditory verbal hallucinations (AVH) that are resistant to antipsychotics. The use of repetitive transcranial magnetic stimulation (rTMS) is a therapeutic option that may disrupt or attenuate treatment resistant (TR) AVHs. This article reviews the available literature on the use of rTMS to treat AVHs, particularly focusing on randomised controlled trials, which have introduced new definitions ("refractory AVHs"), and techniques (active comparator strategies and imaging-guided rTMS). A number of meta-analyses are considered, which support a range of positive effect sizes for AVH attenuation in response to rTMS. Larger maintenance and follow-up studies with clearer clinical definitions of TR AVH are required. The underlying mechanism of action of rTMS on language networks needs further clarification and future trials should focus on methods for assessing AVH changes, time courses of response, and the development of response markers.