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News Brief: Non-invasive Brain Stimulation Tempers Hallucinations

7 June 2012. For 25%-30% of people with schizophrenia, auditory hallucinations continue mostly unabated despite treatment with antipsychotic drugs. According to a study published online 11 May in the American Journal of Psychiatry, non-invasive brain stimulation may quell these diehard symptoms. Led by Jerome Brunelin of the University of Lyon, France, the study reports that transcranial direct current stimulation (tDCS) significantly reduced the severity of these remaining hallucinations by 31% compared to an 8% reduction in the group receiving sham stimulation. This reduction persisted three months following the 5-day course of tDCS treatment, and no adverse effects were detected.

The results suggest that non-invasive ways of shifting brain activity may successfully treat hallucinations. Like repetitive transcranial magnetic stimulation (rTMS), tDCS is thought to work by changing neural excitability in brain regions underneath the stimulation sites on the scalp. Unlike rTMS however, tDCS can simultaneously increase and decrease neuron excitability in two different regions. Brunelin and colleagues employed this ability in order to deliver excitatory stimulation over an area of prefrontal cortex and inhibitory stimulation over the left temporo-parietal cortex – both regions implicated in auditory hallucinations. Though based on only 30 people with treatment-resistant hallucinations, the findings urge further exploration of tDCS in larger sample sizes.—Michele Solis.

Brunelin J, Mondino M, Gassab L, Haesebaert F, Gaha L, Suaud-Chagny MF, Saoud M, Mechri A, Poulet E. Examining Transcranial Direct-Current Stimulation (tDCS) as a Treatment for Hallucinations in Schizophrenia. Am J Psychiatry. 2012 May 11.

Comments on Related Papers
Related Paper: Examining Transcranial Direct-Current Stimulation (tDCS) as a Treatment for Hallucinations in Schizophrenia.

Comment by:  Ralph Hoffman
Submitted 21 May 2012 Posted 21 May 2012

The report by Brunelin et al. describes the first-ever transcranial direct-current stimulation (tDCS) clinical trial targeting auditory/verbal hallucinations (AVHs) in schizophrenia, a core positive symptom that is often highly distressing and disabling. Multiple studies of repetitive transcranial magnetic stimulation (rTMS) targeting AVHs have been described with overall promise, but negative studies as well. rTMS, for this application, induces actual neuronal firing at 1 Hertz, producing cortical effects akin to long-term depression. Instead, tDCS achieves physiological results through more subtle, sustained shifts in membrane polarity. The tDCS protocol reported by Brunelin et al. has a sound rationale, with the suppressive cathode positioned over the left temporoparietal junction (where cortical activation generating AVHs is likely to occur), and the activating anodal electrode over a left prefrontal site (possibly boosting deficient corollary discharge postulated to contribute also to AVHs). There is good reason to believe that blindness was maintained for their...  Read more

View all comments by Ralph Hoffman

Related Paper: Examining Transcranial Direct-Current Stimulation (tDCS) as a Treatment for Hallucinations in Schizophrenia.

Comment by:  Flavie Waters
Submitted 22 May 2012 Posted 22 May 2012

I was intrigued by the findings reported by Brunelin and colleagues on tDCS as a treatment for hallucinations. There have been increasing reports that this non-invasive neurostimulation technique may be efficacious in the treatment of a range of psychiatric and neurological disorders, including depression, stroke, pain, and epilepsy.

Brunelin and colleagues focused tDCS activity on two cortical "nodes" to provide local and opposing effects on two different brain cortical areas—the left temporo-parietal junction (cathodal inhibition), and the left dorsolateral prefrontal cortex (DLPFC, anodal stimulation). The results showed positive effects of the active tDCS treatment on auditory verbal hallucinations (31 percent hallucination score reduction vs. 8 percent reduction in the sham treatment), which were sustained after a three-month period. There was also a reduction in the negative symptom dimension, though not in the disorganization and grandiosity dimensions.

I would have been interested to see a finer-grained analysis of the findings. Specifically, which...  Read more

View all comments by Flavie Waters

Related Paper: Examining Transcranial Direct-Current Stimulation (tDCS) as a Treatment for Hallucinations in Schizophrenia.

Comment by:  Ans Vercammen
Submitted 24 May 2012 Posted 29 May 2012

Brunelin and colleagues present important and exciting findings in this American Journal of Psychiatry report. After an initial enthusiastic surge of positive reports on the efficacy of rTMS in the treatment of auditory-verbal hallucinations several years ago, recent findings have painted a rather less encouraging picture. Larger-scale, well-controlled studies failed to replicate the beneficial effect of low-frequency rTMS of the left temporoparietal regions compared to sham. This suggests that the effects are not as robust as originally believed and/or that earlier positive findings may have been due to small sample-related biases.

As this new report suggests, tDCS may provide an alternative and potentially superior approach to the treatment of psychotic symptoms in medication-resistant schizophrenia. Perhaps the key component here is the use of a dual-target electrode montage, focusing on two sites known to show functional (and structural) alterations in schizophrenia. As the authors suggest, the idea that frontotemporal connectivity may be at the heart of some of the...  Read more

View all comments by Ans Vercammen

Related Paper: Examining Transcranial Direct-Current Stimulation (tDCS) as a Treatment for Hallucinations in Schizophrenia.

Comment by:  Iris Sommer
Submitted 8 June 2012 Posted 8 June 2012

Is direct current stimulation a wonder method for schizophrenia?

Written in collaboration with André Aleman, Christina W. Slotema and Dennis J.L.G. Schutter

With great interest, we read the randomized controlled trial (RCT) by Brunelin et al. in advance publication in the American Journal of Psychiatry. In this study, transcranial direct current stimulation (tDCS) was administered over the left temporo-parietal and frontal cortex for the treatment of both auditory verbal hallucinations and negative symptoms in medication-refractory patients with schizophrenia. Fifteen patients received a series of 10 2-mA tDCS treatments, applied twice daily and another 15 patients received a series of 10 sham treatments. A 31% improvement in clinical symptoms was observed in the active treatment group, as compared to an 8% improvement in the placebo treatment group. For the severity of the auditory verbal hallucinations, an acute large effect size of 1.58 was reported (95% CI=0.76–2.40). Indeed, this is a very large effect size, when compared, for example, to the...  Read more

View all comments by Iris Sommer
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