Transcranial Magnetic Stimulation for the Treatment of Pharmacoresistant Nondelusional Auditory Verbal Hallucinations in Dementia

Abstract

Auditory verbal hallucinations (AVHs) are known as a core symptom of schizophrenia, but also occur in a number of other conditions, not least in neurodegenerative disorders such as dementia. In the last decades, Transcranial Magnetic Stimulation (TMS) emerged as a valuable therapeutic approach towards several neurological and psychiatric diseases, including AVHs. Herein we report a case of a seventy-six-years-old woman with vascular-degenerative brain disease, complaining of threatening AVHs. The patient was treated with a high-frequency temporoparietal (T3P3) rTMS protocol for fifteen days. A considerable reduction of AVHs in frequency and content (no more threatening) was observed. Although further research is needed, this seems an encouraging result.

Noninvasive brain stimulation for behavioural and psychological symptoms of dementia: A systematic review and meta‐analysis

“…29,33,34 We also found 2 case reports. One describing a patient with vascular degenerative disease receiving rTMS, 35 and another a patient with behavioural variant frontotemporal dementia (bvFTD) treated with tDCS. 36…”

“…Regarding hallucinations and delusions, while these are frequent psychopathological manifestations in patients with AD and other dementias, there is a lack of studies to address the potential of noninvasive brain stimulation to treat these symptoms. In a case report, Marras and Palanti have revealed promising results in this area, with findings of a marked reduction of threatening auditory verbal hallucinations after application of high‐frequency temporoparietal rTMS protocol.…”

Transcranial magnetic stimulation and transcranial direct current stimulation: treatments for cognitive and neuropsychiatric symptoms in the neurodegenerative dementias?

“…The majority of the studies in the dementias examined cognitive outcome measures [ 28 ]-[ 42 ] whilst several examined neuropsychiatric symptoms [ 43 ]-[ 45 ]. A total of 13 studies targeted AD patients [ 28 ]-[ 33 ],[ 37 ]-[ 42 ], 4 studies included MCI patients [ 34 ]-[ 36 ],[ 43 ] and 1 study involved DLB patients [ 44 ]. No studies reported the therapeutic use of TMS or tDCS in individuals with VaD, PDD, or FTD.…”

“…Typical sites of stimulation included the DLPFC [ 28 ]-[ 31 ],[ 37 ],[ 42 ], temporal regions [ 38 ], temporoparietal regions [ 41 ] or a combination of multiple regions [ 32 ],[ 33 ],[ 39 ]. However, sample sizes were often small (including single-case studies [ 36 ],[ 37 ],[ 43 ]), and the majority were open-label in design. Nevertheless, these studies will help inform future work because several concepts, which are likely to impact upon the utility and effectiveness of non-invasive stimulation, were apparent:…”

“…Whilst there is a substantive evidence base for the use of TMS in the treatment of psychosis in schizophrenia [ 61 ], we did not find any studies where TMS or tDCS was used to treat psychosis in dementia. Notably, a single-case study conducted in an MCI patient reported a reduction in the frequency of auditory verbal hallucinations following TMS, which was accompanied by a reduction in threatening content during the hallucinations and in associated distress [ 43 ].…”