Chapter

Transcranial Magnetic Stimulation

André Aleman and Ralph Hoffman

in Hallucinations

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199548590
Published online February 2013 | e-ISBN: 9780191754623 | DOI: http://dx.doi.org/10.1093/med/9780199548590.003.0003
Transcranial Magnetic Stimulation

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It seems safe to conclude that rTMS has shown some promise for the treatment of hallucinations. Several studies have reported significant improvement in hallucination severity after a course of rTMS, and this has been confirmed meta-analytically. However, due to the small sample sizes, large placebo effects and other methodological difficulties, including location of stimulation and the chronicity of the groups studied, strong conclusions cannot be reached at this point. Future research should definitely include larger groups, in a multi-centre effort. Finally, it is important to note that the majority of rTMS studies included treatment-resistant patients. Given the favourable side effect profile of TMS, it is conceivable to extend its use to less chronic patient groups. For example, first-episode patients with primary auditory hallucinations could benefit from rTMS, maybe even without needing medication. We are aware, however, that this might be a small group. On the other hand, TMS could also be used as an adjunctive for those patients that use medication but still complain about the hallucinations. Indeed, given the fact that TMS primarily seems to reduce the frequency of hallucinations (Hoffman et al., 2005), and not so much other aspects of hallucinations, it might be effective to combine it with cognitive therapies, so that people learn to cope with their hallucinatory propensity and may reduce distress due to hallucinations. Whether the use of MRI-based neuronavigation will improve the efficacy of TMS should also be determined in the coming years.

Chapter.  5933 words. 

Subjects: Psychiatry

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