Significant improvement in treatment resistant auditory verbal hallucinations after 5 days of double-blind, randomized, sham controlled, fronto-temporal, transcranial direct current stimulation (tDCS): A replication/extension study

Brain Stimulation

Guillermo Horga¹  Pejman Sehatpour²  Mathew J. Hoptman²  Odeta Beggel³  Marlene Carlson³  Michael Avissar³  Blair Vail³  Gail Silipo⁴  Daniel C. Javitt⁴  Ragy R. Girgis⁴  Joshua T. Kantrowitz⁵  Anna Gwak⁵ 

[1] Corresponding author. 1051 Riverside Drive, New York, NY, 10032, USA.;Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA;Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA;Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA;Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, 10962, USA;

关键词: tDCS;    Auditory hallucinations;    Target engagement;    Schizophrenia;    Clinical trial;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Transcranial direct current stimulation (tDCS) is a potentially novel treatment for antipsychotic-resistant auditory verbal hallucinations (AVH) in schizophrenia. Nevertheless, results have been mixed across studies. Methods: 89 schizophrenia/schizoaffective subjects (active: 47; Sham: 42) were randomized to five days of twice-daily 20-min active tDCS vs. sham treatments across two recruitment sites. AVH severity was assessed using the Auditory Hallucination Rating Scale (AHRS) total score. To assess target engagement, MRI was obtained in a sub sample. Results: We observed a statistically significant, moderate effect-size change in AHRS total score across one-week and one-month favoring active treatment following covariation for baseline symptoms and antipsychotic dose (p = 0.036; d = 0.48). Greatest change was observed on the AHRS loudness item (p = 0.003; d = 0.69). In exploratory analyses, greatest effects on AHRS were observed in patients with lower cognitive symptoms (d = 0.61). In target engagement analysis, suprathreshold mean field-strength (>0.2 V/m) was seen within language-sensitive regions. However, off-target field-strength, which correlated significantly with less robust clinical response, was observed in anterior regions. Conclusions: This is the largest study of tDCS for persistent AVH conducted to date. We replicate previous reports of significant therapeutic benefit, but only if medication dosage is considered, with patients receiving lowest medication dosage showing greatest effect. Response was also greatest in patients with lowest levels of cognitive symptoms. Overall, these findings support continued development of tDCS for persistent AVH, but also suggest that response may be influenced by specific patient and treatment characteristics. ClinicalTrials.gov: NCT01898299.

【 授权许可】

Unknown