"Repetitive Transcranial Magnetic Stimulation for Auditory Hallucinations in Schizophrenia": Scoping Review

Auditory verbal hallucinations (AVH) are among the most disabling symptoms of schizophrenia, often resistant to pharmacological treatment. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential non-pharmacological intervention; however, existing evidence is fragmented across heterogeneous study designs.

This scoping review aimed to map the available evidence on the use of rTMS for AVH in patients with schizophrenia, focusing on stimulation parameters, clinical outcomes, neuroimaging findings, and gaps in current research.

A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported in accordance with PRISMA-ScR guidelines. Literature searches were performed in PubMed, Scopus, EBSCO, and ScienceDirect for studies published between 2015 and 2025. Eligible studies included randomized controlled trials (RCTs), observational studies, and exploratory trials investigating rTMS in schizophrenia patients with AVH. Data were extracted and synthesized descriptively.

Eight studies met the inclusion criteria. Most were conducted in China, with additional contributions from France, India, and the Netherlands. Low-frequency rTMS (1 Hz) targeting the temporoparietal junction (TPJ) was the most frequently applied protocol, while high-frequency stimulation (10 Hz) over the dorsolateral prefrontal cortex (DLPFC) and cerebellar theta burst stimulation were less common. Several RCTs demonstrated significant reductions in AVH severity, whereas others highlighted placebo effects. Neuroimaging studies reported rTMS-induced modulation of brain connectivity, particularly within the default mode, language, and auditory networks. Across studies, small sample sizes, heterogeneous protocols, and limited follow-up restricted generalizability.

rTMS shows promise as a non-pharmacological intervention for AVH in schizophrenia, particularly with low-frequency stimulation over the TPJ. However, evidence remains heterogeneous, and future multicenter trials with standardized protocols and long-term outcomes are warranted to establish clinical effectiveness.