Balancing Efficacy and Safety: Transcranial Direct Current Stimulation as an Adjunctive Intervention for Persistent Auditory Verbal Hallucinations in a Case of Schizophrenia and Seizure Disorder with Incomplete Hippocampal Inversion
Varsha Shamanna, Harsh Pathak, Swarna Buddha Nayok, Rujuta Parlikar, Vanteemar S Sreeraj, Ganesan Venkatasubramanian
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
Correspondence to: Vanteemar S Sreeraj
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029, India
E-mail: vs8sreeraj@yahoo.com
ORCID: https://orcid.org/0000-0002-2946-1228
Received: June 20, 2024; Revised: August 27, 2024; Accepted: October 7, 2024; Published online: October 29, 2024.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Incomplete hippocampal inversion (IHI) is associated with epilepsy and schizophrenia, often leading to persistent auditory verbal hallucinations (AVH). This case study discusses a 23-year-old with diagnosed with schizophrenia, intellectual disability, and a seizure disorder, having AVH non-responsive to multiple antipsychotics. Magnetic resonance imaging indicated left hippocampal IHI. In view of the increased risk of seizure with clozapine, transcranial direct current stimulation (tDCS) was administered, targeting the left temporoparietal junction using cathodal stimulation and left dorsolateral prefrontal cortex using anodal stimulation. Following 20 sessions over 10 days, AVH significantly improved, with Scale for the Assessment of Positive Symptoms and Auditory Hallucination Rating Scale scores reducing by over 70%, maintaining at a 3-month follow-up. This case highlights tDCS as an effective adjunctive treatment for AVH in schizophrenia with structural brain abnormalities, emphasizing the need for further research into tDCS effects on hippocampal- temporoparietal connectivity.
Keywords: Hippocampus malrotation; Epilepsy; Psychotic disorders; Neuromodulation; Intellectual disability


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