P0317 - Stereotactic neuronavigation of rTMS in the treatment of auditory hallucinations: A pilot study

Abstract

Objectives:

It was repeatedly reported that low frequency rTMS diminishes treatment-resistant auditory hallucinations. The main drawback to rTMS in general, so far has been the impossibility of precise targeting of the rTMS coil at the given cortical area. Stereotactic neuronavigation is a unique technology utilising the ability of aiming the coil with a high degree of anatomic accuracy based on an evaluation of the structural or functional neuroimaging of the brain.

Aim:

To prove the clinical effect of using rTMS neuronavigation in the therapy of treatment-resistant auditory hallucinations

Methods:

Seventeen schizophrenic patients with predominantly symptoms of treatment-resistant auditory hallucinations were treated.

Using double-blind sham-controlled parallel design, we evaluated the effect rTMS neuronavigation focused over the left temporo-parietal area, direct to the place with the highest metabolic activity (SPM II analysed PET contrast).

Parameter settings were: 0.9Hz, MT 100%, 1080 puses/session, 10 sessions, duration: 20 minutes per session.

Clinical effect was assessed using PANNS, AHRS and HCS.

Results:

We found a significant improvement in the total on scales of HCS and AHRS, representing more than 30% reduction of the symptoms after neuronavigated rTMS. Sham rTMS did not showed a trend for improvement over time. No side effects during rTMS were observed.

Conlusions:

Our study shows the acute effect of rTMS neuronavigation in the therapy of auditory hallucinations in schizophrenia. We believe that using neuronavigation and respecting an individual brain parameters and metabolic changes, we can evaluate higher efficiency of the rTMS method.

Supported by CNS, MZČR MZ0PCP2005 and MŠMT 1M0517