آیا rTMS کارآمد به عنوان یک درمان با دوز نگهدارنده برای توهم شنوایی کلامی است؟ گزارش یک مورد

Auditory verbal hallucinations (AH) occur frequently in schizophrenia; in 25% of cases, they are resistant to antipsychotic medication (Shergill et al., 1998) and can produce significant distress and behavioural difficulties. Low frequency (1-Hz), extended duration repetitive Transcranial Magnetic Stimulation (rTMS) could reduce excitability in the brain region directly stimulated as well as in other functionally connected brain areas (Wassermann, 1998). An over-activation of the left temporoparietal cortex, which is critical to speech perception, has been implicated in the genesis of AH (Lennox et al., 2000 and Brunelin et al., 2006) and is readily accessible to rTMS. Suppressive 1-Hz rTMS delivered to this area may therefore produce sustained reductions in AH. It has been reported that about 10,000 stimulations delivered in 10 sessions may temporarily curtail refractory AH (Hoffman et al., 2003, Hoffman et al., 2005 and Poulet et al., 2005). Indeed, the duration of this effect is variable; Hoffman et al. (2005) reported that the mean duration of survivorship was roughly 4 months, where survivorship was defined as a sustained reduction in hallucination severity of at least 20% relative to pre-trial baseline scores. In rTMS treatment of bipolar depression, Li et al. (2004) reported the efficiency of a 1-day-per-week maintenance treatment during 1 year. Our objective was to evaluate the efficiency of rTMS on AH improvement with a once-weekly maintenance treatment.