آیا هدایت fMRI می تواند اثربخشی درمان rTMS برای توهم شنوایی کلامی بهبود دهد؟

The majority of auditory verbal hallucinations (AVH) are responsive to antipsychotic medication, but in 25–30% hallucinations persist despite adequate pharmacotherapy (Shergill et al., 1998). Low frequency repetitive Transcranial Magnetic Stimulation (rTMS) offers an alternative treatment for this medication-resistant group (Hoffman et al., 2005). A recent meta-analysis concluded that rTMS is an effective treatment for AVH, with an effect size of 0.76 (Aleman et al., 2007). So far, rTMS was mostly applied to the left temporo-parietal area. However, functional Magnetic Resonance Imaging (fMRI) studies show that in approximately 50% of patients hallucinatory activation mainly involves the right hemisphere (Sommer et al., 2003). The effect of rTMS may therefore be increased when the treatment is applied exactly over the cortical area that is active in hallucinations. In this study we used individual fMRI scans of hallucinatory activation to stereotactically guide TMS treatment to the cerebral area with maximal hallucinatory activation.