Authors
Provaznikova, B., Monn, A., Ertuğrul, A., Weber, S., Seifritz, E., Jungwirth, J., Kronenberg, G., Olbrich, Welt, S. &., & T.
https://doi.org/10.1016/j.psycr.2025.100306Abstract
Auditory verbal hallucinations (AVH) are a particularly distressing symptom of schizophrenia and are associated with significant reductions in quality of life. Antipsychotic medications fail to produce adequate symptom relief in approximately 25–30% of patients and are frequently accompanied by adverse side effects, underscoring the need for effective alternative treatment. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a non-invasive intervention for patients experiencing persistent AVH. While previous studies have explored the effects of rTMS on AVH, this is the first case report, to our knowledge, that combines individual localization of the primary auditory cortex using acoustic evoked potentials (AEP) and precise MRI-based neuronavigation for targeted rTMS application. The changes in auditory hallucinations were assessed through questionnaires and EEG (Electroencephalography), with standardized Low Resolution Brain Electromagnetic Tomography Analysis (sLORETA) used to investigate alterations in functional brain connectivity. We present the case of a 53-year-old male patient with schizoaffective disorder and persistent AVH, in whom AEP and MRI-based neuronavigation were combined to guide individualized rTMS targeting of the left primary auditory cortex. This personalized approach resulted in a rapid and complete remission of AVH after 5 days of rTMS treatment with 1 Hz Protocol. Notably, the clinical improvement was mirrored in source-localized EEG data using sLORETA, which showed reduced activity in the left parietal lobe (Brodmann area 40, postcentral gyrus) across higher frequency bands (Beta and Gamma). This could reflect a downstream or network-level modulation related to auditory processing and AVH symptoms. Further studies are needed to investigate the reproducibility of this approach. Keywords auditory verbal hallucinations repetitive transcranial magnetic stimulation EEG sLORETA MRI