Abstract
Objective: Low frequency rTMS is an useful therapeutic method in the treatment of acoustic hallucinations (AH). Majority of rTMS studies use "standard" coil positioning, which often does not correspond to cortical area(s) of maximal functional changes.
Stereotactic neuronavigation enables to target the coil according to individual physiological parameters obtained from neuroimaging. rTMS navigated according to 18FGD PET allows us to focus the coil explicitly at the given area with detected maxima of specific metabolic abnormalities. Aim: To prove the clinical effect (measured in AHRS score) of low-frequency rTMS administered according to individual cluster of abnormities, evidenced by 18FDG PET in related region of left temporo-parietal cortex (LTPC).
Methods: 0,9 Hz rTMS applied to LTPC with using a) "neuronavigation" according to individual metabolic changes detected by 18FDG PET b) "standard" positioning administered to posterior border superior temporal gyrus and c) inactive "sham", in 10 days serie of AH treatment in a double blind sham controlled cross-over design. Results: We identified (AHRS score) two responders from 13(15%) after sham, six responders from 14(43%) after standard rTMS, and eight responders from 12(67%) after navigated rTMS.
Conclusions: We confirmed the acute effect of rTMS quided according brain metabolism (on local maxima of 18FDG uptake in LTPC). Compared to standard and sham rTMS, we found neuronavigated rTMS the most effective.