# fMRI-guided rTMS in the treatment of auditory verbal hallucinations in schizophrenia: a case report

## TL;DR

This case report shows that fMRI-guided rTMS can reduce auditory hallucinations in schizophrenia patients who do not respond to medication.

## Contribution

The study demonstrates a personalized fMRI-guided rTMS approach for treatment-resistant auditory verbal hallucinations.

## Key findings

- AVH severity decreased by 33% after three cycles of rTMS.
- Global symptom scores improved by 40% in the patient.
- Functional connectivity increased between the target and a key brain network.

## Abstract

Auditory verbal hallucinations (AVH) are a core symptom of schizophrenia and contribute substantially to patient suffering and disability. They are among the most persistent symptoms and do not respond to medication in a substantial portion of patients. Here, we report the application of task-based functional magnetic resonance imaging (fMRI)-guided repetitive transcranial magnetic stimulation (rTMS) in a patient with treatment-resistant AVH. An individualized stimulation target was identified in the left temporal cortex near Heschl’s gyrus using a validated fMRI task. Over a period of 18 months, the patient underwent three cycles of inhibitory 1 Hz rTMS of this target. As a result, AVH severity decreased by 33% and the global symptom score improved by 40%. Functional connectivity analyses revealed an increase in coupling between the temporal target seed and a fronto-cingulate-insular network that has been implicated in reality and performance monitoring. This case highlights the potential of fMRI-guided rTMS as a personalized neuromodulatory therapy for refractory AVH in schizophrenia, warranting further systematic investigation.