Auditory verbal hallucinations (AVHs) are among the most frequent and disabeling symptoms of schizophrenic diseases. In approximately one quarter of patients, AVHs have to be considered as therapy-refractory with regard to pharmacological treatment options. This group of patients may benefit from a treatment protocol with repetitive Transcranial magnetic stimulation (rTMS) aiming on an inhibition of AVH-associated increased activity of auditory brain areas in the temporal cortex. However, optimal protocols for the guidance and control of such innovative treatment regimens are still lacking.

We propose the application of a non-invasive optical imaging technique (functional Near-Infrared Spectroscopy; fNIRS) for the measurement of the AVH-related activity of the auditory cortex, for the guidance of the rTMS-treatment and for the control of a treatment success on the brain metabolic level.

In the reported patient, NIRS measurement indicated AVH-related activity in the left auditory cortex which strongly decreased after a period of three weeks with daily inhibitory rTMS treatment, in parallel with drastically diminished AVHs.

This is the first report of a NIRS-guided and –controlled inhibitory rTMS treatment of therapy-refractory AVHs in a schizophrenic patient. Given the excellent clinical applicability of the applied methods, the combination of fNIRS and rTMS might have the potential to establish new treatment options in psychiatry aiming on the modulation of pathological regional brain activity patterns.