P012 Unexpected improvement of motor function in a stroke patient following an rTMS treatment for auditory hallucinations: a case report

Abstract

Introduction Auditory verbal hallucinations (AVHs) are perception-like experiences that occur without an external stimulus. AVHs can occur following a stroke. Repetitive Transcranial Magnetic Stimulation (rTMS) is a tool used to induce brain plasticity in local and remote areas of the brain that may be used for AVHs treatment. Here, we report the case of a patient experiencing AVHs following a stroke treated with rTMS applied to the left temporoparietal junction. Objective To treat AVHs in a post-stroke incomplete locked-in patient with rTMS. Patient and methods Following a stroke event, an MRI revealed bilateral lesions in a 55-year-old male brain (large lesion from the bulbo-pontine junction to the cerebral peduncles, and small lesions in the right cerebellar and the left capsulo-thalamic regions). The patient developed an incomplete locked-in syndrome and he experienced AVHs and delusional melancholia six years after the insult. An antipsychotic treatment was not tolerated well and, consequently, an experimental treatment by rTMS was applied to this patient to ameliorate these symptoms. To this purpose, an inhibitory 1-Hz rTMS protocol was delivered twice per day, with an interval of 1 h and an intensity of 100% of his resting Motor Threshold of the left hemisphere. Each session lasted 20 min and delivered 1200 pulses. In total, 56 rTMS sessions were administered. AVHs and mood were assessed using the Auditory Hallucinations Rating Scale (AHRS), the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression scale (HAD) before and during the treatment. Results After 26 sessions of the 1-Hz rTMS, the AHRS score was reduced from 29 to 0, indicating the absence of AVHs. A reduction of BDI and HAD scores showed an improvement in mood. In addition, there was an unexpected improvement of motor function in the contralateral hand to the stimulated region. Conclusion Repetitive TMS should be considered as a therapeutic option for AVHs following a stroke. Potential associated motor improvement that stimulation could unfold provides additional value to the use of rTMS such clinical scenario. Further investigations are underway to understand the brain plasticity mechanisms underlying such unexpected motor improvement.