Abstract
Background: The left superior temporal gyrus (STG) has been suggested to play a key role in auditory verbal hallucinations (AVH) in patients with schizophrenia.Methods: Eleven medicated subjects with schizophrenia and medication-resistant AVH and 19 healthy controls underwent perfusion magnetic resonance (MR) imaging with arterial spin labeling (ASL). Three additional repeated measurements were conducted in the patients. Patients underwent a treatment with transcranial magnetic stimulation (TMS) between the first 2 measurements. The main outcome measure was the pooled cerebral blood flow (CBF), which consisted of the regional CBF measurement in the left STG and the global CBF measurement in the whole brain.Results: Regional CBF in the left STG in patients was significantly higher compared to controls (p < 0.0001) and to the global CBF in patients (p < 0.004) at baseline. Regional CBF in the left STG remained significantly increased compared to the global CBF in patients across time (p < 0.0007), and it remained increased in patients after TMS compared to the baseline CBF in controls (p < 0.0001). After TMS, PANSS (p = 0.003) and PSYRATS (p = 0.01) scores decreased significantly in patients.Conclusions: This study demonstrated tonically increased regional CBF in the left STG in patients with schizophrenia and auditory hallucinations despite a decrease in symptoms after TMS. These findings were consistent with what has previously been termed a trait marker of AVH in schizophrenia.
Highlights
In schizophrenia, auditory verbal hallucinations (AVH) comprise a critical domain
Regional cerebral blood flow (CBF) in the left superior temporal gyrus (STG) in patients was significantly higher compared to controls (p < 0.0001) and to the global CBF in patients (p < 0.004) at baseline
Regional CBF in the left STG remained significantly increased compared to the global CBF in patients across time (p < 0.0007), and it remained increased in patients after transcranial magnetic stimulation (TMS) compared to the baseline CBF in controls (p < 0.0001)
Summary
Auditory verbal hallucinations (AVH) comprise a critical domain. The 1-month prevalence of these hallucinations exceeds 70% (Sartorius et al, 1986), and, in 25–30% of patients, these perceptions are resistant to medication, resulting in functional disability and a low quality of life (Shergill et al, 1998; Copolov et al, 2004). The CBF in the left STG before treatment predicted the response to TMS, indicating that resting perfusion measurements before treatment might be appropriate for differentiating possible responders and non-responders to TMS (Homan et al, 2012). Those CBF measurements were limited to only one time point, which was before treatment, and the time courses of the CBF and the psychopathological symptoms were not assessed with repeated measurements. The left superior temporal gyrus (STG) has been suggested to play a key role in auditory verbal hallucinations (AVH) in patients with schizophrenia
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