To provide clinical insights on managing refractory auditory hallucinations in a patient with schizophrenia who developed intracranial hypertension syndrome following MECT.
Approach:
Patient Background: A 21-year-old female with treatment-resistant schizophrenia and persistent auditory hallucinations underwent MECT and subsequently rTMS.
Treatment Details: After MECT, the patient received rTMS at 1 Hz to the left temporo-parietal cortex, delivering 1,500 pulses at 74% of the resting motor threshold.
Key Findings:
The patient experienced significant reduction in auditory hallucinations three days post-rTMS, with complete resolution one week later.
Improvement in social functioning was noted, with no recurrence of symptoms during a three-week follow-up.
Intracranial hypertension syndrome developed after the first MECT session, characterized by severe headache, projectile vomiting, diplopia, and meningeal signs.
Interpretation:
rTMS may be a safe and effective alternative for patients with refractory auditory hallucinations who cannot tolerate MECT.
Limitations:
The case study is based on a single patient, limiting generalizability.
Long-term effects and safety of rTMS in this context require further investigation.
Conclusion:
This case highlights the importance of monitoring for elevated intracranial pressure following MECT.
