Long-term effects of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic tinnitus.

Abstract

OBJECTIVES:

The pathophysiologic mechanisms of idiopathic tinnitus remain unclear. Recent studies demonstrated focal brain activation in the auditory cortex of patients with chronic tinnitus. Low-frequency repetitive transcranial magnetic stimulation (rTMS) is able to reduce cortical hyperexcitability.

STUDY DESIGN:

Fusing of the individual PET-scan with the structural MRI-scan (T1, MPRAGE) allowed us to identify exactly the area of increased metabolic activity in the auditory cortex of patients with chronic tinnitus. With the use of a neuronavigational system, this target area was exactly stimulated by the figure 8-shaped magnetic coil. In a prospective study, rTMS (110% motor threshold; 1 Hz; 2000 stimuli/day over 5 days) was performed using a placebo controlled cross-over design. Patients were blinded regarding the stimulus condition. For the sham stimulation a specific sham-coil system was used. Fourteen patients were followed for 6 months. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller).

SETTING:

Tertiary referral medical center.

RESULTS:

Increased metabolic activation in the auditory cortex was verified in all patients. After 5 days of verum rTMS, a highly significant improvement of the tinnitus score was found whereas the sham treatment did not show any significant changes. The treatment outcome after 6 months still demonstrated significant reduction of tinnitus score.

CONCLUSION:

These preliminary results demonstrate that neuronavigated rTMS offers new possibilities in the understanding and treatment of chronic tinnitus.

• Authors: Tobias Kleinjung, Peter Eichhammer, Berthold Langguth, Peter Jacob, Joerg Marienhagen, Goeran Hajak, Stephan R Wolf, Juergen Strutz
• Journal: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Otolaryngol Head Neck Surg) Vol. 132 Issue 4 Pg. 566-9 (Apr 2005) ISSN: 0194-5998 [Print] England
• PMID: 15806046 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Topics

• Adult
• Auditory Cortex (physiopathology)
• Chronic Disease
• Cross-Over Studies
• Dominance, Cerebral (physiology)
• Double-Blind Method
• Energy Metabolism (physiology)
• Female
• Humans
• Image Processing, Computer-Assisted
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neuronavigation (instrumentation)
• Parietal Lobe (physiopathology)
• Patient Satisfaction
• Positron-Emission Tomography
• Retreatment
• Surveys and Questionnaires
• Temporal Lobe (physiopathology)
• Tinnitus (diagnosis, physiopathology, therapy)
• Transcranial Magnetic Stimulation (therapeutic use)
• Treatment Outcome