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Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus.

ABSTRACT: To examine the effectiveness and safety of low-frequency repetitive transcranial magnetic stimulation (rTMS) to the temporoparietal junction in a cohort of patients with bothersome tinnitus.Crossover, double-blind, randomized clinical trial.Outpatient academic medical center.Fourteen adults aged 42 to 59 years with subjective, unilateral or bilateral, nonpulsatile tinnitus of 6 months' duration or longer and a score of 38 or greater on the Tinnitus Handicap Inventory (THI).Low-frequency (1-Hz) 110% motor threshold rTMS or sham treatment to the left temporoparietal junction for 2 weeks.The difference in the change of the THI score between active and sham rTMS.Active treatment was associated with a median (95% confidence interval) reduction in THI score of 5 (0-14) points, and sham treatment was associated with a median reduction in THI score of 6 (-2 to 12) points. The difference in THI scores between the change associated with active and sham rTMS ranged from a 34-point reduction in THI score after active treatment to a 22-point increase after sham treatment, with a median difference change of only 1 point (-6 to 4 points).Daily low-frequency rTMS to the left temporoparietal junction area for 2 weeks is no more effective than placebo for patients with chronic bothersome tinnitus. Possible explanations for the negative findings are short duration of treatment, failure of rTMS stimulation over the temporoparietal area to affect the auditory cortex buried within the Sylvian fissure, or more widespread cortical network changes associated with severe bothersome tinnitus not amenable to localized rTMS effects. Trial Registration clinicaltrials.gov Identifier: NCT00567892.

SUBMITTER: Piccirillo JF

PROVIDER: S-EPMC3140874 | biostudies-literature | 2011 Mar

REPOSITORIES: biostudies-literature

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Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus.

Piccirillo Jay F JF Garcia Keith S KS Nicklaus Joyce J Pierce Katherine K Burton Harold H Vlassenko Andrei G AG Mintun Mark M Duddy Diane D Kallogjeri Dorina D Spitznagel Edward L EL

Archives of otolaryngology--head & neck surgery 20110301 3

<h4>Objective</h4>To examine the effectiveness and safety of low-frequency repetitive transcranial magnetic stimulation (rTMS) to the temporoparietal junction in a cohort of patients with bothersome tinnitus.<h4>Design</h4>Crossover, double-blind, randomized clinical trial.<h4>Setting</h4>Outpatient academic medical center.<h4>Participants</h4>Fourteen adults aged 42 to 59 years with subjective, unilateral or bilateral, nonpulsatile tinnitus of 6 months' duration or longer and a score of 38 or g ...[more]

PMID: 21422304

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Project description:Chronic tinnitus is associated with neuroplastic changes in auditory and non-auditory cortical areas. About 10 years ago, repetitive transcranial magnetic stimulation (rTMS) of auditory and prefrontal cortex was introduced as potential treatment for tinnitus. The resulting changes in tinnitus loudness are interpreted in the context of rTMS induced activity changes (neuroplasticity). Here, we investigate the effect of single rTMS sessions on oscillatory power to probe the capacity of rTMS to interfere with tinnitus-specific cortical plasticity. We measured 20 patients with bilateral chronic tinnitus and 20 healthy controls comparable for age, sex, handedness, and hearing level with a 63-channel electroencephalography (EEG) system. Educational level, intelligence, depressivity and hyperacusis were controlled for by analysis of covariance. Different rTMS protocols were tested: Left and right temporal and left and right prefrontal cortices were each stimulated with 200 pulses at 1 Hz and with an intensity of 60% stimulator output. Stimulation of central parietal cortex with 6-fold reduced intensity (inverted passive-cooled coil) served as sham condition. Before and after each rTMS protocol 5 min of resting state EEG were recorded. The order of rTMS protocols was randomized over two sessions with 1 week interval in between. Analyses on electrode level showed that people with and without tinnitus differed in their response to left temporal and right frontal stimulation. In tinnitus patients left temporal rTMS decreased frontal theta and delta and increased beta2 power, whereas right frontal rTMS decreased right temporal beta3 and gamma power. No changes or increases were observed in the control group. Only non-systematic changes in tinnitus loudness were induced by single sessions of rTMS. This is the first study to show tinnitus-related alterations of neuroplasticity that were specific to stimulation site and oscillatory frequency. The observed effects can be interpreted within the thalamocortical dysrhythmia model assuming that slow waves represent processes of deafferentiation and that high frequencies might be indicators for tinnitus loudness. Moreover our findings confirm the role of the left temporal and the right frontal areas as relevant hubs in tinnitus related neuronal network. Our results underscore the value of combined TMS-EEG measurements for investigating disease related changes in neuroplasticity.

Project description:BackgroundChronic tinnitus affects approximately 10-15% of the population. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been considered as a promising and well-tolerated therapeutic strategy for chronic tinnitus. However, a recent large-scale multicenter clinical trial showed a negative result.ObjectiveThis systematic review is aimed at assessing the efficacy and safety of low-frequency rTMS in chronic tinnitus.MethodsWe searched PubMed, Embase, and Cochrane Library for randomized controlled studies of rTMS treatment of chronic tinnitus. A pooled analysis of standardized mean difference (SMD) was performed with 95% confidence intervals (CI).ResultsTen RCTs involving 567 participants were included in this review. Compared with sham stimulation, rTMS showed no significant efficacy in tinnitus severity and disability measured by Tinnitus Handicap Inventory (THI) in short-term (SMD = -0.04, 95% CI -0.23 to 0.16, P = 0.72), medium-term (SMD = -0.13, 95% CI -0.43 to 0.17, P = 0.41), and long-term (SMD = -0.16, 95% CI -0.38 to 0.05, P = 0.14) follow-up. Tinnitus severity and disability measured by Tinnitus Questionnaire (TQ) also showed no significant improvement in short-term (SMD = -0.11, 95% CI -0.31 to 0.10, P = 0.30), medium-term (SMD = -0.10, 95% CI -0.37 to 0.16, P = 0.44), and long-term (SMD = -0.20, 95% CI -0.40 to 0.01, P = 0.06) follow-up. Additionally, no statistically significant difference was shown in the changes of tinnitus loudness assessed by a visual analogue scale (VAS) between rTMS and sham groups in the short-term (SMD = -0.28, 95% CI -0.59 to 0.02, P = 0.07), medium-term (SMD = -0.26, 95% CI -0.59 to 0.07, P = 0.13), and long-term (SMD = -0.20, 95% CI -0.53 to 0.13, P = 0.24) follow-up. Few mild or moderate adverse events were observed in both the rTMS and sham groups.ConclusionLow-frequency rTMS is well tolerated but not effective in treating chronic tinnitus based on the current analysis of pooled data. Further studies with modified and uniform protocols are required to investigate the potential benefit of rTMS in chronic tinnitus.

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Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus.

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Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus.

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