Dataset Information

Effects of individual alpha rTMS applied to the auditory cortex and its implications for the treatment of chronic tinnitus.

ABSTRACT: An increasing amount of studies apply repetetive transcranial magnetic stimulation (rTMS) to treat chronic tinnitus, yet the neurophysiological impacts have remained largely obscure. Several studies show that endogenous brain rhythms may be enhanced via diverse brain stimulation techniques applying rhythmic stimulation. Here, we investigated in normal hearing participants whether application of rTMS (left auditory cortex) with an individualized alpha frequency was capable of increasing alpha activity in stimulated auditory regions in a sustained manner. Behavioral intensity discrimination performance worsened for the rTMS group as compared to Sham. Electroencephalography (EEG) data, however, clearly show that this functional inhibition is not accompanied by increases of auditory cortical alpha. Even though more pronounced power reductions for the rTMS group were observed at slower frequencies (delta to theta range) at stimulated and other sites of the left hemisphere, they were unrelated to behavioral changes. Our results also strongly suggest that the amount of power modulations at these slower frequencies is strongly dependent on pre-rTMS power, thus supporting current state-dependency notions. Strong relationships to behavioral changes were in particular observed for anterior cingulate cortex (ACC) beta power and posterior cingulate cortex (PCC) beta connectivity. Moreover, these beta band measures were strongly inter-related and when viewed together specifically sensitive to behavioral changes in the rTMS group. We conclude that currently alpha frequency rTMS is not a promising avenue for the treatment of chronic tinnitus and that beneficial effects could be mediated via nonauditory systems. Our study argues for the value of combined EEG-TMS studies when investigating the impacts of rTMS.

SUBMITTER: Weisz N

PROVIDER: S-EPMC6869412 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Effects of individual alpha rTMS applied to the auditory cortex and its implications for the treatment of chronic tinnitus.

Weisz Nathan N Lüchinger Claudia C Thut Gregor G Müller Nadia N

Human brain mapping 20120924 1

An increasing amount of studies apply repetetive transcranial magnetic stimulation (rTMS) to treat chronic tinnitus, yet the neurophysiological impacts have remained largely obscure. Several studies show that endogenous brain rhythms may be enhanced via diverse brain stimulation techniques applying rhythmic stimulation. Here, we investigated in normal hearing participants whether application of rTMS (left auditory cortex) with an individualized alpha frequency was capable of increasing alpha act ...[more]

PMID: 23008160

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Project description:Preliminary studies have demonstrated the therapeutic potential of transcranial direct current stimulation (tDCS) for chronic tinnitus. However, the findings are controversial and most of the studies investigated effects of a single session of tDCS and short after-effects, ranging from hours to days. To our knowledge, there is no published study investigating the effects of a chronic protocol of bilateral tDCS over auditory cortex (AC) with one month follow-up in a double blinded randomized clinical trial. This dataset presents the results of a double-blinded placebo controlled trial investigating the effects of chronic protocol (10 sessions) of tDCS over AC with 1 month follow-up. The data of the two groups, real tDCS (n=25) and sham tDCS (n=15), are reported. The dataset includes three main data groups: patient- and tinnitus-specific data, data of the primary and secondary outcomes, and data on the adverse effects of and tolerability to tDCS. The first group includes demographic information, audiometric assessments, and tinnitus-specific characteristics. The second group includes tinnitus handicap inventory (THI) scores, tinnitus loudness, and tinnitus related distress based on 0-10 numerical visual analogue scale (VAS) scores. The values of the primary and secondary outcomes for pre-intervention and at different time points following interventions are presented. THI scores pre-intervention and immediately post-intervention and at 1 month follow-up; the scores of tinnitus loudness and distress scores for pre-intervention, and immediately, 1 hour, 1 week, and at 1 month after the last stimulation session are presented. Moreover, the adverse effects of and tolerability to the tDCS were assessed using a customized questionnaire after the last tDCS session. This dataset can be used alone or in combination with other datasets using advanced statistical analyses and modeling to investigate the treatment efficacy of tDCS in chronic intractable tinnitus.

Project description:Several years ago, repetitive transcranial magnetic stimulation (rTMS) of the auditory cortex has been introduced as a treatment approach for chronic tinnitus. Even if this treatment is beneficial for a subgroup of patients, the overall effects are limited. This limitation may be due to the fact that the auditory cortex is only one of several brain areas involved in tinnitus. Whereas auditory areas are considered to code for tinnitus loudness, conscious perception of and attention allocation to tinnitus is supposed to be reflected by network activity involving frontal and parietal cortical areas. The aim of the present study is to influence this frontoparietal network more efficiently by perturbing the most important nodes with rTMS.This is a randomized, double-blind, parallel-group study. Patients receive rTMS treatment on 10 consecutive working days using either the multisite rTMS protocol (left dorsolateral prefrontal, 1,000 stimuli, 20 Hz; left temporoparietal, 1,000 stimuli, 1 Hz; right temporoparietal stimulation, 1,000 stimuli, 1 Hz) or a single-site protocol (unilateral stimulation of the temporoparietal cortex, 3,000 stimuli, 1 Hz). Individuals aged 18 to 70 years with chronic tinnitus ?6-month duration and a Tinnitus Handicap Inventory score ?38 are recruited for the study. A total of 50 patients are needed to detect a clinical relevant change of tinnitus severity (??=?0.05; 1 - ??=?0.80). Primary outcome measures are the change in the Tinnitus Questionnaire score from baseline to the end of treatment as well as the number of treatment responders as defined by a reduction in the Tinnitus Questionnaire score of ?5 points. Furthermore, changes in brain structure and activity are assessed using (functional) magnetic resonance imaging and electroencephalography in the resting state. Those measurements are also performed in 25 healthy control subjects.This study is designed to reveal whether network stimulation is superior to single-site stimulation in the treatment of chronic tinnitus. Furthermore, the comparison between tinnitus patients and healthy controls and the longitudinal effects of both rTMS treatment protocols on brain structure and function allow inferences to be made about the neural correlates of tinnitus.Clinical Trials: NCT01663324.

Project description:First attempts have demonstrated that the application of alpha/delta neurofeedback in the treatment of chronic tinnitus leads to a reduction of symptoms at the group level. However, recent research also suggests that chronic tinnitus is a decidedly heterogeneous phenomenon, one that requires treatment of distinct subgroups or even on an individual level. Thus, the purpose of this study was to evaluate an individually adjusted alpha/delta neurofeedback protocol. Following previous studies, the delta band fixed between 3 and 4 Hz was chosen as the frequency for inhibition. However, unlike the previous studies, the frequency range for the rewarded alpha band was not fixed between 8 and 12 Hz but rather individually determined according to each patient's specific alpha peak frequency (IAF). Twenty-six chronic tinnitus patients participated in 15 weekly neurofeedback training sessions and extensive pre- and post-tests, as well as follow-up testing 3 and 6 months after training. The main outcome measures were tinnitus-related distress measured with the Tinnitus Handicap Inventory (THI) and Tinnitus Questionnaire (TQ), tinnitus loudness, and pre- and post-training resting-state EEG activity in trained frequency bands. In Results, the neurofeedback protocol led to a significant reduction of tinnitus-related distress and tinnitus loudness. While distress remained on a low level even 6 months after the completion of training, loudness returned to baseline levels in the follow-up period. In addition, resting-state EEG activity showed an increase in the trained alpha/delta ratio over the course of the training. This ratio increase was related to training-induced changes of tinnitus-related distress as measured with TQ, mainly due to increases in the alpha frequency range. In sum, this study confirms the alpha/delta neurofeedback as a suitable option for the treatment of chronic tinnitus and represents a first step towards the development of individual neurofeedback protocols. This clinical trial was registered online at ClinicalTrials.gov (NCT02383147) and kofam.ch (SNCTP000001313).

Dataset Information

Effects of individual alpha rTMS applied to the auditory cortex and its implications for the treatment of chronic tinnitus.

Publications

Effects of individual alpha rTMS applied to the auditory cortex and its implications for the treatment of chronic tinnitus.

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