Abstract
Prefrontal and temporo-parietal repetitive transcranial magnetic stimulation (rTMS) in patients suffering from chronic tinnitus have shown significant but only moderate effectiveness with high interindividual variability in treatment response. This open-label pilot study was designed to examine the general feasibility of an individualized fronto-temporal rTMS protocol and to explore what criteria are needed for a more detailed evaluation in randomized clinical studies. During the first session of a 2-week rTMS protocol, we applied different rTMS protocols to the left and right temporo-parietal and dorsolateral prefrontal cortex (DLPFC) in 25 tinnitus patients. Short trains of 1, 5, 10, and 20 Hz and continuous theta burst stimulation were applied, and patients were asked for immediate tinnitus reductions after each train. If a patient reported such improvements, rTMS treatment was applied over nine sessions with a combined protocol consisting of the most effective frontal and the most effective temporo-parietal stimulation protocol. Those patients who did not improve after the test session were treated with a standard prefrontal plus temporo-parietal protocol (20 Hz over left DLPFC + 1 Hz over temporo-parietal cortex). Almost half of the patients (12 of 25) reported immediate tinnitus reductions during the test session. In this group, the mean pre- to post-treatment amelioration in the tinnitus questionnaire was higher (medium to high effect sizes) in contrast to the patients who did not respond to the test session. Treatment outcome remained stable over a follow-up period of 10 weeks. Individualized rTMS was shown to be feasible and effective in chronic tinnitus. The results obtained from this study provide tentative evidence in support of an individualized rTMS treatment approach and might provide a basis for a "tailored" application of rTMS in tinnitus and other neuropsychiatric disorders.
Highlights
Chronic TinnitusSubjective tinnitus is characterized by the perception of sound in the absence of a corresponding sound source [1]
Patients who did not experience immediate tinnitus modulation during the testing session on day 1 were treated by a “standard” combined treatment consisting of 2,000 stimuli of 20 Hz repetitive transcranial magnetic stimulation (rTMS) delivered to the left dorsolateral prefrontal cortex (DLPFC) followed by 2,000 stimuli of 1 Hz rTMS of the left temporo-parietal junction area (n = 3) or a “triple” paradigm consisting of 2,000 stimuli of 20 Hz rTMS of the left DLPFC followed by rTMS (1,000 stimuli left, 1,000 stimuli right) of the bilateral temporo-parietal junction area (n = 9) [52]
Changes in tinnitus loudness were not significantly different between groups with small or negligible effects sizes. From this pilot study examining the feasibility of an individualized treatment approach in patients suffering from chronic tinnitus, three main conclusions can be drawn: (i) The application of a testing rTMS session with different frequencies and stimulation sites has proven to be feasible with almost 50% of the patients reporting immediate effects in our study sample
Summary
Chronic TinnitusSubjective tinnitus is characterized by the perception of sound in the absence of a corresponding sound source [1]. 1% of the general population report severe tinnitus-related impairment of daily living [2] and seek medical help [3]. The available evidence-based treatments for tinnitus have only small effect sizes [4, 10, 11], indicating the urgent need for the development and optimization of innovative therapeutic attempts. Prefrontal and temporo-parietal repetitive transcranial magnetic stimulation (rTMS) in patients suffering from chronic tinnitus have shown significant but only moderate effectiveness with high interindividual variability in treatment response. This open-label pilot study was designed to examine the general feasibility of an individualized fronto-temporal rTMS protocol and to explore what criteria are needed for a more detailed evaluation in randomized clinical studies
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