The nationwide multicenter trials of the German Research Network on Neuropathic Pain (DFNS) aim to characterize the somatosensory phenotype of patients with neuropathic pain. For this purpose, we have implemented a standardized quantitative sensory testing (QST) protocol giving a complete profile for one region within 30 min. To judge plus or minus signs in patients we have now established age- and gender-matched absolute and relative QST reference values from 180 healthy subjects, assessed bilaterally over face, hand and foot. We determined thermal detection and pain thresholds including a test for paradoxical heat sensations, mechanical detection thresholds to von Frey filaments and a 64 Hz tuning fork, mechanical pain thresholds to pinprick stimuli and blunt pressure, stimulus/response-functions for pinprick and dynamic mechanical allodynia, and pain summation (wind-up ratio). QST parameters were region specific and age dependent. Pain thresholds were significantly lower in women than men. Detection thresholds were generally independent of gender. Reference data were normalized to the specific group means and variances (region, age, gender) by calculating z-scores. Due to confidence limits close to the respective limits of the possible data range, heat hypoalgesia, cold hypoalgesia, and mechanical hyperesthesia can hardly be diagnosed. Nevertheless, these parameters can be used for group comparisons. Sensitivity is enhanced by side-to-side comparisons by a factor ranging from 1.1 to 2.5. Relative comparisons across body regions do not offer advantages over absolute reference values. Application of this standardized QST protocol in patients and human surrogate models will allow to infer underlying mechanisms from somatosensory phenotypes.

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Treating chronic tinnitus for 4 weeks by applying cTBS to the temporal or temporoparietal cortex of both hemispheres appears to be safe but not more effective than sham stimulation. However, these results are not to be generalized to all forms of rTMS treatments for tinnitus.

BackgroundTranscranial direct current stimulation (tDCS) may alleviate motor symptoms in Parkinson's disease (PD). However, the neurophysiological effects of tDCS on cortical activation, synchronization, and the relation to clinical motor symptoms and motor integration need characterization.ObjectiveWe aimed to explore the effect of tDCS over the left sensorimotor area on clinical motor outcome, right hand fine motor performance as well as cortical activity and synchronization in the high beta range.MethodsIn this double-blind randomized sham-controlled clinico-neurophysiological study we investigated ten idiopathic PD patients and eleven matched healthy controls (HC) on two days during an isometric precision grip task and at rest before and after ‘verum’ and ‘sham’ anodal tDCS (20 min; 1 mA; anode [C3], cathode [Fp2]). We measured clinical outcome, fine motor performance, and analysed both cortical frequency domain activity and corticocortical imaginary coherence.ResultstDCS improved PD motor symptoms. Neurophysiological features indicated a motor-task-specific modulation of activity and coherence from 22 to 27 Hz after ‘verum’ stimulation in PD. Activity was significantly reduced over the left sensorimotor and right frontotemporal area. Before stimulation, PD patients showed reduced coherence over the left sensorimotor area during motor task compared to HC, and this increased after ‘verum’ stimulation in the motor task. The activity and synchronization modulation were neither observed at rest, after sham stimulation nor in healthy controls.ConclusionVerum tDCS modulated the PD cortical network specifically during fine motor integration. Cortical oscillatory features were not in general deregulated in PD, but depended on motor processing.

subscale score: 27→11, negative subscale score: 25→22, general psychopathology subscale score: 41→28). His score on the Global Assessment of Functioning increased from 42 to 55. Weekly evaluation of hallucinations confi rmed their continuous absence for 3 months.The observation in the present case provides the fi rst evidence, to our knowledge, that a long-term bilateral application of continuous theta burst stimulation can achieve a complete and long-lasting elimination of auditory hallucinations and an improvement in global function. Of note, an amelioration of delusions, anxiety, tension, and unusual thought content was also accomplished. Since auditory hallucination-associated cortical activities are not limited to the left hemisphere, we opted for bilateral stimulation to optimize effi cacy. Notably, improvement was achieved gradually, with complete remission, pointing toward a benefi t of prolonged treatment, not occurring until 6 weeks. As intended, continuous theta burst stimulation beyond remission was followed by maintenance of the effect. However, in addition to briefer treatment sessions, an advantage of continuous theta burst stimulation relative to rTMS cannot be derived from this report. Further trials are needed to disentangle the infl uence of treatment duration, laterality, and stimulation paradigm in order to determine treatment effi cacy, clinical practicability, and sustainability. References 1. Hoffmann RE, Boutros NN, Hu S, Berman RM, Krystal JH, Charney DS: Transcranial magnetic stimulation of the left temporoparietal cortex and medication-resistant auditory hallucinations. Arch Gen Psychiatry 2003; 60:49-56 2. Slotema CW, Blom JD, Hoek HW, Sommer IE: Should we expand the toolbox of psychiatric treatment methods to include repetitive transcranial magnetic stimulation (rTMS)? A meta-analysis of the effi cacy of rTMS in psychiatric disorders. J Clin Psychiatry 2010; 71:873-884 3. Huang YZ, Edwards MJ, Rounis E, Bhatia KP, Rothwell JC: Theta burst stimulation of the human motor cortex. Neuron 2005; 45:201-206TO THE EDITOR: Auditory hallucinations in patients with schizophrenia are severely distressing and increase the risk for violence and suicide. In up to 25% of patients, such hallucinations resist therapeutic efforts. Repetitive transcranial magnetic stimulation (rTMS) to the left temporoparietal cortex has been established as an effective new treatment option (1, 2). However, the effectiveness and sustainability of this treatment are still under debate. Bilateral stimulation and prolongation of the treatment course might enhance the size and maintenance of the effect. The use of continuous theta burst stimulation, a patterned form of rTMS with brief stimulation sessions, could improve clinical practicability (3). We report on the case of a patient who received continuous theta burst stimulation applied to the left and right temporoparietal cortex."Mr. C" was a 52-year-old right-handed man with a 22-year history of paranoid schizophrenia (consistent with DSM-IV criteria). The patient suffe...

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