Objective
The goal of this study was to examine the effectiveness and safety of low-frequency rTMS to the temporoparietal junction in a cohort of patients with bothersome tinnitus.
Design
Cross-over, double-blind, randomized clinical trial.
Setting
Outpatient, academic medical center
Participants
14 adults between the ages of 42 and 59 with subjective, unilateral or bilateral, non-pulsatile tinnitus of 6 months duration or greater, and a score of 38 or greater on the Tinnitus Handicap Inventory (THI).
Interventions
Low-frequency (1 Hz) 110% motor threshold rTMS or sham to left temporoparietal junction for 2 weeks.
Main Outcome Measure
The difference in the change of the Tinnitus Handicap Inventory score between active and sham rTMS.
Results
Active treatment was associated with a median (95% CI) reduction in THI of 5 points (0 to 14) and sham treatment was associated with a median reduction in THI of 6 points (−2 to 12). The difference in THI between the change associated with active and sham rTMS ranged from 34 points reduction in THI score after active treatment when compared to THI score after sham, to an increase of 22 points, with a median difference change of only 1 point (−6 to 4).
Conclusions
Daily low-frequency rTMS to the left temporoparietal junction area for 2 weeks was 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 auditory cortex buried within the Sylvian fissure, or more widespread cortical network changes associated with severe bothersome tinnitus not amenable to localized rTMS effects.
rTMS given at low frequency over the right frontal cortex appears to be as effective treatment of refractory depression as high frequency treatment over the left frontal cortex.
Neurocognitive tests compared abilities in people with bothersome tinnitus against an age, gender, and education matched normative population. Participants between 18 and 60 years had subjective, unilateral or bilateral, non-pulsatile tinnitus for >6 months, and a Tinnitus Handicap Inventory score of ≥38. Results from a first testing session showed deficits in learning, learning rates, immediate recall of heard words, and use of a serial order encoding strategy. Initial reliance on serial order encoding and later, increased intrusion of incorrect words towards normal levels might indicate a less demanding strategy to compensate for weakness in associative memory for semantic categories.
When promoting parenting self-efficacy, both social support and family empowerment are important domains to consider for treatment planning and resource development among pregnant women with substance use disorders.
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