Individualized Repetitive Transcranial Magnetic Stimulation Treatment in Chronic Tinnitus?

Abstract

BackgroundPrefrontal 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.MethodsDuring 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).ResultsAlmost 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.DiscussionIndividualized 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.

Single-Session of Combined tDCS-TMS May Increase Therapeutic Effects in Subjects With Tinnitus

“…Second, although we have found that tDCS-TMS has the potential to improve the neuromodulatory effect, thereby creating an improvement of tinnitus, the results are limited as we have utilized only 200 pulses of low-frequency TMS due to time and space constraints in our hospital. Most of the previous tinnitus studies utilizing low-frequency TMS used 2,000 stimuli (46)(47)(48). In this regard, future tDCS-TMS studies using conventional TMS with 2,000 stimuli should be performed to explore further additive neuromodulatory effects on tinnitus.…”

A Pilot Study of Peripheral Muscle Magnetic Stimulation as Add-on Treatment to Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus

“…Moreover the combination of two techniques—such as rPMS plus rTMS—is challenging to explore, as the complexity is increased by additional aspects such as the temporal relationship between peripheral and central stimulation. Consequently, future studies should try to concentrate on subgroup-specific effects of different treatment strategies or, more generally, on individualized treatment programs considering the very specific combination of possible causes and/or tinnitus-related alterations of a particular patient (Kreuzer et al, 2017 ).…”

Transcranial Magnetic Stimulation in the Treatment of Tinnitus

“…Kreuzer et al's study suggested that individualized rTMS sessions' outcomes were better, since tinnitus is a personal symptom and hard to generalize [131]. In Yilmaz et al's study, THI score decreased by 8 points after the application of low-frequency rTMS, and also a statistically significant decrease was observed in tinnitus loudness and subjective score after the application of rTMS [50].…”