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Houdayer E, Teggi R, Velikova S, Gonzalez-Rosa J, Bussi M, Comi G, Leocani L. Involvement of cortico-subcortical circuits in normoacousic chronic tinnitus: A source localization EEG study. Clin Neurophysiol 2015; 126:2356-65. [DOI: 10.1016/j.clinph.2015.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/25/2014] [Accepted: 01/09/2015] [Indexed: 12/27/2022]
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Takahashi S, Ukai S, Tsuji T, Ueyama T, Kono M, Yamanaka N, Shinosaki K. Reduction of cortical excitability and increase of thalamic activity in a low-frequency rTMS treatment for chronic tinnitus. Neurocase 2015; 21:339-44. [PMID: 24606019 DOI: 10.1080/13554794.2014.893000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Low-frequency repetitive transcranial magnetic stimulation (rTMS) has received increasing attention for the treatment of tinnitus, but its therapeutic mechanisms are unclear. We performed low-frequency rTMS treatment for a patient with chronic tinnitus and examined changes of cortical excitability and cerebral blood flow using paired-pulse TMS and single-photon emission computed tomography. After the rTMS treatment, tinnitus loudness was decreased, cortical excitability was reduced, and blood flow in the thalamus was increased. Our results suggest that low-frequency rTMS treatment reduces tinnitus loudness by an inhibitory effect on the cortical excitability and a remote activation effect on the thalamus through the corticothalamic networks.
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Affiliation(s)
- Shun Takahashi
- a Department of Neuropsychiatry , Wakayama Medical University , Wakayama , Japan
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Schneider DM, Nelson A, Mooney R. A synaptic and circuit basis for corollary discharge in the auditory cortex. Nature 2014; 513:189-94. [PMID: 25162524 PMCID: PMC4248668 DOI: 10.1038/nature13724] [Citation(s) in RCA: 350] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/31/2014] [Indexed: 02/07/2023]
Abstract
Sensory regions of the brain integrate environmental cues with copies of motor-related signals important for imminent and ongoing movements. In mammals, signals propagating from the motor cortex to the auditory cortex are thought to have a critical role in normal hearing and behaviour, yet the synaptic and circuit mechanisms by which these motor-related signals influence auditory cortical activity remain poorly understood. Using in vivo intracellular recordings in behaving mice, we find that excitatory neurons in the auditory cortex are suppressed before and during movement, owing in part to increased activity of local parvalbumin-positive interneurons. Electrophysiology and optogenetic gain- and loss-of-function experiments reveal that motor-related changes in auditory cortical dynamics are driven by a subset of neurons in the secondary motor cortex that innervate the auditory cortex and are active during movement. These findings provide a synaptic and circuit basis for the motor-related corollary discharge hypothesized to facilitate hearing and auditory-guided behaviours.
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Affiliation(s)
- David M. Schneider
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
| | - Anders Nelson
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
| | - Richard Mooney
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
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Sowman PF, Dueholm SS, Rasmussen JH, Mrachacz-Kersting N. Induction of plasticity in the human motor cortex by pairing an auditory stimulus with TMS. Front Hum Neurosci 2014; 8:398. [PMID: 24917810 PMCID: PMC4042887 DOI: 10.3389/fnhum.2014.00398] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/18/2014] [Indexed: 11/13/2022] Open
Abstract
Acoustic stimuli can cause a transient increase in the excitability of the motor cortex. The current study leverages this phenomenon to develop a method for testing the integrity of auditorimotor integration and the capacity for auditorimotor plasticity. We demonstrate that appropriately timed transcranial magnetic stimulation (TMS) of the hand area, paired with auditorily mediated excitation of the motor cortex, induces an enhancement of motor cortex excitability that lasts beyond the time of stimulation. This result demonstrates for the first time that paired associative stimulation (PAS)-induced plasticity within the motor cortex is applicable with auditory stimuli. We propose that the method developed here might provide a useful tool for future studies that measure auditory-motor connectivity in communication disorders.
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Affiliation(s)
- Paul F Sowman
- Department of Cognitive Science, Macquarie University Sydney, NSW, Australia ; Perception and Action Research Centre (PARC), Faculty of Human Sciences, Macquarie University Sydney, NSW, Australia ; Australian Research Council Centre of Excellence in Cognition and its Disorders (CCD), Macquarie University Sydney, NSW, Australia
| | - Søren S Dueholm
- Department of Cognitive Science, Macquarie University Sydney, NSW, Australia ; Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Aalborg University Aalborg, Denmark
| | - Jesper H Rasmussen
- Department of Cognitive Science, Macquarie University Sydney, NSW, Australia ; Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Aalborg University Aalborg, Denmark
| | - Natalie Mrachacz-Kersting
- Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Aalborg University Aalborg, Denmark
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Schecklmann M, Landgrebe M, Kleinjung T, Frank E, Rupprecht R, Sand PG, Eichhammer P, Hajak G, Langguth B. State- and trait-related alterations of motor cortex excitability in tinnitus patients. PLoS One 2014; 9:e85015. [PMID: 24409317 PMCID: PMC3883686 DOI: 10.1371/journal.pone.0085015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 11/20/2013] [Indexed: 11/18/2022] Open
Abstract
Chronic tinnitus is a brain network disorder with involvement of auditory and non-auditory areas. Repetitive transcranial magnetic stimulation (rTMS) over the temporal cortex has been investigated for the treatment of tinnitus. Several small studies suggest that motor cortex excitability is altered in people with tinnitus. We retrospectively analysed data from 231 patients with chronic tinnitus and 120 healthy controls by pooling data from different studies. Variables of interest were resting motor threshold (RMT), short-interval intra-cortical inhibition (SICI), intra-cortical facilitation (ICF), and cortical silent period (CSP). 118 patients were tested twice - before and after ten rTMS treatment sessions over the left temporal cortex. In tinnitus patients SICI and ICF were increased and CSP was shortened as compared to healthy controls. There was no group difference in RMT. Treatment related amelioration of tinnitus symptoms were correlated with normalisations in SICI. These findings confirm earlier studies of abnormal motor cortex excitability in tinnitus patients. Moreover our longitudinal data suggest that altered SICI may reflect a state parameter, whereas CSP and ICF may rather mirror a trait-like predisposing factor of tinnitus. These findings are new and innovative as they enlarge the knowledge about basic physiologic and neuroplastic processes in tinnitus.
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Affiliation(s)
- Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
- * E-mail:
| | - Michael Landgrebe
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University of Zurich, Zurich, Switzerland
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Philipp G. Sand
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
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Plewnia C. Brain stimulation: new vistas for the exploration and treatment of tinnitus. CNS Neurosci Ther 2010; 17:449-61. [PMID: 20626436 DOI: 10.1111/j.1755-5949.2010.00169.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Tinnitus, the perception of sounds or noise in the absence of auditory stimuli, is a frequent and often severely disabling symptom of different disorders of the auditory system. Attempts to develop evidence-based therapies have been thwarted by a poor understanding of the underlying pathophysiology. However, recent work points toward a pivotal role of maladaptive cortical reorganization in the generation and perpetuation of tinnitus. Changes in the representation of sounds, abnormalities of oscillatory activity, and hyperactivity in higher order areas of auditory processing have been linked with the perception of tinnitus. Brain stimulation techniques have entered the field and have opened exciting new perspectives for the modulation of dysfunctional brain activity. In this review, a comprehensive overview on the use of brain-stimulation techniques in the exploration and experimental treatment of tinnitus is provided. DISCUSSIONS Noninvasive and invasive brain stimulation techniques, for example, transcranial magnetic stimulation (TMS), direct current stimulation (tDCS), and direct electrical cortical stimulation gave rise to a new line of investigation in tinnitus research. First, it has been shown that focal interference with presumably pathological cortical function can reduce tinnitus at least transiently. Second, the reduction of tinnitus-associated enhancement of cortical activity by neuronavigated TMS has been demonstrated to ameliorate tinnitus. Third, preliminary data suggest that repeated application of TMS or continuous cortical stimulation may lead to a longer lasting suppression of tinnitus. CONCLUSIONS These proof of principle studies point toward a new option for the investigation and neurophysiology based treatment of tinnitus. Based on these findings, larger scale randomized clinical trials are needed to explore the efficacy of different brain stimulation techniques and parameters as well as the optimal target sites and treatment schedules. Particularly, a careful evaluation of clinical relevance under consideration of an adequate sham control and attention to possible unwanted side effects of these new interventions are indispensable.
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Affiliation(s)
- Christian Plewnia
- Department of Psychiatry and Psychotherapy, Neurophysiology and Interventional Psychiatry, University of Tübingen Medical School, Tübingen, Germany.
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Langguth B, Kleinjung T, Landgrebe M, de Ridder D, Hajak G. rTMS for the treatment of tinnitus: The role of neuronavigation for coil positioning. Neurophysiol Clin 2010; 40:45-58. [DOI: 10.1016/j.neucli.2009.03.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 03/08/2009] [Indexed: 12/30/2022] Open
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Arfeller C, Vonthein R, Plontke SK, Plewnia C. Efficacy and safety of bilateral continuous theta burst stimulation (cTBS) for the treatment of chronic tinnitus: design of a three-armed randomized controlled trial. Trials 2009; 10:74. [PMID: 19698089 PMCID: PMC2739195 DOI: 10.1186/1745-6215-10-74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 08/21/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tinnitus, the perception of sound and noise in absence of an auditory stimulus, has been shown to be associated with maladaptive neuronal reorganization and increased activity of the temporoparietal cortex. Transient modulation of tinnitus by repetitive transcranial magnetic stimulation (rTMS) indicated that these areas are critically involved in the pathophysiology of tinnitus and suggested new treatment strategies. However, the therapeutic efficacy of rTMS in tinnitus is still unclear, individual response is variable, and the optimal stimulation area disputable. Recently, continuous theta burst stimulation (cTBS) has been put forward as an effective rTMS protocol for the reduction of pathologically enhanced cortical excitability. METHODS 48 patients with chronic subjective tinnitus will be included in this randomized, placebo controlled, three-arm trial. The treatment consists of two trains of cTBS applied bilaterally to the secondary auditory cortex, the temporoparietal associaction cortex, or to the lower occiput (sham condition) every working day for four weeks. Primary outcome measure is the change of tinnitus distress as quantified by the Tinnitus Questionnaire (TQ). Secondary outcome measures are tinnitus loudness and annoyance as well as tinnitus change during and after treatment. Audiologic and speech audiometric measurements will be performed to assess potential side effects. The aim of the present trail is to investigate effectiveness and safety of a four weeks cTBS treatment on chronic tinnitus and to compare two areas of stimulation. The results will contribute to clarify the therapeutic capacity of rTMS in tinnitus. TRIAL REGISTRATION The trial was registered with the clinical trials register of http://www.clinicaltrials.gov (NCT00518024).
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Affiliation(s)
- Carola Arfeller
- University Hospital of Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany.
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Poreisz C, Paulus W, Moser T, Lang N. Does a single session of theta-burst transcranial magnetic stimulation of inferior temporal cortex affect tinnitus perception? BMC Neurosci 2009; 10:54. [PMID: 19480651 PMCID: PMC2703646 DOI: 10.1186/1471-2202-10-54] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 05/29/2009] [Indexed: 11/10/2022] Open
Abstract
Background Cortical excitability changes as well as imbalances in excitatory and inhibitory circuits play a distinct pathophysiological role in chronic tinnitus. Repetitive transcranial magnetic stimulation (rTMS) over the temporoparietal cortex was recently introduced to modulate tinnitus perception. In the current study, the effect of theta-burst stimulation (TBS), a novel rTMS paradigm was investigated in chronic tinnitus. Twenty patients with chronic tinnitus completed the study. Tinnitus severity and loudness were monitored using a tinnitus questionnaire (TQ) and a visual analogue scale (VAS) before each session. Patients received 600 pulses of continuous TBS (cTBS), intermittent TBS (iTBS) and intermediate TBS (imTBS) over left inferior temporal cortex with an intensity of 80% of the individual active or resting motor threshold. Changes in subjective tinnitus perception were measured with a numerical rating scale (NRS). Results TBS applied to inferior temporal cortex appeared to be safe. Although half of the patients reported a slight attenuation of tinnitus perception, group analysis resulted in no significant difference when comparing the three specific types of TBS. Converting the NRS into the VAS allowed us to compare the time-course of aftereffects. Only cTBS resulted in a significant short-lasting improvement of the symptoms. In addition there was no significant difference when comparing the responder and non-responder groups regarding their anamnestic and audiological data. The TQ score correlated significantly with the VAS, lower loudness indicating less tinnitus distress. Conclusion TBS does not offer a promising outcome for patients with tinnitus in the presented study.
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Affiliation(s)
- Csaba Poreisz
- Department of Clinical Neurophysiology Georg-August University, Göttingen, Germany.
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Cortical excitability and transcallosal inhibition in chronic tinnitus: Transcranial magnetic study. Neurophysiol Clin 2008; 38:243-8. [DOI: 10.1016/j.neucli.2008.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 01/11/2008] [Accepted: 03/24/2008] [Indexed: 11/24/2022] Open
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Langguth B, de Ridder D, Dornhoffer JL, Eichhammer P, Folmer RL, Frank E, Fregni F, Gerloff C, Khedr E, Kleinjung T, Landgrebe M, Lee S, Lefaucheur JP, Londero A, Marcondes R, Moller AR, Pascual-Leone A, Plewnia C, Rossi S, Sanchez T, Sand P, Schlee W, Pysch D, Steffens T, van de Heyning P, Hajak G. Controversy: Does repetitive transcranial magnetic stimulation/ transcranial direct current stimulation show efficacy in treating tinnitus patients? Brain Stimul 2008; 1:192-205. [PMID: 20633385 DOI: 10.1016/j.brs.2008.06.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 05/29/2008] [Accepted: 06/06/2008] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Tinnitus affects 10% of the population, its pathophysiology remains incompletely understood, and treatment is elusive. Functional imaging has demonstrated a relationship between the intensity of tinnitus and the degree of reorganization in the auditory cortex. Experimental studies have further shown that tinnitus is associated with synchronized hyperactivity in the auditory cortex. Therefore, targeted modulation of auditory cortex has been proposed as a new therapeutic approach for chronic tinnitus. METHODS Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are noninvasive methods that can modulate cortical activity. These techniques have been applied in different ways in patients with chronic tinnitus. Single sessions of high-frequency rTMS over the temporal cortex have been successful in reducing the intensity of tinnitus during the time of stimulation and could be predictive for treatment outcome of chronic epidural stimulation using implanted electrodes. RESULTS Another approach that uses rTMS as a treatment for tinnitus is application of low-frequency rTMS in repeated sessions, to induce a lasting change of neuronal activity in the auditory cortex beyond the duration of stimulation. Beneficial effects of this treatment have been consistently demonstrated in several small controlled studies. However, results are characterized by high interindividual variability and only a moderate decrease of the tinnitus. The role of patient-related (for example, hearing loss, tinnitus duration, age) and stimulation-related (for example, stimulation site, stimulation protocols) factors still remains to be elucidated. CONCLUSIONS Even in this early stage of investigation, there is a convincing body of evidence that rTMS represents a promising tool for pathophysiological assessment and therapeutic management of tinnitus. Further development of this technique will depend on a more detailed understanding of the neurobiological effects mediating the benefit of TMS on tinnitus perception. Moreover clinical studies with larger sample sizes and longer follow-up periods are needed.
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Langguth B, Kleinjung T, Marienhagen J, Binder H, Sand PG, Hajak G, Eichhammer P. Transcranial magnetic stimulation for the treatment of tinnitus: effects on cortical excitability. BMC Neurosci 2007; 8:45. [PMID: 17605764 PMCID: PMC1929114 DOI: 10.1186/1471-2202-8-45] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 07/02/2007] [Indexed: 11/29/2022] Open
Abstract
Background Low frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an innovative treatment for chronic tinnitus. The aim of the present study was to elucidate the underlying mechanism and to evaluate the relationship between clinical outcome and changes in cortical excitability. We investigated ten patients with chronic tinnitus who participated in a sham-controlled crossover treatment trial. Magnetic-resonance-imaging and positron-emission-tomography guided 1 Hz rTMS were performed over the auditory cortex on 5 consecutive days. Active and sham treatments were separated by one week. Parameters of cortical excitability (motor thresholds, intracortical inhibition, intracortical facilitation, cortical silent period) were measured serially before and after rTMS treatment by using single- and paired-pulse transcranial magnetic stimulation. Clinical improvement was assessed with a standardized tinnitus-questionnaire. Results We noted a significant interaction between treatment response and changes in motor cortex excitability during active rTMS. Specifically, clinical improvement was associated with an increase in intracortical inhibition, intracortical facilitation and a prolongation of the cortical silent period. These results indicate that intraindividual changes in cortical excitability may serve as a correlate of response to rTMS treatment. Conclusion The observed alterations of cortical excitability suggest that low frequency rTMS may evoke long-term-depression like effects resulting in an improvement of subcortical inhibitory function.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Tobias Kleinjung
- Department of Otorhinolaryngology and Audiology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Joerg Marienhagen
- Department of Nuclear Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Harald Binder
- Department of Medical Biometry and Statistics, University of Freiburg, Stefan-Meier-Strasse 26, 79104 Freiburg, Germany
| | - Philipp G Sand
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Peter Eichhammer
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
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Landgrebe M, Hauser S, Langguth B, Frick U, Hajak G, Eichhammer P. Altered cortical excitability in subjectively electrosensitive patients: results of a pilot study. J Psychosom Res 2007; 62:283-8. [PMID: 17324677 DOI: 10.1016/j.jpsychores.2006.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 11/02/2006] [Accepted: 11/13/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Hypersensitivity to electromagnetic fields is frequently claimed to be linked to a variety of unspecific somatic and/or neuropsychological complaints. Whereas provocation studies often failed to demonstrate a causal relationship between electromagnetic field exposure and symptom formation, neurophysiological examinations highlight baseline deviations in people claiming to be electrosensitive. METHODS To elucidate a potential role of dysfunctional cortical regulations in mediating hypersensitivity to electromagnetic fields, cortical excitability parameters were measured by transcranial magnetic stimulation in subjectively electrosensitive patients (n=23) and two control groups (n=49) differing in their level of unspecific health complaints. RESULTS Electrosensitive patients showed reduced intracortical facilitation as compared to both control groups, while motor thresholds and intracortical inhibition were unaffected. CONCLUSIONS This pilot study gives additional evidence that altered central nervous system function may account for symptom manifestation in subjectively electrosensitive patients as has been postulated for several chronic multisymptom illnesses sharing a similar clustering of symptoms.
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Affiliation(s)
- Michael Landgrebe
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Regensburg, Regensburg, Germany
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Eichhammer P, Kleinjung T, Landgrebe M, Hajak G, Langguth B. TMS for treatment of chronic tinnitus — neurobiological effects. PROGRESS IN BRAIN RESEARCH 2007; 166:369-75. [DOI: 10.1016/s0079-6123(07)66035-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Langguth B, Hajak G, Kleinjung T, Pridmore S, Sand P, Eichhammer P. Repetitive transcranial magnetic stimulation and chronic tinnitus. Acta Otolaryngol 2006:102-5. [PMID: 17114153 DOI: 10.1080/03655230600895457] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONCLUSION There is a good theoretical basis and early research evidence suggesting that transcranial magnetic stimulation (TMS) may have treatment potential in tinnitus. Further studies with larger sample sizes and additional assessment of neurobiological effects are necessary. OBJECTIVES Tinnitus is a common and often severely disabling disorder for which there is no satisfactory treatment. TMS is a new, non-invasive method of modifying the excitability of the cerebral cortex, which has proven effective in auditory hallucinations and other disorders. Some early studies have been published in which TMS has been used in the treatment of tinnitus. The objective of this paper is to examine the literature and consider the potential for TMS as a therapy in tinnitus. METHODS A thorough search of the tinnitus and TMS literature was conducted, and all available relevant material was examined. RESULTS Tinnitus is common, with a prevalence of 8.2% in subjects aged 50 years and over, and may be associated with great distress (tinnitus sufferers). There are no effective treatments. Tinnitus is frequently associated with deafness, and may be the result of a pathological plasticity process. Neuroimaging studies demonstrate increased activity within the central auditory system. TMS is a non-invasive method of modulating excitability in cerebral cortex. It uses electromagnetic principles and has been successfully employed in the treatment of other conditions associated with increased activity of the cerebral cortex. Meanwhile, a growing number of studies suggest that repetitive TMS may be effective in the treatment of chronic tinnitus.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Germany.
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Kleinjung T, Steffens T, Strutz J, Eichhammer P, Hajak G, Langguth B. [Transcranial magnetic stimulation for the treatment of tinnitus]. HNO 2006; 54:665-6. [PMID: 16896970 DOI: 10.1007/s00106-006-1444-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- T Kleinjung
- Klinik für HNO-Heilkunde der Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg.
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Kleinjung T, Steffens T, Langguth B, Eichhammer P, Marienhagen J, Hajak G, Strutz J. Neuronavigierte repetitive transkranielle Magnetstimulation (rTMS). HNO 2006; 54:439-44. [PMID: 16170508 DOI: 10.1007/s00106-005-1329-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic tinnitus is a frequent and debilitating disorder of largely unknown pathophysiology. Focal brain activation in the auditory cortex has recently been demonstrated in chronic tinnitus. Low-frequency rTMS can reduce cortical hyperexcitability. PATIENTS AND METHODS In 12 patients with chronic tinnitus, fusion of [18F]deoxyglucose-PET and structural MRI (T1, MPRAGE) scans allowed the area of increased metabolic activity in the auditory cortex to be exactly identified; this area was selected as the target for rTMS. A neuronavigational system adapted for TMS positioning enabled the relative positions of the figure-8 coil and the target area to be monitored. Repetitive TMS (110% motor threshold; 1 Hz; 2000 stimuli per day over 5 days) was performed using a placebo-controlled crossover design. A sham coil system was used for the placebo stimulation. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller). RESULTS In all 12 patients an asymmetrically increased metabolic activation of the gyrus of Heschl was detected. The tinnitus score was significantly improved after 5 days of active rTMS, an effect not seen after placebo stimulation. CONCLUSION These preliminary results show that neuronavigated rTMS may improve our understanding and treatment of chronic tinnitus.
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Affiliation(s)
- T Kleinjung
- Klinik für HNO-Heilkunde der Universität Regensburg, Regensburg.
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Londero A, Langguth B, De Ridder D, Bonfils P, Lefaucheur JP. Repetitive transcranial magnetic stimulation (rTMS): a new therapeutic approach in subjective tinnitus? Neurophysiol Clin 2006; 36:145-55. [PMID: 17046609 DOI: 10.1016/j.neucli.2006.08.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Subjective (non-recordable) tinnitus is the conscious perception of a phantom sound, and a very frequent, sometimes disabling, condition. Even if subjective tinnitus is often related to peripheral hearing loss, neurophysiological and functional imaging studies provide increasing evidence for an involvement both auditory and non-auditory central nervous pathways in the generation of tinnitus and related distress. Repetitive transcranial magnetic stimulation (rTMS) has been proposed to relieve tinnitus by reducing auditory cortex hyperexcitability associated with this condition. This paper will review the first clinical results reported in auditory cortex rTMS studies, with special reference to the pathophysiology of tinnitus processing and the mechanisms of action of rTMS. Although rTMS appears to be a very promising tool for the diagnosis and the treatment of tinnitus patients, available knowledge is still very limited at the moment. Further basic research and clinical studies are needed in order to optimize the parameters of stimulation (stimulus frequency, cortical target definition) and to validate the application of this technique in the management of patients with disabling tinnitus.
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Affiliation(s)
- A Londero
- Service ORL et chirurgie cervicofaciale, hôpital européen Georges-Pompidou, Paris, France.
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