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Schoisswohl S, Langguth B, Hebel T, Abdelnaim MA, Volberg G, Schecklmann M. Heading for Personalized rTMS in Tinnitus: Reliability of Individualized Stimulation Protocols in Behavioral and Electrophysiological Responses. J Pers Med 2021; 11:536. [PMID: 34207847 DOI: 10.3390/jpm11060536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool potentially modulating pathological brain activity. Its clinical effectiveness is hampered by varying results and characterized by inter-individual variability in treatment responses. RTMS individualization might constitute a useful strategy to overcome this variability. A precondition for this approach would be that repeatedly applied protocols result in reliable effects. The condition tinnitus provides the advantage of immediate behavioral consequences (tinnitus loudness changes) after interventions and thus offers an excellent model to exemplify TMS personalization. Objective: The aim was to investigate the test–retest reliability of short rTMS stimulations in modifying tinnitus loudness and oscillatory brain activity as well as to examine the feasibility of rTMS individualization in tinnitus. Methods: Three short verum (1, 10, 20 Hz; 200 pulses) and one sham (0.1 Hz; 20 pulses) rTMS protocol were administered on two different days in 22 tinnitus patients. Before and after each protocol, oscillatory brain activity was recorded with electroencephalography (EEG), together with behavioral tinnitus loudness ratings. RTMS individualization was executed on the basis of behavioral and electrophysiological responses. Stimulation responders were identified via consistent sham-superior increases in tinnitus loudness (behavioral responders) and alpha power increases or gamma power decreases (alpha responders/gamma responders) in accordance with the prevalent neurophysiological models for tinnitus. Results: It was feasible to identify individualized rTMS protocols featuring reliable tinnitus loudness changes (55% behavioral responder), alpha increases (91% alpha responder) and gamma decreases (100% gamma responder), respectively. Alpha responses primary occurred over parieto-occipital areas, whereas gamma responses mainly appeared over frontal regions. On the contrary, test–retest correlation analyses per protocol at a group level were not significant neither for behavioral nor for electrophysiological effects. No associations between behavioral and EEG responses were found. Conclusion: RTMS individualization via behavioral and electrophysiological data in tinnitus can be considered as a feasible approach to overcome low reliability at the group level. The present results open the discussion favoring personalization utilizing neurophysiological markers rather than behavioral responses. These insights are not only useful for the rTMS treatment of tinnitus but also for neuromodulation interventions in other pathologies, as our results suggest that the individualization of stimulation protocols is feasible despite absent group-level reliability.
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Wei W, Yi X, Ruan J, Duan X, Luo H. The efficacy of repetitive transcranial magnetic stimulation on emotional processing in apathetic patients with Parkinson's disease: A Placebo-controlled ERP study. J Affect Disord 2021; 282:776-785. [PMID: 33601718 DOI: 10.1016/j.jad.2020.12.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/21/2020] [Accepted: 12/24/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Few studies have examined the effect of rTMS on impaired emotional processing in apathetic Parkinson's disease (PD) patients, which impelled us to use a combination of repetitive transcranial magnetic stimulation (rTMS) with event-related potentials (ERPs) to gain insight into the underlying mechanisms. METHODS Apathetic and non-apathetic patients diagnosed with PD performed a facial emotion categorization task, and ERP data were collected before and after HF-rTMS or sham stimulation over the right dorsolateral prefrontal cortex (DLPFC). We observed the behavioural results and early components of P100 and N170. RESULTS After rTMS, accuracy (ACC) was higher for negative expressions, and reaction times (RTs) were shorter for all expressions in both apathetic and non-apathetic patients. P100 amplitudes significantly increased except for negative expressions in the right hemisphere, and hemisphere lateralization was reversed in apathetic patients. P100 amplitudes increased for all expressions bilaterally in non-apathetic patients. N170 amplitudes in apathetic patients increased, and hemisphere lateralization was normalized. Neither the apathetic sham group nor the non-apathetic cohort of patients showed changes in P100 or N170 lateralization. LIMITATIONS The effects of rTMS on PD patients relative to normal subjects should be compared and observed over a long period of time. CONCLUSIONS HF-rTMS over the right DLPFC is beneficial for emotional processing in both apathetic and non-apathetic PD patients but shows different sensitivities. The effect of rTMS on emotional processing impairments in apathetic PD patients is profound. Treatment with rTMS may be an important, novel nonpharmaceutical approach for apathy in PD patients.
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Affiliation(s)
- Wei Wei
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Jianghai Ruan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Xiaodong Duan
- Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
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Carter G, Govindan RB, Brown G, Heimann C, Hayes H, Thostenson JC, Dornhoffer J, Brozoski T, Kimbrell TA, Hayar A, Shihabuddin B, James GA, Garcia-Rill E, Padala PR, Mennemeier M. Change in EEG Activity is Associated with a Decrease in Tinnitus Awareness after rTMS. Front Neurol Neurosci Res 2021; 2:100010. [PMID: 34263262 PMCID: PMC8277104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine how 1Hz and 10Hz rTMS temporarily influence ratings of tinnitus loudness, annoyance, and awareness. The thalamocortical dysrhythmia (TCD) model of tinnitus was tested by examining changes in spectral power and coherence of resting state EEGs from baseline to each phase of treatment and correlating these data with change in tinnitus. METHODS Nineteen participants completed a double-blind, placebo (sham rTMS) controlled, within-subjects study with crossover between the two active rTMS treatment conditions. An imposed order effect, sham rTMS first, eliminated drift of active treatment into the placebo condition. The primary outcome measures were analogue ratings of tinnitus loudness, annoyance, and awareness, assessed repeatedly at baseline and during treatment, and 64 channel, resting state EEGs collected at baseline and the end of each treatment phase. Active rTMS consisted of 1800 pulses at 110% of motor threshold over temporal cortex delivered at 1Hz and 10Hz over four days. The research design also examined the effect of rTMS immediately following stimulation, regression to the mean in tinnitus ratings made over multiple days, and differences between treatment responders and non-responders. RESULTS There was no immediate effect of rTMS on tinnitus during a single rTMS session. Regression to the mean in tinnitus ratings occurred over three days of baseline and four days of treatment (both sham and active rTMS). After accounting for regression to the mean in the statistical model, 1Hz rTMS led to a significant decrease in tinnitus awareness from baseline and 10Hz rTMS trended in the same direction, whereas sham rTMS showed little change from baseline other than regression to the mean. Changes from baseline in spectral power of the resting state EEG provided partial support for predictions based on TCD model of tinnitus for active 1 and 10Hz rTMS but not sham rTMS. However, only an increase in beta coherence correlated significantly with a decrease in tinnitus awareness. Changes in the EEG were robust in treatment responders but absent among non-responders and during sham rTMS. CONCLUSIONS A positive response to rTMS for tinnitus is associated with an rTMS-induced change in beta coherence of the EEG. Increased beta coherence may be a biomarker of the rTMS effect; a "top-down" modulation of the EEG that promotes habituation to tinnitus. Participants whose tinnitus did not improve after rTMS did not show any changes in the EEG.
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Affiliation(s)
- G Carter
- Department of Anatomy and Physiology, National Park College, USA
| | - RB Govindan
- Prenatal Pediatrics Institute, Children’s National Hospital, USA
| | - G Brown
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences USA
| | - C Heimann
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences USA
| | - H Hayes
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences USA
| | - JC Thostenson
- Department of Biostatistics, University of Arkansas for Medical Sciences, USA
| | - J Dornhoffer
- Department of Otolaryngology, University of Arkansas for Medical Sciences, USA
| | - T Brozoski
- Division of Otolaryngology, Southern Illinois University School of Medicine, USA
| | - TA Kimbrell
- Section of Psychiatry, Central Arkansas Veterans Healthcare System, USA
| | - A Hayar
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences USA
| | - B Shihabuddin
- Department of Neurology, University of Arkansas for Medical Sciences, USA,Section of Neurology, Central Arkansas Healthcare System, USA
| | - GA James
- Department of Psychiatry, University of Arkansas for Medical Sciences, USA
| | - E Garcia-Rill
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences USA
| | - PR Padala
- Central Arkansas Veterans Healthcare System, Geriatric Research Education and Clinical Center, USA
| | - M Mennemeier
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences USA
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Aydın M, Erkan M, Gündoğdu R, Vural A, Kökoğlu K, Şahin Mİ. Assessment of the Effectiveness of Transcranial Magnetic Stimulation in Subjective Tinnitus. Int Arch Otorhinolaryngol 2020; 25:e453-e458. [PMID: 34377184 PMCID: PMC8321633 DOI: 10.1055/s-0040-1718530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/13/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction
Increases in spontaneous activity in the neurons of the auditory cortex are presumed as the pathophysiology of tinnitus.
Objective
To investigate the effectiveness of transcranial magnetic stimulation (TMS) in the treatment of tinnitus.
Methods
A total of 62 patients between the ages of 22 and 74 with chronic subjective tinnitus were enrolled in the study. The inclusion criteria were normal findings on an otolaryngologic examination and normal ranges of complete blood count, routine biochemical parameter levels, thyroid function, air-bone gap on pure-tone audiometry, and middle-ear pressure and stapedial reflex on tympanometry. The patients were randomized into 2 groups: 40 patients were placed in the treatment for TMS (tTMS) group, and the rest (22 patients) were placed in the sham TMS group. The frequency and severity of the tinnitus, as well as the tinnitus handicap inventory (THI) score of each patient were measured before and one month after the treatment, and the values were statistically evaluated.
Results
We observed a statistically significant improvement in the tTMS group (
p
< 0.05 and
p
< 0.05 respectively) regarding the THI and tinnitus severity scores. The sham TMS group showed no significant improvement in terms of the THI (
p
> 0.05). However, the tinnitus severity showed a significant increase in this group (
p
< 0.05). The comparison of differences in the changes in the THI and the tinnitus severity scores showed a significant statistical improvement in the tTMS group compared with the sham TMS group (
p
< 0.05 and
p
< 0.05 respectively).
Conclusion
Transcranial magnetic stimulation was found to be effective in the treatment of tinnitus, and may be adopted as a treatment for tinnitus after further comprehensive studies.
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Affiliation(s)
- Mesut Aydın
- Deparment of Otolaryngology, Kayseri City Hospital, Kayseri, Turkey
| | - Mustafa Erkan
- Deparment of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ramazan Gündoğdu
- Deparment of Otolaryngology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Alperen Vural
- Deparment of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Kerem Kökoğlu
- Deparment of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet İlhan Şahin
- Deparment of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Souza DDS, Almeida AA, Andrade SMDS, Machado DGDS, Leitão M, Sanchez TG, Rosa MRDD. Transcranial direct current stimulation improves tinnitus perception and modulates cortical electrical activity in patients with tinnitus: A randomized clinical trial. Neurophysiol Clin 2020; 50:289-300. [PMID: 32863109 DOI: 10.1016/j.neucli.2020.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study aims to determine whether transcranial direct current stimulation (tDCS): a) is effective in the treatment of tinnitus by decreasing its annoyance and severity; b) modulates the cortical electrical activity of such individuals. METHODS A double-blind, placebo-controlled clinical trial was conducted with 24 patients with tinnitus, randomized into two groups: Group 1 (n = 12) received anodal tDCS over the left temporoparietal area (LTA) and cathodal tDCS over the right dorsolateral prefrontal cortex (DLPFC) and Group 2 (n = 12) received placebo intervention. Tinnitus perception using a visual analog scale (VAS) and the Tinnitus Handicap Inventory (THI) questionnaire, in addition to electroencephalogram (EEG) was measured with eyes opened and closed at baseline and after the intervention. For the treatment, patients were subjected to five consecutive sessions of tDCS with the anodal electrode over the LTA and cathodal electrode over the right DLPFC (7 × 5 cm, 2 mA for 20 min). tDCS was turned off after 30 s in the sham group. RESULTS Active tDCS significantly improved tinnitus annoyance and severity. It was associated with decreased beta and theta EEG frequency bands with eyes opened and decreased alpha frequency with eyes closed. sLORETA identified changes in frequency bands in the frontal, temporoparietal, and limbic regions. Finally, there were negative correlations between baseline EEG frequency bands and tDCS-induced change in tinnitus annoyance and severity. CONCLUSIONS These results demonstrate that tDCS modulates the EEG activity and alleviates tinnitus perception. This effect may be related to baseline EEG activity.
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Affiliation(s)
- Dayse da Silva Souza
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil.
| | - Alexandre Alex Almeida
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil
| | | | | | - Márcio Leitão
- Department of Classical and Vernacular Letters, Federal University of Paraíba, Brazil
| | - Tanit Ganz Sanchez
- University of São Paulo School of Medicine, São Paulo, Brazil; Ganz Sanches Institute of Integrated Otorhinolaryngology, São Paulo, Brazil
| | - Marine Raquel Diniz da Rosa
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil.
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Bae EB, Lee JH, Song JJ. Single-Session of Combined tDCS-TMS May Increase Therapeutic Effects in Subjects With Tinnitus. Front Neurol 2020; 11:160. [PMID: 32292383 PMCID: PMC7118567 DOI: 10.3389/fneur.2020.00160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
To treat motor and psychiatric disorders, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) are used in clinics worldwide. We combined these two types of neuromodulation technique to increase the effective response of a single session of neuromodulation in subjective tinnitus. Eighty tinnitus subjects were split into four different treatment groups: tDCS, tDCS with sham TMS, tDCS-TMS, and TMS group. Subjects were given 1.5 mA tDCS on the bi-frontal area and TMS stimulated the contralateral single side of the temporo-parietal cortex with 200 pulses at 1 Hz stimulation. Comparing pre-treatment questionnaire scores to post-treatment questionnaire scores, all four groups showed statistically significant improvements. Although there was no significant difference among group comparison, the largest mean difference was shown in the combined group, especially for tinnitus intensity and tinnitus-related distress. Responders in the combined group were the highest for VAS intensity, with a maximum of 80% of twenty subjects. To summarize, dual-neuromodulation responders could consist of responders of frontal tDCS and temporal TMS. In addition, abnormal activity in the frontal or temporal area of the responders is presumed to be modulated by treatment and will be suggested as the target areas in future studies.
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Affiliation(s)
- Eun Bit Bae
- Interdisciplimentary Program in Neuroscience, Seoul National University, Seoul, South Korea.,Laboratory of Electrophysiology, Department of Otorhinolaryngology, Center of Medical Research Innovation, Seoul National University Hospital, Seoul, South Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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7
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Abstract
Tinnitus is described as the perception of any sound or noise in the absence of real acoustic stimulation. Numerous investigations have been tried for this potentially debilitating, heterogeneous symptom. The authors overview the current concepts of the management of the suffering tinnitus patients. The review contains modern views on the mechanisms of generation, etiology and pathogenesis of tinnitus. Classifications for practical management of patients are presented. The review of medical and physical methods of therapy and rehabilitation of a tinnitus patients given. The review includes the most clinically reliable and common methods of treatment and rehabilitation.
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Affiliation(s)
- N L Kunelskaya
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152; Department of Otorhinolaryngology N.I.Pirogov Russian National Research Medical University, Moscow, Russia,117997
| | - Yu V Levina
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152; Department of Otorhinolaryngology N.I.Pirogov Russian National Research Medical University, Moscow, Russia,117997
| | - E V Baibakova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - V I Shurpo
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
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8
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Schecklmann M, Schmaußer M, Klinger F, Kreuzer PM, Krenkel L, Langguth B. Resting motor threshold and magnetic field output of the figure-of-8 and the double-cone coil. Sci Rep 2020; 10. [PMID: 32015398 PMCID: PMC6997368 DOI: 10.1038/s41598-020-58034-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/04/2019] [Indexed: 12/05/2022] Open
Abstract
The use of the double-cone (DC) coil in transcranial magnetic stimulation (TMS) is promoted with the notion that the DC coil enables stimulation of deeper brain areas in contrast to conventional figure-of-8 (Fo8) coils. However, systematic comparisons of these two coil types with respect to the spatial distribution of the magnetic field output and also to the induced activity in superficial and deeper brain areas are limited. Resting motor thresholds of the left and right first dorsal interosseous (FDI) and tibialis anterior (TA) were determined with the DC and the Fo8 coil in 17 healthy subjects. Coils were orientated over the corresponding motor area in an angle of 45 degrees for the hand area with the handle pointing in posterior direction and in medio-lateral direction for the leg area. Physical measurements were done with an automatic gantry table using a Gaussmeter. Resting motor threshold was higher for the leg area in contrast to the hand area and for the Fo8 in contrast to the DC coil. Muscle by coil interaction was also significant providing higher differences between leg and hand area for the Fo8 (about 27%) in contrast to the DC coil (about 15%). Magnetic field strength was higher for the DC coil in contrast to the Fo8 coil. The DC coil produces a higher magnetic field with higher depth of penetration than the figure of eight coil.
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Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipović SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen JP, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, Ziemann U. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018). Clin Neurophysiol 2020; 131:474-528. [PMID: 31901449 DOI: 10.1016/j.clinph.2019.11.002] [Citation(s) in RCA: 839] [Impact Index Per Article: 209.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/21/2019] [Accepted: 11/02/2019] [Indexed: 02/08/2023]
Abstract
A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jérôme Brunelin
- PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Saša R Filipović
- Department of Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Christian Grefkes
- Department of Neurology, Cologne University Hospital, Cologne, Germany; Institute of Neurosciences and Medicine (INM3), Jülich Research Centre, Jülich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Friedhelm C Hummel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair in Clinical Neuroengineering, Swiss Federal Institute of Technology (EPFL) Valais and Clinique Romande de Réadaptation, Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Letizia Leocani
- Department of Neurorehabilitation and Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alain Londero
- Department of Otorhinolaryngology - Head and Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Jean-Paul Nguyen
- Multidisciplinary Pain Center, Clinique Bretéché, ELSAN, Nantes, France; Multidisciplinary Pain, Palliative and Supportive Care Center, UIC22-CAT2-EA3826, University Hospital, CHU Nord-Laënnec, Nantes, France
| | - Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Bern, Switzerland; Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Albino J Oliveira-Maia
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Medical Park Chiemseeblick, Bernau, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Emmanuel Poulet
- PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France; Department of Emergency Psychiatry, Edouard Herriot Hospital, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Irena Rektorová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Si-BIN Lab Human Physiology Section, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Hanna Sahlsten
- ENT Clinic, Mehiläinen and University of Turku, Turku, Finland
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - David Szekely
- Department of Psychiatry, Princess Grace Hospital, Monaco
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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Mohsen S, Mahmoudian S, Talebian S, Pourbakht A. Multisite transcranial Random Noise Stimulation (tRNS) modulates the distress network activity and oscillatory powers in subjects with chronic tinnitus. J Clin Neurosci 2019; 67:178-84. [DOI: 10.1016/j.jocn.2019.06.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/28/2019] [Accepted: 06/21/2019] [Indexed: 12/27/2022]
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Kyong JS, Noh TS, Park MK, Oh SH, Lee JH, Suh MW. Phantom Perception of Sound and the Abnormal Cortical Inhibition System: An Electroencephalography (EEG) Study. Ann Otol Rhinol Laryngol 2019; 128:84S-95S. [DOI: 10.1177/0003489419837990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objectives: Despite no observable external sound present, a perceived feeling of a recurrent unpleasant sound is a main complaint in the patients with chronic tinnitus. This phantom perception of sound is considered as the auditory equivalent of phantom limb pain, and altered excitability may be involved in its underlying pathology. Tinnitus-related hyper-excitation is suppressed by inhibitory repetitive transcranial magnetic stimulation (rTMS). However, the neural mechanism underlying the treatment is not fully understood, and quantifying the suppression induced by rTMS has yet to be considered. Methods: We evaluated the effect of rTMS on the cortical inhibition status following single-site stimulation over the auditory temporal cortex (T group) or dual-site stimulation over the auditory temporal and the frontal regions (TF group). These effects were also compared with outcomes following sham stimulation (S group). Subjective response was recorded using tinnitus-related handicap index (THI), and changes in the cortical inhibition status were assessed using an auditory paired-pulse suppression index (PPSI). Results: TF group showed the greatest benefit from the treatment evidenced in the reduced PPSI and THI scores. T and S groups did not benefit much. TF group overlapped mostly with the responder group, indicating improvement in both subjective THI and objective PPSI measurements. Conclusion: Our results suggest that rTMS is a beneficial therapeutic treatment for chronic tinnitus patients and the dual-site treatment was the most effective in terms of both tinnitus complaint and quantitative indices. Thus, subjective reports and electrophysiological signatures may be complementary for the diagnosis/prognosis of tinnitus.
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Affiliation(s)
- Jeong-Sug Kyong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
- Audiology Institute, Department of Audiology and Speech-Language Pathology, Hallym University of Graduate Studies, Seoul, Korea
| | - Tae-Soo Noh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seung-Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
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Londero A, Bonfils P, Lefaucheur J. Transcranial magnetic stimulation and subjective tinnitus. A review of the literature, 2014–2016. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:51-58. [DOI: 10.1016/j.anorl.2017.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kreuzer PM, Poeppl TB, Rupprecht R, Vielsmeier V, Lehner A, Langguth B, Schecklmann M. Individualized Repetitive Transcranial Magnetic Stimulation Treatment in Chronic Tinnitus? Front Neurol 2017; 8:126. [PMID: 28428769 PMCID: PMC5382205 DOI: 10.3389/fneur.2017.00126] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/16/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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. DISCUSSION 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.
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Affiliation(s)
- Peter M. Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Timm B. Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Veronika Vielsmeier
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
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Schecklmann M, Giani A, Tupak S, Langguth B, Raab V, Polak T, Várallyay C, Großmann W, Herrmann MJ, Fallgatter AJ. Neuronavigated left temporal continuous theta burst stimulation in chronic tinnitus. Restor Neurol Neurosci 2016; 34:165-75. [PMID: 26890094 DOI: 10.3233/rnn-150518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Clinical effects of repetitive transcranial magnetic stimulation (rTMS) in chronic tinnitus are moderate. More precise coil localisation strategies, innovative stimulation protocols, and identification of predictors for treatment response were proposed as promising attempts to enhance treatment efficacy. In this pilot study we investigated neuronavigated continuous theta burst TMS (cTBS). METHODS Twenty-three patients received neuronavigated cTBS over the left primary auditory cortex in a randomized sham-controlled trial (verum = 12; sham = 11). Treatment response was evaluated with tinnitus questionnaires and numeric rating scales. Immediate change in numeric rating scales during the first session was used as predictor for treatment response. RESULTS Tinnitus was significantly reduced after treatment, but there were no superior effects between verum vs. sham treatment. Immediate change in the first treatment session predicted the response to treatment only in the verum group. CONCLUSIONS In our study, verum cTBS was not superior to sham which highlights the persistent need for improving non-invasive brain stimulation techniques for the treatment of tinnitus. Future research should focus on the transfer of positive single session effects to daily treatment trials.
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Affiliation(s)
- Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Anette Giani
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Sara Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Vincent Raab
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Thomas Polak
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Csanád Várallyay
- Department of Neuroradiology, University of Würzburg, Würzburg, Germany.,Departments of Neurology/Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Wilma Großmann
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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