Moderate therapeutic efficacy of positron emission tomography-navigated repetitive transcranial magnetic stimulation for chronic tinnitus: a randomised, controlled pilot study
Moderate therapeutic efficacy of positron emission tomography-navigated repetitive transcranial magnetic stimulation for chronic tinnitus: a randomised, controlled pilot study
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DOI：
10.1136/jnnp.2006.095612
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发表时间：
2007-02-01
影响因子：
11
通讯作者：
Gerloff, C.
中科院分区：
文献类型：
--
作者：
Plewnia, C.;Reimold, M.;Gerloff, C.
背景资料：已显示Tintin对通过高频和低频重复经颅磁刺激（rTMS）的皮质活动的调制作出响应。目的：确定2周每日rTMS方案的耳鸣减弱效应，导航至局部脑血流量中耳鸣相关增加的最大值。研究方法：6例慢性耳鸣患者参加了这项假对照交叉研究，并接受了262周的阈上1 Hz rTMS（30 min）治疗，该治疗应用于[O-15]H2O正电子发射断层扫描功能成像描绘的局部脑血流量最大耳鸣相关增加区域和对照区域。在每次治疗前后和4周刺激疗程结束后2周，使用经验证的耳鸣问卷评估耳鸣相关的痛苦。获得耳鸣变化、响度和烦恼的额外自我评估分数。结果：在6名患者中的5名中，rTMS引起耳鸣问卷评分比假刺激更大的减少。在两名患者中，测量的所有参数（耳鸣变化评分、耳鸣响度、耳鸣烦恼）均显示明显改善。在组水平上，耳鸣问卷评分的反应程度与耳鸣相关的前扣带皮层激活相关。最后一次刺激后两周，除一名患者外，所有患者的耳鸣均恢复至基线水平。结论：通过低频rTMS导航到每个人的最大耳鸣相关皮质功能亢进，可以减弱耳鸣。影响只是中等;个体间反应性变化，衰减似乎在最后一次刺激会话后2周内消失。值得注意的是，耳鸣相关的前扣带皮层激活似乎预测rTMS治疗的反应。
Background: Tinnitus has been shown to respond to modulations of cortical activity by high-frequency and low-frequency repetitive transcranial magnetic stimulation (rTMS). Objective: To determine the tinnitus-attenuating effects of a 2-week daily regimen of rTMS, navigated to the maximum of tinnitus-related increase in regional cerebral blood flow. Methods: Six patients with chronic tinnitus were enrolled in this sham-controlled crossover study and treated with 262 weeks of suprathreshold 1 Hz rTMS (30 min) applied to the region with maximal tinnitus-related increase in regional cerebral blood flow delineated by functional imaging with [O-15]H2O positron emission tomography and a control area. Tinnitus-related distress was assessed before and after each treatment and 2 weeks after the end of the 4-week course of stimulation using a validated tinnitus questionnaire. Additional self-assessment scores of tinnitus change, loudness and annoyance were obtained. Results: In five of six patients, rTMS induced greater reduction of the tinnitus questionnaire score than sham stimulation. In two patients, all parameters measured (tinnitus change score, tinnitus loudness, tinnitus annoyance) showed unequivocal improvement. At the group level, the degree of response in the tinnitus questionnaire score was correlated with tinnitus- associated activation of the anterior cingulate cortex. Two weeks after the final stimulation, tinnitus had returned to baseline in all patients but one. Conclusion: Tinnitus can be attenuated by low-frequency rTMS navigated to each person's maximum tinnitus-related cortical hyperactivity. The effects are only moderate; interindividual responsiveness varies and the attenuation seems to wear off within 2 weeks after the last stimulation session. Notably, tinnitus- related anterior cingulate cortex activation seems to predict the response to rTMS treatment.