Repetitive Transcranial magnetic stimulation for tinnitus: A case study
Repetitive Transcranial magnetic stimulation for tinnitus: A case study
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DOI：
10.1097/01.mlg.0000234936.82619.69
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发表时间：
2006-10-01
期刊：
影响因子：
2.6
通讯作者：
Dornhoffer, John L.
中科院分区：
文献类型：
--
作者：
Richter, Gresham T.;Mennemeier, Mark;Dornhoffer, John L.
目的/假设：将耳鸣严重程度的主观改善与神经导航低频重复经颅磁刺激（rTMS）后皮质对称性的恢复和持续注意力相关。研究设计：病例研究。研究方法：正电子发射断层扫描和计算机断层扫描成像（PET-CT）引导的rTMS进行了一个43岁的白色男性有超过30年的历史，双侧耳鸣。在PET-CT上以1 Hz的速率对皮层激活增加的区域施用rTMS，持续30分钟（1，800次脉冲/疗程），连续5天，在第5天使用TMS的单脉冲进行优化，以暂时改变耳鸣感知。采用耳鸣严重程度指数模拟量表对rTMS前后主观耳鸣严重程度进行评定。注意力和警惕性在治疗前后使用心理警觉任务（PVT）进行评估，这是一种简单的反应时间测试，对丘脑皮质对持续注意力的贡献敏感。治疗后PET-CT用于评价不对称皮质激活的任何变化。结果：耳鸣严重程度的最显着减少发生在rTMS优化后，这持续到rTMS后4周。PVT测试显示，患者在rTMS后平均最慢10%反应时间出现统计学显著改善（P =.004）。停止rTMS后2天的PET-CT成像显示皮质血流或代谢不对称性没有变化。结论：应用于初级听觉皮层的低频rTMS可以降低耳鸣的严重程度，rTMS优化产生最有利的结果。患者最慢反应时间的有益变化表明，与耳鸣相关的注意力缺陷也可能对低频rTMS产生反应。
Objectives/Hypothesis: Correlate subjective improvements in tinnitus severity with restoration of cortical symmetry and sustained attention after neuronavigated low-frequency, repetitive transcranial magnetic stimulation (rTMS). Study Design: Case study. Methods: Positron emission tomography and computed tomography imaging (PET-CT) guided rTMS was performed on a 43-year-old white male with more than a 30 year history of bilateral tinnitus. rTMS was administered to the area of increased cortical activation visualized on PET-CT at a rate of 1 Hz for 30 minutes (1,800 pulses/session) for each of 5 consecutive days, with optimization applied on day 5 using single pulses of TMS to temporarily alter tinnitus perception. Subjective tinnitus severity was rated before and after rTMS using the tinnitus severity index with analogue scale. Attention and vigilance were assessed before and after therapy using the psychomotor vigilance task (PVT), a simple reaction time test that is sensitive to thalamocortical contributions to sustained attention. Post-therapy PET-CT was used to evaluate any change in asymmetric cortical activation. Results: The most marked reduction in tinnitus severity occurred after rTMS optimization; this persisted up to 4 weeks after rTMS. PVT testing showed the patient exhibited a statistically significant improvement in mean slowest 10% reaction times after rTMS (P =.004). PET-CT imaging 2 days after the cessation of rTMS showed no changes in cortical blood flow or metabolic asymmetries. Conclusions: Low-frequency rTMS applied to the primary auditory cortex can reduce tinnitus severity, with rTMS optimization yielding the most favorable results. Beneficial changes occurring in the patient's slowest reaction times suggest that attentional deficits associated with tinnitus may also respond to low-frequency rTMS.