Elsevier

Brain Stimulation

Volume 4, Issue 4, October 2011, Pages 222-227
Brain Stimulation

Original Article
Transcranial magnetic stimulation for the treatment of tinnitus: 4-year follow-up in treatment responders—a retrospective analysis

https://doi.org/10.1016/j.brs.2010.11.003Get rights and content

Background

Repetitive transcranial magnetic stimulation (rTMS) over the temporal cortex has been proposed as a new approach for the treatment of tinnitus. Even if most studies have shown beneficial effects, there is only limited knowledge about clinical predictors for treatment response and about the duration of treatment effects.

Objective

In this study, we compared clinical characteristics of rTMS responders and nonresponders and assessed long-term outcome in the responder group.

Method

Results from 235 patients, who were treated with rTMS because of chronic tinnitus were analysed. Patients received either a standard protocol of low-frequency rTMS (n = 188; 110% motor threshold, 1 Hz, 2000 stimuli/day) over the left temporal cortex or combined frontal and temporal rTMS (n = 47; 110% motor threshold, 1000 stimuli at 20 Hz, left dorsolateral prefrontal cortex plus 1000 stimuli at 1 Hz left temporal cortex). Response criterion was defined as an improvement of at least 10 points in the tinnitus questionnaire (TQ) score between baseline and the follow-up assessment 90 days after treatment.

Results

For the entire study group there was a highly significant effect of treatment on the TQ score. Fifty patients (21.3%) were responders according to the above mentioned definition. The response criterion was fulfilled by 19.7% of the patients receiving left temporal rTMS and by 26% of the patients receiving combined rTMS. The only significant difference between responders and nonresponders was a higher baseline score of the TQ in the responder group. There were no significant differences in all other assessed patient parameters (gender, age, tinnitus duration, tinnitus laterality, motor threshold, handedness). Ninety days after treatment the average TQ reduction in the responder group was 18.2 points as compared with baseline. At the two long-term follow-up assessments (2.12 ± 1.17 years and 3.9 ± 1.17 years after treatment) the improvement in the responder group was still 14.2, respective 14.4 points.

Conclusions

These data underscore the clinical relevance of rTMS in the treatment of tinnitus. A potential explanation for the observed long-lasting clinical effects is that rTMS interferes with tinnitus related neuronal activity and thus facilitates the intrinsic ability of the brain to restore normal function.

Section snippets

Materials and methods

Data from 235 patients (63 women and 172 men; age 51.2 ± 11.5 years) were analyzed retrospectively. Patients received rTMS either in the context of different clinical trials26, 27, 28, 29 or as compassionate use treatment between 2004 and January 2008. All patients were recruited from the Tinnituscenter at the University of Regensburg, Germany, and gave written informed consent. Study protocols were approved by the ethics committee of the University of Regensburg and conducted according to the

Results

Data of 235 patients with chronic tinnitus who completed 10 days of rTMS treatment were analyzed. No serious side effects were reported, neither with the temporal low-frequency stimulation protocol nor with the combined frontotemporal stimulation protocol. Some patients complained about irritations at the stimulation site and slight headaches during rTMS treatment.

For the entire study group. the repeated measure ANOVA revealed a highly significant change of the TQ score over time (F = 17.4; df

Discussion

Long-term follow-up assessments revealed that among those patients, who responded to rTMS treatment, most still experience an improvement in their tinnitus 2 and even almost 4 years after rTMS. We are well aware that our results have to be interpreted carefully because data are not derived from a controlled study but from clinical observations under naturalistic conditions. Analogous to other long-term follow-up studies35, 36 confounding factors such as a tendency to the mean, spontaneous

Acknowledgment

We thank Helene Niebling and Sandra Pfluegl for their technical assistance in administering rTMS and collecting data.

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    Parts of this study were funded by a grant from the Tinnitus Research Initiative (TRI).

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