A proof-of-concept study on the combination of repetitive transcranial magnetic stimulation and relaxation techniques in chronic tinnitus

Abstract

Interference of ongoing neuronal activity and brain stimulation motivated this study to combine repetitive transcranial magnetic stimulation (rTMS) and relaxation techniques in tinnitus patients. Forty-two patients were enrolled in this one-arm proof-of-concept study to receive ten sessions of rTMS applied to the left dorsolateral prefrontal cortex and temporo-parietal cortex. During stimulation, patients listened to five different kinds of relaxation audios. Variables of interest were tinnitus questionnaires, tinnitus numeric rating scales, depressivity, and quality of life. Results were compared to results of historical control groups having received the same rTMS protocol (active control) and sham treatment (placebo) without relaxation techniques. Thirty-eight patients completed the treatment, drop-out rates and adverse events were low. Responder rates (reduction in tinnitus questionnaire (TQ) score ≥5 points 10 weeks after treatment) were 44.7 % in the study, 27.8 % in the active control group, and 21.7 % in the placebo group, differing between groups on a near significant level. For the tinnitus handicap inventory (THI), the main effect of group was not significant. However, linear mixed model analyses showed that the relaxation/rTMS group differed significantly from the active control group showing steeper negative THI trend for the relaxation/rTMS group indicating better amelioration over the course of the trial. Deepness of relaxation during rTMS and selection of active relaxation vs. passive listening to music predicted larger TQ. All remaining secondary outcomes turned out non-significant. This combined treatment proved to be a safe, feasible and promising approach to enhance rTMS treatment effects in chronic tinnitus.

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Acknowledgments

We thank Sandra Pfluegl, Ulrike Stadler, Helene Niebling, Jarmila Gerxhaliu-Holan, and Jan Brauner for their assistance in administering rTMS and data management. Most of all we want to thank our patients for participating in our studies and allowing us to use their data for analyses.

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Correspondence to Peter M. Kreuzer.

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The study was supported by the non-profit Tinnitus Research Initiative (TRI) foundation.

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The authors have no conflicts of interest, financial or otherwise, related directly or indirectly to the submitted work.

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Kreuzer, P.M., Poeppl, T.B., Bulla, J. et al. A proof-of-concept study on the combination of repetitive transcranial magnetic stimulation and relaxation techniques in chronic tinnitus. J Neural Transm 123, 1147–1157 (2016). https://doi.org/10.1007/s00702-016-1588-4

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Keywords

  • Chronic tinnitus
  • Repetitive transcranial magnetic stimulation
  • Relaxation
  • Muscle relaxation
  • Hypnosis