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Multisite rTMS for the Treatment of Chronic Tinnitus: Stimulation of the Cortical Tinnitus Network—A Pilot Study

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Abstract

Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the auditory cortex has been shown to significantly reduce tinnitus severity in some patients. There is growing evidence that a neural network of both auditory and non-auditory cortical areas is involved in the pathophysiology of chronic subjective tinnitus. Targeting several core regions of this network by rTMS might constitute a promising strategy to enhance treatment effects. This study intends to test the effects of a multisite rTMS protocol on tinnitus severity. 45 patients with chronic tinnitus were treated with multisite stimulation (left dorsolateral prefrontal, 2,000 stimuli, 20 Hz; left temporoparietal, 1,000 stimuli, 1 Hz; right temporoparietal, 1,000 stimuli, 1 Hz). Results were compared with a historical control group consisting of 29 patients who received left temporal stimulation (2,000 stimuli, 1 Hz). Both groups were treated on ten consecutive working days. Tinnitus severity was assessed at three time points: at baseline, after the last treatment session (day 12) and after a follow-up period of 90 days. A change of tinnitus severity over time was tested using repeated measures ANOVA with the between-subjects factor treatment group. Both groups improved similarly from baseline to day 12. However, there was a difference on day 90: the multisite stimulation group showed an overall improvement whereas patients receiving temporal stimulation returned to their baseline level of tinnitus severity. These pilot data suggest that multisite rTMS is superior to temporal rTMS and represents a promising strategy for enhancing treatment effects of rTMS in tinnitus. Future studies should explore this new protocol with respect to clinical and neurobiological effects in more detail.

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References

  • Adamchic I, Tass PA, Langguth B, Hauptmann C, Koller M, Schecklmann M, Landgrebe M (2012) Linking the tinnitus questionnaire and the subjective clinical global impression: which differences are clinically important? Health Qual Life Outcomes 10(1):79

    Article  PubMed  Google Scholar 

  • Adjamian P, Sereda M, Hall DA (2009) The mechanisms of tinnitus: perspectives from human functional neuroimaging. Hear Res 253(1–2):15–31

    Article  PubMed  Google Scholar 

  • Beck AT, Steer RA (1984) Internal consistencies of the original and revised Beck depression inventory. J Clin Psychol 40(6):1365–1367

    Article  PubMed  CAS  Google Scholar 

  • De Ridder D, Elgoyhen AB, Romo R, Langguth B (2011) Phantom percepts: tinnitus and pain as persisting aversive memory networks. Proc Natl Acad Sci USA 108(20):8075–8080

    Article  PubMed  Google Scholar 

  • Dehaene S, Changeux J-P (2004) Neural mechanisms for access to consciousness. In: Gazzaniga M (ed) The cognitive neurosciences III. MIT, Cambridge

    Google Scholar 

  • Eichhammer P, Langguth B, Marienhagen J, Kleinjung T, Hajak G (2003) Neuronavigated repetitive transcranial magnetic stimulation in patients with tinnitus: a short case series. Biol Psychiatry 54(8):862–865

    Article  PubMed  Google Scholar 

  • Frank G, Kleinjung T, Landgrebe M, Vielsmeier V, Steffenhagen C, Burger J, Langguth B (2010) Left temporal low-frequency rTMS for the treatment of tinnitus: clinical predictors of treatment outcome-a retrospective study. Eur J Neurol 17(7):951–956

    Article  PubMed  CAS  Google Scholar 

  • Frank E, Eichhammer P, Burger J, Zowe M, Landgrebe M, Hajak G, Langguth B (2011) Transcranial magnetic stimulation for the treatment of depression: feasibility and results under naturalistic conditions: a retrospective analysis. Eur Arch Psychiatry Clin Neurosci 261(4):261–266

    Article  PubMed  Google Scholar 

  • Goebel G, Hiller W (1994) The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire. HNO 42(3):166–172

    PubMed  CAS  Google Scholar 

  • Gross M, Nakamura L, Pascual-Leone A, Fregni F (2007) Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression improved? A systematic review and meta-analysis comparing the recent versus the earlier rTMS studies. Acta Psychiatr Scand 116(3):165–173

    Article  PubMed  CAS  Google Scholar 

  • Hoekstra CEL, Versnel H, Neggers SFW, Niesten MEF, and Van Zanten GA (2012) Effectiveness of bilateral repetitive transcranial magnetic stimulation in patients with chronic tinnitus. Paper presented at the sixth international conference on tinnitus., Bruges, Belgium, p 34

  • Hoffman RE, Cavus I (2002) Slow transcranial magnetic stimulation, long-term depotentiation, and brain hyperexcitability disorders. Am J Psychiatry 159(7):1093–1102

    Article  PubMed  Google Scholar 

  • Hoffman HJ, Reed GW (2004) Epidemiology of tinnitus. In: Snow JB (ed) Tinnitus: Theory and Management. BC Decker Inc, Lewiston, pp 16–41

    Google Scholar 

  • Hoffman RE, Boutros NN, Hu S, Berman RM, Krystal JH, Charney DS (2000) Transcranial magnetic stimulation and auditory hallucinations in schizophrenia. Lancet 355(9209):1073–1075

    Article  PubMed  CAS  Google Scholar 

  • Jasper HH (1958) The ten-twenty electrode system of the international federation. Electroencephalogr Clin Neurophysiol 10:371–375

    Google Scholar 

  • Khedr EM, Rothwell JC, Ahmed MA, El-Atar A (2008) Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus: comparison of different stimulus frequencies. J Neurol Neurosurg Psychiatry 79(2):212–215

    Article  PubMed  CAS  Google Scholar 

  • Khedr EM, Abo-Elfetoh N, Rothwell JC, El-Atar A, Sayed E, Khalifa H (2010) Contralateral versus ipsilateral rTMS of temporoparietal cortex for the treatment of chronic unilateral tinnitus: comparative study. Eur J Neurol 17(7):976–983

    Article  PubMed  CAS  Google Scholar 

  • Kleinjung T, Fischer B, Langguth B, Sand PG, Hajak G, Dvorakova J, Eichhammer P (2007a) Validierung einer deutschsprachigen Version des “Tinnitus Handicap Inventory”. Psychiat Prax 34(1):140–142

    Article  Google Scholar 

  • Kleinjung T, Steffens T, Sand P, Murthum T, Hajak G, Strutz J, Eichhammer P (2007b) Which tinnitus patients benefit from transcranial magnetic stimulation? Otolaryngol Head Neck Surg 137(4):589–595

    Article  PubMed  Google Scholar 

  • Kleinjung T, Eichhammer P, Landgrebe M, Sand P, Hajak G, Steffens T, Langguth B (2008) Combined temporal and prefrontal transcranial magnetic stimulation for tinnitus treatment: a pilot study. Otolaryngol Head Neck Surg 138(4):497–501

    Article  PubMed  Google Scholar 

  • Kleinjung T, Steffens T, Landgrebe M, Vielsmeier V, Frank E, Hajak G, Langguth B (2009) Levodopa does not enhance the effect of low-frequency repetitive transcranial magnetic stimulation in tinnitus treatment. Otolaryngol Head Neck Surg 140(1):92–95

    Article  PubMed  Google Scholar 

  • Kleinjung T, Steffens T, Landgrebe M, Vielsmeier V, Frank E, Burger J, Langguth B (2011) Repetitive transcranial magnetic stimulation for tinnitus treatment: no enhancement by the dopamine and noradrenaline reuptake inhibitor bupropion. Brain Stimul 4(2):65–70

    Article  PubMed  Google Scholar 

  • Kreuzer PM, Landgrebe M, Schecklmann M, Poeppl TB, Vielsmeier V, Hajak G, Langguth B (2011) Can temporal repetitive transcranial magnetic stimulation be enhanced by targeting affective components of tinnitus with frontal rTMS? A randomized controlled pilot trial. Front Syst Neurosci 5:88

    Article  PubMed  Google Scholar 

  • Landgrebe M, Zeman F, Koller M, Eberl Y, Mohr M, Reiter J, Langguth B (2010) The tinnitus research initiative (TRI) database: a new approach for delineation of tinnitus subtypes and generation of predictors for treatment outcome. BMC Med Inform Decis Mak 10:42

    Article  PubMed  Google Scholar 

  • Langguth B (2011) A review of tinnitus symptoms beyond ‘ringing in the ears’: a call to action. Curr Med Res Opin 27(8):1635–1643

    Article  PubMed  Google Scholar 

  • Langguth B, Zowe M, Landgrebe M, Sand P, Kleinjung T, Binder H, Eichhammer P (2006) Transcranial magnetic stimulation for the treatment of tinnitus: a new coil positioning method and first results. Brain Topogr 18(4):241–247

    Article  PubMed  Google Scholar 

  • Langguth B, Goodey R, Azevedo A, Bjorne A, Cacace A, Crocetti A, Vergara R (2007) Consensus for tinnitus patient assessment and treatment outcome measurement: tinnitus research initiative meeting, Regensburg, July 2006. Prog Brain Res 166:525–536

    Article  PubMed  CAS  Google Scholar 

  • Lanting CP, de Kleine E, van Dijk P (2009) Neural activity underlying tinnitus generation: results from PET and fMRI. Hear Res 255(1–2):1–13

    Article  PubMed  CAS  Google Scholar 

  • Lehner A, Schecklmann M, Landgrebe M, Kreuzer PM, Poeppl TB, Frank E, Langguth B (2012) Predictors for rTMS response in chronic tinnitus. Front Syst Neurosci 6:11

    Article  PubMed  Google Scholar 

  • Newman CW, Jacobson GP, Spitzer JB (1996) Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg 122(2):143–148

    Article  PubMed  CAS  Google Scholar 

  • Plewnia C (2011) Brain stimulation: new vistas for the exploration and treatment of tinnitus. CNS Neurosci Ther 17(5):449–461

    Article  PubMed  Google Scholar 

  • Plewnia C, Reimold M, Najib A, Brehm B, Reischl G, Plontke SK, Gerloff C (2007) Dose-dependent attenuation of auditory phantom perception (tinnitus) by PET-guided repetitive transcranial magnetic stimulation. Hum Brain Mapp 28(3):238–246

    Article  PubMed  Google Scholar 

  • Plewnia C, Vonthein R, Wasserka B, Arfeller C, Naumann A, Schraven SP, Plontke SK (2012) Treatment of chronic tinnitus with theta burst stimulation: a randomized controlled trial. Neurology 78(21):1628–1634

    Article  PubMed  CAS  Google Scholar 

  • Roberts LE, Eggermont JJ, Caspary DM, Shore SE, Melcher JR, Kaltenbach JA (2010) Ringing ears: the neuroscience of tinnitus. J Neurosci 30(45):14972–14979

    Article  PubMed  CAS  Google Scholar 

  • Rossi S, De Capua A, Ulivelli M, Bartalini S, Falzarano V, Filippone G, Passero S (2007) Effects of repetitive transcranial magnetic stimulation on chronic tinnitus: a randomised, crossover, double blind, placebo controlled study. J Neurol Neurosurg Psychiatry 78(8):857–863

    Article  PubMed  Google Scholar 

  • Schlee W, Hartmann T, Langguth B, Weisz N (2009a) Abnormal resting-state cortical coupling in chronic tinnitus. BMC Neurosci 10:11

    Article  PubMed  Google Scholar 

  • Schlee W, Mueller N, Hartmann T, Keil J, Lorenz I, Weisz N (2009b) Mapping cortical hubs in tinnitus. BMC Biol 7:80

    Article  PubMed  Google Scholar 

  • Schlee W, Lorenz I, Hartmann T, Müller N, Schulz H, Weisz N (2011) A global brain model of tinnitus. In: Moller AR (ed) Textbook of tinnitus. Springer, New York, pp 161–169

    Chapter  Google Scholar 

  • Speer AM, Kimbrell TA, Wassermann EM, Repella JD, Willis MW, Herscovitch P, Post RM (2000) Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biol Psychiatry 48(12):1133–1141

    Article  PubMed  CAS  Google Scholar 

  • Tracy DK, O’Daly O, Joyce DW, Michalopoulou PG, Basit BB, Dhillon G, Shergill SS (2010) An evoked auditory response fMRI study of the effects of rTMS on putative AVH pathways in healthy volunteers. Neuropsychologia 48(1):270–277

    Article  PubMed  CAS  Google Scholar 

  • van der Loo E, Gais S, Congedo M, Vanneste S, Plazier M, Menovsky T, De Ridder D (2009) Tinnitus intensity dependent gamma oscillations of the contralateral auditory cortex. PLoS ONE 4(10):e7396

    Article  PubMed  Google Scholar 

  • Weisz N, Moratti S, Meinzer M, Dohrmann K, Elbert T (2005) Tinnitus perception and distress is related to abnormal spontaneous brain activity as measured by magnetoencephalography. PLoS Med 2(6):e153

    Article  PubMed  Google Scholar 

  • Weisz N, Dohrmann K, Elbert T (2007) The relevance of spontaneous activity for the coding of the tinnitus sensation. Prog Brain Res 166:61–70

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Helene Niebling and Sandra Pfluegl for their technical assistance in administering rTMS and collecting data. Parts of this study were funded by a grant from the tinnitus research initiative (TRI). Astrid Lehner is supported by a Grant from the American Tinnitus Association (ATA).

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany

    Astrid Lehner, Martin Schecklmann, Timm B. Poeppl, Peter M. Kreuzer, Rainer Rupprecht & Berthold Langguth

  2. Interdisciplinary Tinnitus Center, University Regensburg, Regensburg, Germany

    Astrid Lehner, Martin Schecklmann, Timm B. Poeppl, Peter M. Kreuzer, Veronika Vielsmeier, Michael Landgrebe & Berthold Langguth

  3. Department of Otorhinolaryngology, University Regensburg, Regensburg, Germany

    Veronika Vielsmeier

  4. Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany

    Michael Landgrebe

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  1. Astrid Lehner
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  2. Martin Schecklmann
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  3. Timm B. Poeppl
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  4. Peter M. Kreuzer
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  5. Veronika Vielsmeier
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  6. Rainer Rupprecht
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  7. Michael Landgrebe
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  8. Berthold Langguth
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Correspondence to Astrid Lehner.

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Lehner, A., Schecklmann, M., Poeppl, T.B. et al. Multisite rTMS for the Treatment of Chronic Tinnitus: Stimulation of the Cortical Tinnitus Network—A Pilot Study. Brain Topogr 26, 501–510 (2013). https://doi.org/10.1007/s10548-012-0268-4

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  • DOI: https://doi.org/10.1007/s10548-012-0268-4

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