Effective deep brain stimulation of intractable tinnitus: A case study

Dijkstra, Eva; Figee, Martijn; Schuurman, P. Richard; Denys, Damiaan

doi:10.1016/j.brs.2018.07.001

Cited by 7 publications

(20 citation statements)

References 10 publications

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“…Both auditory and limbic regions are involved in tinnitus pathophysiology [ 22 , 23 ]. Stimulation of some areas within the basal ganglia has been shown to be effective in managing tinnitus symptoms [ 24 , 25 , 26 , 27 , 28 ]. However, the link between these regions and tinnitus has yet to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Noise Trauma and Deep Brain Stimulation of the Medial Geniculate Body on Tissue Activity in the Auditory Pathway

et al. 2022

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Tinnitus is defined as the phantom perception of sound. To date, there is no curative treatment, and contemporary treatments have failed to show beneficial outcomes. Deep brain stimulation has been suggested as a potential therapy for refractory tinnitus. However, the optimal target and stimulation regimens remain to be defined. Herein, we investigated metabolic and neuronal activity changes using cytochrome C oxidase histochemistry and c-Fos immunohistochemistry in a noise trauma-induced rat model of tinnitus. We also assessed changes in neuronal activity following medial geniculate body (MGB) high-frequency stimulation (HFS). Metabolic activity was reduced in the primary auditory cortex, MGB and CA1 region of the hippocampus in noise-exposed rats. Additionally, c-Fos expression was increased in the primary auditory cortex of those animals. Furthermore, MGB-HFS enhanced c-Fos expression in the thalamic reticular nucleus. We concluded that noise trauma alters tissue activity in multiple brain areas including the auditory and limbic regions. MGB-HFS resulted in higher neuronal activity in the thalamic reticular nucleus. Given the prominent role of the auditory thalamus in tinnitus, these data provide more rationales towards targeting the MGB with HFS as a symptom management tool in tinnitus.

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Section: Discussionmentioning

confidence: 99%

The Effect of Noise Trauma and Deep Brain Stimulation of the Medial Geniculate Body on Tissue Activity in the Auditory Pathway

et al. 2022

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“…All studies used the Tinnitus Functional Index (TFI) [17] as a primary outcome measure, which is a standardized self-report questionnaire that was designed to maximize sensitivity in measuring treatment-related changes [17]. It should be noted that Dijkstra et al [18] reported TFI on a scale of 0-10, while it is standard to use a scale of 0-100 when reporting TFI. Thus, for the data analysis, the TFI scores in the Dijkstra et al manuscript were multiplied by 10 to maintain equivalency between papers, and will be referred to as the adjusted-TFI.…”

Section: Primary Outcomesmentioning

confidence: 99%

Deep Brain Stimulation for Primary Refractory Tinnitus: A Systematic Review

Basner,

Smit,

Zeitler

et al. 2024

Brain Sciences

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Background: tinnitus is a common and often debilitating condition with limited evidence-based treatment options. Deep brain stimulation (DBS) is an approved treatment modality for certain neurological conditions; its experimental use as a treatment modality for severe tinnitus is novel and beginning to show promise. This systematic review focuses on the current evidence for the safety and efficacy of DBS for treatment of refractory tinnitus. Methods: a systematic search in PubMed and EMBASE was performed to identify peer-reviewed studies on DBS of non-cortical structures for the primary indication of tinnitus treatment. Three studies were identified as meeting these criteria, one of which had two related sub-studies. Results: seven patients with available data who underwent DBS for tinnitus were identified. DBS targets included nucleus accumbens (NAc), ventral anterior limb of the internal capsule (vALIC), caudate nucleus, and the medial geniculate body (MGB) of the thalamus. All studies used the Tinnitus Functional Index (TFI) as a primary outcome measure. DBS of the caudate was most commonly reported (n = 5), with a mean TFI improvement of 23.3 points. Only one subject underwent DBS targeting the NAc/vALIC (extrapolated TFI improvement 46.8) and one subject underwent DBS targeting the MGB (TFI improvement 59 points). Conclusions: DBS is a promising treatment option for refractory subjective tinnitus, with early data, from small patient cohorts in multiple studies, suggesting its safety and efficacy. Further studies with a larger patient population are needed to support this safety and efficacy before implementing this treatment to daily practice.

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“…Moreover, preclinical studies support the beneficial effects of DBS on tinnitus when applied in auditory brain areas [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. In Table 1 we listed all currently available animal and human studies that applied DBS for tinnitus.…”

Section: Introductionmentioning

confidence: 98%

“…Further, patients treated with DBS for a movement disorder sometimes also suffered from tinnitus. DBS of non-auditory structures in these patients led to diminished or completely suppressed tinnitus [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Other implants that could potentially influence tinnitus, and have been investigated, are a cochlear implant (CI) [ 28 ] and an auditory brainstem implant (ABI) [ 29 ], however, these can only be used in patients with severe hearing loss.…”

Section: Introductionmentioning

confidence: 99%

A Protocol to Investigate Deep Brain Stimulation for Refractory Tinnitus: From Rat Model to the Set-Up of a Human Pilot Study

et al. 2022

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Background: Chronic tinnitus can have an immense impact on quality of life. Despite recent treatment advances, many tinnitus patients remain refractory to them. Preclinical and clinical evidence suggests that deep brain stimulation (DBS) is a promising treatment to suppress tinnitus. In rats, it has been shown in multiple regions of the auditory pathway that DBS can have an alleviating effect on tinnitus. The thalamic medial geniculate body (MGB) takes a key position in the tinnitus network, shows pathophysiological hallmarks of tinnitus, and is readily accessible using stereotaxy. Here, a protocol is described to evaluate the safety and test the therapeutic effects of DBS in the MGB in severe tinnitus sufferers. Methods: Bilateral DBS of the MGB will be applied in a future study in six patients with severe and refractory tinnitus. A double-blinded, randomized 2 × 2 crossover design (stimulation ON and OFF) will be applied, followed by a period of six months of open-label follow-up. The primary focus is to assess safety and feasibility (acceptability). Secondary outcomes assess a potential treatment effect and include tinnitus severity measured by the Tinnitus Functional Index (TFI), tinnitus loudness and distress, hearing, cognitive and psychological functions, quality of life, and neurophysiological characteristics. Discussion: This protocol carefully balances risks and benefits and takes ethical considerations into account. This study will explore the safety and feasibility of DBS in severe refractory tinnitus, through extensive assessment of clinical and neurophysiological outcome measures. Additionally, important insights into the underlying mechanism of tinnitus and hearing function might be revealed. Trial registration: ClinicalTrials.gov NCT03976908 (6 June 2019).

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Effective deep brain stimulation of intractable tinnitus: A case study

Cited by 7 publications

References 10 publications

The Effect of Noise Trauma and Deep Brain Stimulation of the Medial Geniculate Body on Tissue Activity in the Auditory Pathway

The Effect of Noise Trauma and Deep Brain Stimulation of the Medial Geniculate Body on Tissue Activity in the Auditory Pathway

Deep Brain Stimulation for Primary Refractory Tinnitus: A Systematic Review

A Protocol to Investigate Deep Brain Stimulation for Refractory Tinnitus: From Rat Model to the Set-Up of a Human Pilot Study

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