rTMS over the cerebellum modulates temperature detection and pain thresholds through peripheral mechanisms

Zunhammer, Matthias; Busch, Volker; Griesbach, Franz; Landgrebe, Michael; Hajak, Göran; Langguth, Berthold

doi:10.1016/j.brs.2010.11.002

Cited by 21 publications

(12 citation statements)

References 278 publications

(444 reference statements)

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“…Peripheral effects of rTMS have been shown to reduce pain perception (Zunhammer et al, 2011) and it has also been suggested that the peripheral effects of rTMS may be involved in tinnitus reduction after single sessions of rTMS (Vanneste et al, 2011). Thus, one could speculate that in patients with comorbid temporomandibular problems tinnitus might be especially sensitive for modulation of sensory input resulting in tinnitus reduction via peripheral effects of rTMS on the temporal muscle.…”

Section: Discussionmentioning

confidence: 99%

Predictors for rTMS response in chronic tinnitus

Lehner¹,

Schecklmann²,

Landgrebe³

et al. 2012

Front. Syst. Neurosci.

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Background: Repetitive transcranial magnetic stimulation (rTMS) has been studied as a treatment option for chronic tinnitus for almost 10 years now. Although most of these studies have demonstrated beneficial effects, treatment results show high interindividual variability and yet, little is known about predictors for treatment response. Methods: Data from 538 patients with chronic tinnitus were analyzed. Patients received either low-frequency rTMS over the left temporal cortex (n = 345, 1 Hz, 110% motor threshold, 2000 stimuli/day) or combined temporal and frontal stimulation (n = 193, 110% motor threshold, 2000 stimuli at 20 Hz over left dorsolateral prefrontal cortex plus 2000 stimuli at 1 Hz over temporal cortex). Numerous demographic, clinical, and audiological variables as well as different tinnitus characteristics were analyzed as potential predictors for treatment outcome, which was defined as change in the tinnitus questionnaire (TQ) score. Results: Both stimulation protocols resulted in a significant decrease of TQ scores. Effect sizes were small, however. In the group receiving combined treatment, patients with comorbid temporomandibular complaints benefited more from rTMS than patients without those complaints. In addition, patients with higher TQ scores at baseline had more pronounced TQ reductions than patients with low TQ baseline scores. Also, patients who had already improved from screening to baseline benefited less than patients without initial improvement. Conclusions: The results from this large sample demonstrate that rTMS shows only small but clinically significant effects in the treatment of chronic tinnitus. There are no good demographic or clinical predictors for treatment outcome.

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Section: Discussionmentioning

confidence: 99%

Predictors for rTMS response in chronic tinnitus

Lehner¹,

Schecklmann²,

Landgrebe³

et al. 2012

Front. Syst. Neurosci.

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“…Since cortical stimulation with rTMS is always accompanied by some form of auditory and somatosensory stimulation, these effects may play a role in mediating the TMS effect (Schecklmann et al 2011;Zunhammer et al 2011). Since our sham condition involved auditory stimulation, acoustic stimulation can be largely excluded as an explanation of the observed effect.…”

Section: Statement Of Interestmentioning

confidence: 99%

Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies

Langguth

Landgrebe

Frank

et al. 2012

The World Journal of Biological Psychiatry

106

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“…However in the interpretation of the effects it has to be considered that effects of rTMS are not limited to the directly stimulated brain regions, but can also induce changes in remote functionally connected brain areas. Moreover it has to be taken into consideration that rTMS always represents a multimodal stimulation approach involving not only cortical stimulation, but also the stimulation of somatosensory afferents (Vanneste et al, 2011b; Zunhammer et al, 2011) by the stimulation of scalp neurons and auditory stimulation (Schecklmann et al, 2011b) by its acoustic artifact, all of which may be relevant for the observed behavioral effect.…”

Section: Brain Stimulation Techniquesmentioning

confidence: 99%

“…TMS for example represents a multimodal stimulation approach involving stimulation of somatosensory afferents and auditory stimulation in addition to cortical stimulation, all of which may be relevant for the observed behavioral effect (Schecklmann et al, 2011b; Vanneste et al, 2011b; Zunhammer et al, 2011). However, with these limitations in mind brain stimulation techniques still represent useful tools for complementing neuroimaging techniques in the study of brain function by testing hypotheses of causal relationships between the behavioral effects and imaging results.…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging and Neuromodulation: Complementary Approaches for Identifying the Neuronal Correlates of Tinnitus

Langguth

Schecklmann

Lehner

et al. 2012

Front. Syst. Neurosci.

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An inherent limitation of functional imaging studies is their correlational approach. More information about critical contributions of specific brain regions can be gained by focal transient perturbation of neural activity in specific regions with non-invasive focal brain stimulation methods. Functional imaging studies have revealed that tinnitus is related to alterations in neuronal activity of central auditory pathways. Modulation of neuronal activity in auditory cortical areas by repetitive transcranial magnetic stimulation (rTMS) can reduce tinnitus loudness and, if applied repeatedly, exerts therapeutic effects, confirming the relevance of auditory cortex activation for tinnitus generation and persistence. Measurements of oscillatory brain activity before and after rTMS demonstrate that the same stimulation protocol has different effects on brain activity in different patients, presumably related to interindividual differences in baseline activity in the clinically heterogeneous study cohort. In addition to alterations in auditory pathways, imaging techniques also indicate the involvement of non-auditory brain areas, such as the fronto-parietal “awareness” network and the non-tinnitus-specific distress network consisting of the anterior cingulate cortex, anterior insula, and amygdale. Involvement of the hippocampus and the parahippocampal region putatively reflects the relevance of memory mechanisms in the persistence of the phantom percept and the associated distress. Preliminary studies targeting the dorsolateral prefrontal cortex, the dorsal anterior cingulate cortex, and the parietal cortex with rTMS and with transcranial direct current stimulation confirm the relevance of the mentioned non-auditory networks. Available data indicate the important value added by brain stimulation as a complementary approach to neuroimaging for identifying the neuronal correlates of the various clinical aspects of tinnitus.

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rTMS over the cerebellum modulates temperature detection and pain thresholds through peripheral mechanisms

Cited by 21 publications

References 278 publications

Predictors for rTMS response in chronic tinnitus

Predictors for rTMS response in chronic tinnitus

Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies

Neuroimaging and Neuromodulation: Complementary Approaches for Identifying the Neuronal Correlates of Tinnitus

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