Treatment of chronic tinnitus with theta burst stimulation

Plewnia, Christian; Vonthein, Reinhard; Wasserka, Barbara; Arfeller, Carola; Naumann, Andrew; Schraven, Sebastian P.; Plontke, Stefan K.

doi:10.1212/wnl.0b013e3182574ef9

Cited by 55 publications

(43 citation statements)

References 40 publications

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“…In addition to the abovementioned RCTs on low-frequency rTMS, 2 RCT on theta-burst rTMS have been performed and 2 RCT on high-frequency rTMS. One study finds a significant improvement for theta-burst rTMS compared with placebo [Chung et al, 2012], the other did not find a difference between theta-burst rTMS and placebo [Plewnia et al, 2012]. The 2 RCTs on high-frequency rTMS both found a significant effect [Fregni et al, 2006;Khedr et al, 2008].…”

Section: Bilateral Rtms For Tinnitusmentioning

confidence: 99%

Bilateral Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Auditory Cortex in Tinnitus Patients Is Not Effective: A Randomised Controlled Trial

et al. 2013

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Background: Although some therapies may be beneficial for some patients in reducing tinnitus, there is no curative therapy. Repetitive transcranial magnetic stimulation (rTMS) has been applied as a treatment for chronic tinnitus, but the effect remains controversial. Material and Methods: Fifty patients were treated with rTMS or placebo. Treatment consisted of 2,000 TMS pulses on each auditory cortex, at a rate of 1 Hz and an intensity of 110% of the individual motor threshold, on 5 consecutive days. rTMS and placebo effects were evaluated directly after treatment, after 1 week, and after 1, 3 and 6 months. Primary outcome was the Tinnitus Questionnaire (TQ). Secondary outcomes were the Tinnitus Handicap Inventory (THI) and a visual analogue scale. Results: At none of the follow-up evaluation moments a significant difference between rTMS and placebo was observed with respect to changes in TQ or THI scores relative to pretreatment scores. Multilevel modelling (MLM) analyses did not show a global treatment effect either. Patients with a higher degree of burden showed slightly greater improvement after rTMS (only significant on the THI with MLM analyses). Conclusion: Bilateral low-frequency rTMS of the auditory cortex was not effective in treating tinnitus.

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Section: Bilateral Rtms For Tinnitusmentioning

confidence: 99%

Bilateral Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Auditory Cortex in Tinnitus Patients Is Not Effective: A Randomised Controlled Trial

et al. 2013

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“…Based on the hypothesis that repetitive transcranial magnetic stimulation (rTMS) can reduce tinnitus by interfering noninvasively with abnormal activity in the auditory cortex, this method has been investigated for the treatment of tinnitus [10-12]. rTMS treatment in tinnitus patients is so far still of questionable clinical benefit [13], and therefore is not yet ready for application in the clinical routine. Taking into account the lack of other causally oriented treatment options for tinnitus, rTMS treatment is nevertheless considered a promising technique, and miscellaneous optimization strategies have been proposed [14].…”

Section: Introductionmentioning

confidence: 99%

Comparing single-site with multisite rTMS for the treatment of chronic tinnitus – clinical effects and neuroscientific insights: study protocol for a randomized controlled trial

Lehner

Schecklmann

Kreuzer

et al. 2013

Trials

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BackgroundSeveral years ago, repetitive transcranial magnetic stimulation (rTMS) of the auditory cortex has been introduced as a treatment approach for chronic tinnitus. Even if this treatment is beneficial for a subgroup of patients, the overall effects are limited. This limitation may be due to the fact that the auditory cortex is only one of several brain areas involved in tinnitus. Whereas auditory areas are considered to code for tinnitus loudness, conscious perception of and attention allocation to tinnitus is supposed to be reflected by network activity involving frontal and parietal cortical areas. The aim of the present study is to influence this frontoparietal network more efficiently by perturbing the most important nodes with rTMS.Methods/designThis is a randomized, double-blind, parallel-group study. Patients receive rTMS treatment on 10 consecutive working days using either the multisite rTMS protocol (left dorsolateral prefrontal, 1,000 stimuli, 20 Hz; left temporoparietal, 1,000 stimuli, 1 Hz; right temporoparietal stimulation, 1,000 stimuli, 1 Hz) or a single-site protocol (unilateral stimulation of the temporoparietal cortex, 3,000 stimuli, 1 Hz). Individuals aged 18 to 70 years with chronic tinnitus ≥6-month duration and a Tinnitus Handicap Inventory score ≥38 are recruited for the study. A total of 50 patients are needed to detect a clinical relevant change of tinnitus severity (α = 0.05; 1 – β = 0.80). Primary outcome measures are the change in the Tinnitus Questionnaire score from baseline to the end of treatment as well as the number of treatment responders as defined by a reduction in the Tinnitus Questionnaire score of ≥5 points. Furthermore, changes in brain structure and activity are assessed using (functional) magnetic resonance imaging and electroencephalography in the resting state. Those measurements are also performed in 25 healthy control subjects.DiscussionThis study is designed to reveal whether network stimulation is superior to single-site stimulation in the treatment of chronic tinnitus. Furthermore, the comparison between tinnitus patients and healthy controls and the longitudinal effects of both rTMS treatment protocols on brain structure and function allow inferences to be made about the neural correlates of tinnitus.Trial registrationClinical Trials: NCT01663324

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“…Also the group of Tübingen around Plewnia considered the success of rTMS therapy in a rather sober way: 48 patients were treated for 4 weeks, all of them improved a bit based on the tinnitus questionnaire which was observed after placebo as well as after active treatment [94]. …”

Section: Neuromodulation – Instrument-based Medical Interventionsmentioning

confidence: 99%

Evidence and evidence gaps in tinnitus therapy

Hesse¹

2016

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 15:Doc04

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Treatment of chronic tinnitus with theta burst stimulation

Abstract: Treating chronic tinnitus for 4 weeks by applying cTBS to the temporal or temporoparietal cortex of both hemispheres appears to be safe but not more effective than sham stimulation. However, these results are not to be generalized to all forms of rTMS treatments for tinnitus.

Cited by 55 publications

References 40 publications

Bilateral Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Auditory Cortex in Tinnitus Patients Is Not Effective: A Randomised Controlled Trial

Bilateral Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Auditory Cortex in Tinnitus Patients Is Not Effective: A Randomised Controlled Trial

Comparing single-site with multisite rTMS for the treatment of chronic tinnitus – clinical effects and neuroscientific insights: study protocol for a randomized controlled trial

Evidence and evidence gaps in tinnitus therapy

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