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To WT, Hart J, De Ridder D, Vanneste S. Considering the influence of stimulation parameters on the effect of conventional and high-definition transcranial direct current stimulation. Expert Rev Med Devices 2016; 13:391-404. [DOI: 10.1586/17434440.2016.1153968] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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52
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Kasschau M, Sherman K, Haider L, Frontario A, Shaw M, Datta A, Bikson M, Charvet L. A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation (tDCS) in Multiple Sclerosis (MS). J Vis Exp 2015:e53542. [PMID: 26780383 PMCID: PMC4780857 DOI: 10.3791/53542] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses low amplitude direct currents to alter cortical excitability. With well-established safety and tolerability, tDCS has been found to have the potential to ameliorate symptoms such as depression and pain in a range of conditions as well as to enhance outcomes of cognitive and physical training. However, effects are cumulative, requiring treatments that can span weeks or months and frequent, repeated visits to the clinic. The cost in terms of time and travel is often prohibitive for many participants, and ultimately limits real-world access. Following guidelines for remote tDCS application, we propose a protocol that would allow remote (in-home) participation that uses specially-designed devices for supervised use with materials modified for patient use, and real-time monitoring through a telemedicine video conferencing platform. We have developed structured training procedures and clear, detailed instructional materials to allow for self- or proxy-administration while supervised remotely in real-time. The protocol is designed to have a series of checkpoints, addressing attendance and tolerability of the session, to be met in order to continue to the next step. The feasibility of this protocol was then piloted for clinical use in an open label study of remotely-supervised tDCS in multiple sclerosis (MS). This protocol can be widely used for clinical study of tDCS.
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Affiliation(s)
- Margaret Kasschau
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine
| | - Kathleen Sherman
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine
| | | | - Ariana Frontario
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine
| | - Michael Shaw
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine
| | | | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York
| | - Leigh Charvet
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center; Department of Neurology, Stony Brook Medicine;
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53
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Forogh B, Mirshaki Z, Raissi GR, Shirazi A, Mansoori K, Ahadi T. Repeated sessions of transcranial direct current stimulation for treatment of chronic subjective tinnitus: a pilot randomized controlled trial. Neurol Sci 2015; 37:253-9. [PMID: 26498289 DOI: 10.1007/s10072-015-2393-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
Subjective tinnitus is an auditory phantom sensation characterized by the perception of sound in the absence of an identifiable external source. This distressing audiological symptom can severely affect the quality of life. Transcranial direct current stimulation (tDCS) is a noninvasive technique that can induce short-term relief in tinnitus in some patients. The purpose of this pilot double-blind randomized controlled trial was to investigate whether repeated application of anodal tDCS over left temporoparietal area could induce long-lasting relief in patients with chronic tinnitus. Twenty-two patients with chronic tinnitus for at least 6 months were randomly allocated into two groups and received five sessions of anodal (N = 11) or sham (N = 11) stimulation in five consecutive days. A current intensity of 2 mA for 20 min was used for anodal stimulation. Outcomes were assessed using Persian version of tinnitus handicap inventory (THI), loudness and distress visual analog scale (VAS) scores and clinical global impression (CGI) scale. The trial is registered at the Iranian Registry of Clinical Trials (IRCT) with the reference ID of IRCT2014082018871N1. No statistically significant difference was found between anodal and sham stimulation regarding either immediate or long-lasting effects over the 2 weeks follow-up period. Deterioration of symptoms and alteration in tinnitus characteristics were reported by a few patients. There were no significant long-term beneficial effects following tDCS of the left temporoparietal area.
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Affiliation(s)
- Bijan Forogh
- Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran
| | - Zohre Mirshaki
- Physical Medicine and Rehabilitation Specialist at Iran University of Medical Sciences, Firoozgar Hospital, Valiasr Square, Tehran, Iran
| | - Gholam Reza Raissi
- Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran
| | - Ali Shirazi
- Department of Otolaryngology, Firoozgar Hospital, Valiasr square, Tehran, Iran
| | - Korosh Mansoori
- Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran
| | - Tannaz Ahadi
- Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran.
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Cavalcanti K, Brasil-Neto JP, Allam N, Boechat-Barros R. A Double-blind, Placebo-controlled Study of the Effects of Daily tDCS Sessions Targeting the Dorsolateral Prefrontal Cortex on Tinnitus Handicap Inventory and Visual Analog Scale Scores. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shekhawat GS, Sundram F, Bikson M, Truong D, De Ridder D, Stinear CM, Welch D, Searchfield GD. Intensity, Duration, and Location of High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief. Neurorehabil Neural Repair 2015; 30:349-59. [DOI: 10.1177/1545968315595286] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Objective. Tinnitus is the perception of a phantom sound. The aim of this study was to compare current intensity (center anode 1 mA and 2 mA), duration (10 minutes and 20 minutes), and location (left temporoparietal area [LTA] and dorsolateral prefrontal cortex [DLPFC]) using 4 × 1 high-definition transcranial direct current stimulation (HD-tDCS) for tinnitus reduction. Methods. Twenty-seven participants with chronic tinnitus (>2 years) and mean age of 53.5 years underwent 2 sessions of HD-tDCS of the LTA and DLPFC in a randomized order with a 1 week gap between site of stimulation. During each session, a combination of 4 different settings were used in increasing dose (1 mA, 10 minutes; 1 mA, 20 minutes; 2 mA, 10 minutes; and 2 mA, 20 minutes). The impact of different settings on tinnitus loudness and annoyance was documented. Results. Twenty-one participants (77.78%) reported a minimum of 1 point reduction on tinnitus loudness or annoyance scales. There were significant changes in loudness and annoyance for duration of stimulation, F(1, 26) = 10.08, P < .005, and current intensity, F(1, 26) = 14.24, P = .001. There was no interaction between the location, intensity, and duration of stimulation. Higher intensity (2 mA) and longer duration (20 minutes) of stimulation were more effective. Conclusions. A current intensity of 2 mA for 20-minute duration was the most effective setting used for tinnitus relief. The stimulation of the LTA and DLPFC were equally effective for suppressing tinnitus loudness and annoyance.
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Affiliation(s)
| | | | | | | | - Dirk De Ridder
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Tinnitus Research Initiative, Regensburg, Germany
| | | | | | - Grant D. Searchfield
- University of Auckland, New Zealand
- Tinnitus Research Initiative, Regensburg, Germany
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56
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Pal N, Maire R, Stephan MA, Herrmann FR, Benninger DH. Transcranial Direct Current Stimulation for the Treatment of Chronic Tinnitus: A Randomized Controlled Study. Brain Stimul 2015. [PMID: 26198363 DOI: 10.1016/j.brs.2015.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Tinnitus is an often disabling condition for which there is no effective therapy. Current research suggests that tinnitus may develop due to maladaptive plastic changes and altered activity in the auditory and prefrontal cortex. Transcranial direct current stimulation (tDCS) modulates brain activity and has been shown to transiently suppress tinnitus in trials. OBJECTIVE To investigate the efficacy and safety of tDCS in the treatment of chronic subjective tinnitus. METHODS In a randomized, parallel, double-blind, sham-controlled study, the efficacy and safety of cathodal tDCS to the auditory cortex with anode over the prefrontal cortex was investigated in five sessions over five consecutive days. Tinnitus was assessed after the last session on day 5, and at follow-up visits 1 and 3 months post stimulation using the Tinnitus Handicap Inventory (THI, primary outcome measure), Subjective Tinnitus Severity Scale, Hospital Anxiety and Depression scale, Visual Analogue Scale, and Clinical Global Impression scale. RESULTS 42 patients were investigated, 21 received tDCS and 21 sham stimulation. There were no beneficial effects of tDCS on tinnitus as assessed by primary and secondary outcome measures. Effect size assessed with Cohen's d amounted to 0.08 (95% CI: -0.52 to 0.69) at 1 month and 0.18 (95% CI: -0.43 to 0.78) at 3 months for the THI. CONCLUSION tDCS of the auditory and prefrontal cortices is safe, but does not improve tinnitus. Different tDCS protocols might be beneficial.
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Affiliation(s)
- Natassja Pal
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Raphael Maire
- Clinic of Otolaryngology, Head Neck & Ear Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marianne A Stephan
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - David H Benninger
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Charvet LE, Kasschau M, Datta A, Knotkova H, Stevens MC, Alonzo A, Loo C, Krull KR, Bikson M. Remotely-supervised transcranial direct current stimulation (tDCS) for clinical trials: guidelines for technology and protocols. Front Syst Neurosci 2015; 9:26. [PMID: 25852494 PMCID: PMC4362220 DOI: 10.3389/fnsys.2015.00026] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
The effect of transcranial direct current stimulation (tDCS) is cumulative. Treatment protocols typically require multiple consecutive sessions spanning weeks or months. However, traveling to clinic for a tDCS session can present an obstacle to subjects and their caregivers. With modified devices and headgear, tDCS treatment can be administered remotely under clinical supervision, potentially enhancing recruitment, throughput, and convenience. Here we propose standards and protocols for clinical trials utilizing remotely-supervised tDCS with the goal of providing safe, reproducible and well-tolerated stimulation therapy outside of the clinic. The recommendations include: (1) training of staff in tDCS treatment and supervision; (2) assessment of the user’s capability to participate in tDCS remotely; (3) ongoing training procedures and materials including assessments of the user and/or caregiver; (4) simple and fail-safe electrode preparation techniques and tDCS headgear; (5) strict dose control for each session; (6) ongoing monitoring to quantify compliance (device preparation, electrode saturation/placement, stimulation protocol), with corresponding corrective steps as required; (7) monitoring for treatment-emergent adverse effects; (8) guidelines for discontinuation of a session and/or study participation including emergency failsafe procedures tailored to the treatment population’s level of need. These guidelines are intended to provide a minimal level of methodological rigor for clinical trials seeking to apply tDCS outside a specialized treatment center. We outline indication-specific applications (Attention Deficit Hyperactivity Disorder, Depression, Multiple Sclerosis, Palliative Care) following these recommendations that support a standardized framework for evaluating the tolerability and reproducibility of remote-supervised tDCS that, once established, will allow for translation of tDCS clinical trials to a greater size and range of patient populations.
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Affiliation(s)
- Leigh E Charvet
- Department of Neurology, Stony Brook Medicine Stony Brook, NY, USA
| | | | | | | | - Michael C Stevens
- Olin Neuropsychiatry Research Center, Yale University School of Medicine New Haven, CT, USA
| | - Angelo Alonzo
- School of Psychiatry, University of New South Wales, Black Dog Institute Randwick, Australia
| | - Colleen Loo
- School of Psychiatry, University of New South Wales, Black Dog Institute Randwick, Australia
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital Memphis, Tennessee, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY NY, USA
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58
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Altered inhibitory control and increased sensitivity to cross-modal interference in tinnitus during auditory and visual tasks. PLoS One 2015; 10:e0120387. [PMID: 25763867 PMCID: PMC4357462 DOI: 10.1371/journal.pone.0120387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/23/2015] [Indexed: 12/31/2022] Open
Abstract
Tinnitus is the perception of sound in the absence of external stimulus. Currently, the pathophysiology of tinnitus is not fully understood, but recent studies indicate that alterations in the brain involve non-auditory areas, including the prefrontal cortex. In experiment 1, we used a go/no-go paradigm to evaluate the target detection speed and the inhibitory control in tinnitus participants (TP) and control subjects (CS), both in unimodal and bimodal conditions in the auditory and visual modalities. We also tested whether the sound frequency used for target and distractors affected the performance. We observed that TP were slower and made more false alarms than CS in all unimodal auditory conditions. TP were also slower than CS in the bimodal conditions. In addition, when comparing the response times in bimodal and auditory unimodal conditions, the expected gain in bimodal conditions was present in CS, but not in TP when tinnitus-matched frequency sounds were used as targets. In experiment 2, we tested the sensitivity to cross-modal interference in TP during auditory and visual go/no-go tasks where each stimulus was preceded by an irrelevant pre-stimulus in the untested modality (e.g. high frequency auditory pre-stimulus in visual no/no-go condition). We observed that TP had longer response times than CS and made more false alarms in all conditions. In addition, the highest false alarm rate occurred in TP when tinnitus-matched/high frequency sounds were used as pre-stimulus. We conclude that the inhibitory control is altered in TP and that TP are abnormally sensitive to cross-modal interference, reflecting difficulties to ignore irrelevant stimuli. The fact that the strongest interference effect was caused by tinnitus-like auditory stimulation is consistent with the hypothesis according to which such stimulations generate emotional responses that affect cognitive processing in TP. We postulate that executive functions deficits play a key-role in the perception and maintenance of tinnitus.
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59
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Cianfrone G, Mazzei F, Salviati M, Turchetta R, Orlando MP, Testugini V, Carchiolo L, Cianfrone F, Altissimi G. Tinnitus Holistic Simplified Classification (THoSC): A New Assessment for Subjective Tinnitus, With Diagnostic and Therapeutic Implications. Ann Otol Rhinol Laryngol 2015; 124:550-60. [PMID: 25725038 DOI: 10.1177/0003489415570931] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE One of the most debated topics in tinnitus is its standard and practical classification. The most popular classification distinguishes subjective from objective tinnitus. Other classifications are based on different features. On the whole, they seem incomplete, and the diagnostic and therapeutic algorithms are often difficult for practical purposes. The aim of this work is to develop a new diagnostic and therapeutic algorithm. METHODS Our model is based on 10 years of experience. In particular, the starting point is the data retrieved from 212 consecutive patients in our Tinnitus Unit between May and December 2013: We found a clear auditory disorder in 74.5% of the population, muscolo-skeletal disorders and/or trigeminal disease in 57.1%, and psychiatric comorbidities in 43.8%. Different features coexisted in 59.9% of the population. RESULTS Following such data we propose the Tinnitus Holistic Simplified Classification, which takes into account the different tinnitogenic mechanisms and the interactions between them. It differentiates tinnitus that arises from: (1) auditory alterations (Auditory Tinnitus), (2) complex auditory-somatosensory interactions (Somatosensory Tinnitus), (3) psychopathological-auditory interactions (Psychopathology-related Tinnitus), and (4) 2 or all of the previous mechanisms (Combined Tinnitus). CONCLUSIONS In our opinion this classification provides an accurate and easy tailored path to manage tinnitus patients.
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Affiliation(s)
- Giancarlo Cianfrone
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
| | - Filippo Mazzei
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
| | - Massimo Salviati
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Rosaria Turchetta
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
| | - Maria Patrizia Orlando
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
| | - Valeria Testugini
- A.I.R.S. Italian Association for the Research on Deafness, Rome, Italy
| | - Laura Carchiolo
- A.I.R.S. Italian Association for the Research on Deafness, Rome, Italy
| | | | - Giancarlo Altissimi
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
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60
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The differential effect of low- versus high-frequency random noise stimulation in the treatment of tinnitus. Exp Brain Res 2015; 233:1433-40. [DOI: 10.1007/s00221-015-4217-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/23/2015] [Indexed: 12/01/2022]
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61
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Shekhawat GS, Stinear CM, Searchfield GD. Modulation of Perception or Emotion? A Scoping Review of Tinnitus Neuromodulation Using Transcranial Direct Current Stimulation. Neurorehabil Neural Repair 2015; 29:837-46. [DOI: 10.1177/1545968314567152] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background. Tinnitus is the phantom perception of sound and can have negative effect on the quality of life. Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique, which can increase or decrease the cortical excitability in the brain region to which it is applied. tDCS has been used for tinnitus research since 2006. Objective. To investigate whether tDCS affects tinnitus perception, related emotion, or both, and the potential implications for tinnitus management. Methods. A scoping review was undertaken using the methods proposed by Arksey and O’Malley. After initial consideration of title relevance and reading abstracts, 15 studies were included in this review. The data from these studies were charted to investigate the impact of tDCS on tinnitus perception and emotions. Results. tDCS results in transient suppression of tinnitus loudness and annoyance; however, it does not lead to long-term impact on tinnitus related emotion. Local stimulation of different sites of stimulation (left temporoparietal area, dorsolateral prefrontal cortex, and auditory cortex) might modulate tinnitus perception (loudness) and emotions differently; however, further research is needed to explore this hypothesis. This review has identified aspects of methodologies that require attention in upcoming tinnitus and tDCS trials to offer better insights. Conclusions. tDCS is an effective research tool for transient tinnitus neuromodulation. However, efforts should be invested in designing clinical trials using local and multiple sites of stimulation, optimized parameters, and objective outcome measures before it can be translated in to a clinical tool for tinnitus management.
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Affiliation(s)
| | | | - Grant D. Searchfield
- University of Auckland, Auckland, New Zealand
- Tinnitus Research Initiative, Regensburg, Germany
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62
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Auditory cortex tACS and tRNS for tinnitus: single versus multiple sessions. Neural Plast 2014; 2014:436713. [PMID: 25587455 PMCID: PMC4283418 DOI: 10.1155/2014/436713] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/14/2014] [Indexed: 11/20/2022] Open
Abstract
Tinnitus is the perception of a sound in the absence of an external acoustic source, which often exerts a significant impact on the quality of life. Currently there is evidence that neuroplastic changes in both neural pathways are involved in the generation and maintaining of tinnitus. Neuromodulation has been suggested to interfere with these neuroplastic alterations. In this study we aimed to compare the effect of two upcoming forms of transcranial electrical neuromodulation: alternating current stimulation (tACS) and random noise stimulation (tRNS), both applied on the auditory cortex. A database with 228 patients with chronic tinnitus who underwent noninvasive neuromodulation was retrospectively analyzed. The results of this study show that a single session of tRNS induces a significant suppressive effect on tinnitus loudness and distress, in contrast to tACS. Multiple sessions of tRNS augment the suppressive effect on tinnitus loudness but have no effect on tinnitus distress. In conclusion this preliminary study shows a possibly beneficial effect of tRNS on tinnitus and can be a motivation for future randomized placebo-controlled clinical studies with auditory tRNS for tinnitus. Auditory alpha-modulated tACS does not seem to be contributing to the treatment of tinnitus.
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63
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McCormick ZL, Walega DR. Cervical epidural steroid injection for refractory somatic tinnitus. Pain Pract 2014; 15:e28-33. [PMID: 25353360 DOI: 10.1111/papr.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
Abstract
Somatic tinnitus is a common disorder, yet few treatments described in the literature have demonstrated strong efficacy. We report a case of a 61-year-old male with refractory somatic tinnitus, temporally related to a prior bacterial otitis media, wherein auditory symptoms were successfully treated with cervical epidural injections of long-acting corticosteroid. We discuss the proposed mechanism of somatic tinnitus and the means by which neuraxial steroids may inhibit somatic tinnitus symptoms.
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Affiliation(s)
- Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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64
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Shekhawat GS, Kobayashi K, Searchfield GD. Methodology for studying the transient effects of transcranial direct current stimulation combined with auditory residual inhibition on tinnitus. J Neurosci Methods 2014; 239:28-33. [PMID: 25285987 DOI: 10.1016/j.jneumeth.2014.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) and auditory residual inhibition (RI) are short lasting non-invasive techniques that can suppress tinnitus in some people. A pilot study was undertaken to evaluate methods to measure a potential additive effect of these treatments. NEW METHOD Ten participants (mean age 59 years) with chronic tinnitus underwent four sessions of anodal tDCS of the left temporoparietal area(LTA) combined with 1min of auditory stimulation (broadband noise presented at tinnitus minimum masking level [MML]+10 dB), either before, during or immediately after tDCS and in a sham controlled session. Participants continuously monitored and recorded their MML on custom software prior to stimulation, during 20 min of tDCS, and 30 min following tDCS. A tinnitus loudness rating was undertaken before and after completion of testing. RESULTS Nine out of ten participants completed the study, one participant dropped out after two sessions due to self-reported worsening in tinnitus symptoms. Seven out of nine participants reported transient tinnitus suppression when sound stimulation was presented along with tDCS. No reliable change in MML was observed. COMPARISON WITH EXISTING METHOD This is the first study to examine the feasibility of continuously measuring MML while providing a combination of auditory and noninvasive brain stimulation simultaneously. CONCLUSIONS We propose modifications in the protocol used, to find ways to increase the duration of auditory RI and investigate its underlying mechanisms. Recommendations for further research are discussed.
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Affiliation(s)
- Giriraj Singh Shekhawat
- Section of Audiology, University of Auckland, New Zealand; Centre for Brain Research, University of Auckland, New Zealand.
| | - Kei Kobayashi
- Section of Audiology, University of Auckland, New Zealand; Centre for Brain Research, University of Auckland, New Zealand.
| | - Grant D Searchfield
- Section of Audiology, University of Auckland, New Zealand; Centre for Brain Research, University of Auckland, New Zealand; Tinnitus Research Initiative, Germany.
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65
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Heeren A, Maurage P, Perrot H, De Volder A, Renier L, Araneda R, Lacroix E, Decat M, Deggouj N, Philippot P. Tinnitus specifically alters the top-down executive control sub-component of attention: Evidence from the Attention Network Task. Behav Brain Res 2014; 269:147-54. [DOI: 10.1016/j.bbr.2014.04.043] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/16/2014] [Accepted: 04/24/2014] [Indexed: 12/14/2022]
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A brain centred view of psychiatric comorbidity in tinnitus: from otology to hodology. Neural Plast 2014; 2014:817852. [PMID: 25018882 PMCID: PMC4074975 DOI: 10.1155/2014/817852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/18/2014] [Accepted: 05/05/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Comorbid psychiatric disorders are frequent among patients affected by tinnitus. There are mutual clinical influences between tinnitus and psychiatric disorders, as well as neurobiological relations based on partially overlapping hodological and neuroplastic phenomena. The aim of the present paper is to review the evidence of alterations in brain networks underlying tinnitus physiopathology and to discuss them in light of the current knowledge of the neurobiology of psychiatric disorders. Methods. Relevant literature was identified through a search on Medline and PubMed; search terms included tinnitus, brain, plasticity, cortex, network, and pathways. Results. Tinnitus phenomenon results from systemic-neurootological triggers followed by neuronal remapping within several auditory and nonauditory pathways. Plastic reorganization and white matter alterations within limbic system, arcuate fasciculus, insula, salience network, dorsolateral prefrontal cortex, auditory pathways, ffrontocortical, and thalamocortical networks are discussed. Discussion. Several overlapping brain network alterations do exist between tinnitus and psychiatric disorders. Tinnitus, initially related to a clinicoanatomical approach based on a cortical localizationism, could be better explained by an holistic or associationist approach considering psychic functions and tinnitus as emergent properties of partially overlapping large-scale neural networks.
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67
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De Ridder D, Vanneste S. Targeting the parahippocampal area by auditory cortex stimulation in tinnitus. Brain Stimul 2014; 7:709-17. [PMID: 25129400 DOI: 10.1016/j.brs.2014.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The final common pathway in tinnitus generation is considered to be synchronized auditory oscillatory hyperactivity. Intracranial auditory cortex stimulation (iACS) via implanted electrodes has been developed to treat severe cases of intractable tinnitus targeting this final common pathway, in the hope of being a panacea for tinnitus. However, not everybody responds to this treatment. OBJECTIVE The electrical brain activity and functional connectivity at rest might determine who is going to respond or not to iACS and might shed light on the pathophysiology of auditory phantom sound generation. METHOD The resting state electrical brain activity of 5 patients who responded and 5 patients who did not respond to auditory cortex implantation are compared using source localized spectral activity (Z-score of log transformed current density) and lagged phase synchronization. RESULTS sLORETA source localization reveals significant differences between responders vs non-responders for beta3 in left posterior parahippocampal, hippocampal and amygdala area extending into left insula. Gamma band differences exist in the posterior parahippocampal areas and BA10. Functional connectivity between the auditory cortex and the hippocampal area is increased for beta2, delta and theta2 in responders, as well as between the parahippocampal area and auditory cortex for beta3. CONCLUSION The resting state functional connectivity and activity between the auditory cortex and parahippocampus might determine whether a tinnitus patient will respond to a cortical implant. The auditory cortex may only be a functional entrance into a larger parahippocampal based tinnitus network.
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Affiliation(s)
- Dirk De Ridder
- Brai²n, Sint Augustinus Hospital, Antwerp, Belgium; Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, New Zealand.
| | - Sven Vanneste
- School for Behavioral & Brain Sciences, University of Texas at Dallas, Dallas, USA; Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Belgium
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68
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Shahid SS, Bikson M, Salman H, Wen P, Ahfock T. The value and cost of complexity in predictive modelling: role of tissue anisotropic conductivity and fibre tracts in neuromodulation. J Neural Eng 2014; 11:036002. [PMID: 24737098 DOI: 10.1088/1741-2560/11/3/036002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Computational methods are increasingly used to optimize transcranial direct current stimulation (tDCS) dose strategies and yet complexities of existing approaches limit their clinical access. Since predictive modelling indicates the relevance of subject/pathology based data and hence the need for subject specific modelling, the incremental clinical value of increasingly complex modelling methods must be balanced against the computational and clinical time and costs. For example, the incorporation of multiple tissue layers and measured diffusion tensor (DTI) based conductivity estimates increase model precision but at the cost of clinical and computational resources. Costs related to such complexities aggregate when considering individual optimization and the myriad of potential montages. Here, rather than considering if additional details change current-flow prediction, we consider when added complexities influence clinical decisions. APPROACH Towards developing quantitative and qualitative metrics of value/cost associated with computational model complexity, we considered field distributions generated by two 4 × 1 high-definition montages (m1 = 4 × 1 HD montage with anode at C3 and m2 = 4 × 1 HD montage with anode at C1) and a single conventional (m3 = C3-Fp2) tDCS electrode montage. We evaluated statistical methods, including residual error (RE) and relative difference measure (RDM), to consider the clinical impact and utility of increased complexities, namely the influence of skull, muscle and brain anisotropic conductivities in a volume conductor model. MAIN RESULTS Anisotropy modulated current-flow in a montage and region dependent manner. However, significant statistical changes, produced within montage by anisotropy, did not change qualitative peak and topographic comparisons across montages. Thus for the examples analysed, clinical decision on which dose to select would not be altered by the omission of anisotropic brain conductivity. SIGNIFICANCE Results illustrate the need to rationally balance the role of model complexity, such as anisotropy in detailed current flow analysis versus value in clinical dose design. However, when extending our analysis to include axonal polarization, the results provide presumably clinically meaningful information. Hence the importance of model complexity may be more relevant with cellular level predictions of neuromodulation.
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Affiliation(s)
- Syed Salman Shahid
- Research Center for Modeling and Simulation, National University of Sciences and Technology, Islamabad, Pakistan. School of Mechanical and Electrical Engineering, University of Southern Queensland, Toowoomba, QLD, Australia
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69
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Polarity specific suppression effects of transcranial direct current stimulation for tinnitus. Neural Plast 2014; 2014:930860. [PMID: 24812586 PMCID: PMC4000666 DOI: 10.1155/2014/930860] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/22/2014] [Indexed: 02/03/2023] Open
Abstract
Tinnitus is the perception of a sound in the absence of an external auditory stimulus and affects 10-15% of the Western population. Previous studies have demonstrated the therapeutic effect of anodal transcranial direct current stimulation (tDCS) over the left auditory cortex on tinnitus loudness, but the effect of this presumed excitatory stimulation contradicts with the underlying pathophysiological model of tinnitus. Therefore, we included 175 patients with chronic tinnitus to study polarity specific effects of a single tDCS session over the auditory cortex (39 anodal, 136 cathodal). To assess the effect of treatment, we used the numeric rating scale for tinnitus loudness and annoyance. Statistical analysis demonstrated a significant main effect for tinnitus loudness and annoyance, but for tinnitus annoyance anodal stimulation has a significantly more pronounced effect than cathodal stimulation. We hypothesize that the suppressive effect of tDCS on tinnitus loudness may be attributed to a disrupting effect of ongoing neural hyperactivity, independent of the inhibitory or excitatory effects and that the reduction of annoyance may be induced by influencing adjacent or functionally connected brain areas involved in the tinnitus related distress network. Further research is required to explain why only anodal stimulation has a suppressive effect on tinnitus annoyance.
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70
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Combining transcranial direct current stimulation and tailor-made notched music training to decrease tinnitus-related distress--a pilot study. PLoS One 2014; 9:e89904. [PMID: 24587113 PMCID: PMC3934956 DOI: 10.1371/journal.pone.0089904] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/25/2014] [Indexed: 11/19/2022] Open
Abstract
The central auditory system has a crucial role in tinnitus generation and maintenance. Curative treatments for tinnitus do not yet exist. However, recent attempts in the therapeutic application of both acoustic stimulation/training procedures and electric/magnetic brain stimulation techniques have yielded promising results. Here, for the first time we combined tailor-made notched music training (TMNMT) with transcranial direct current stimulation (tDCS) in an effort to modulate TMNMT efficacy in the treatment of 32 patients with tonal tinnitus and without severe hearing loss. TMNMT is characterized by regular listening to so-called notched music, which is generated by digitally removing the frequency band of one octave width centered at the individual tinnitus frequency. TMNMT was applied for 10 subsequent days (2.5 hours of daily treatment). During the initial 5 days of treatment and the initial 30 minutes of TMNMT sessions, tDCS (current strength: 2 mA; anodal (N = 10) vs. cathodal (N = 11) vs. sham (N = 11) groups) was applied simultaneously. The active electrode was placed on the head surface over left auditory cortex; the reference electrode was put over right supra-orbital cortex. To evaluate treatment outcome, tinnitus-related distress and perceived tinnitus loudness were assessed using standardized tinnitus questionnaires and a visual analogue scale. The results showed a significant treatment effect reflected in the Tinnitus Handicap Questionnaire that was largest after 5 days of treatment. This effect remained significant at the end of follow-up 31 days after treatment cessation. Crucially, tDCS did not significantly modulate treatment efficacy - it did not make a difference whether anodal, cathodal, or sham tDCS was applied. Possible explanations for the findings and functional modifications of the experimental design for future studies (e.g. the selection of control conditions) are discussed.
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71
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Vanneste S, Joos K, Langguth B, To WT, De Ridder D. Neuronal correlates of maladaptive coping: an EEG-study in tinnitus patients. PLoS One 2014; 9:e88253. [PMID: 24558383 PMCID: PMC3928191 DOI: 10.1371/journal.pone.0088253] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 01/07/2014] [Indexed: 02/05/2023] Open
Abstract
Here we aimed to investigate the neuronal correlates of different coping styles in patients suffering from chronic tinnitus. Adaptive and maladaptive coping styles were determined in 85 tinnitus patients. Based on resting state EEG recordings, coping related differences in brain activity and connectivity were found. Maladaptive coping behavior was related to increases in subjective tinnitus loudness and distress, higher tinnitus severity and higher depression scores. EEG recordings demonstrated increased alpha activity over the left dorsolateral prefrontal cortex (DLPFC) and subgenual anterior cingulate cortex (sgACC) as well as increased connectivity in the default (i.e. resting state) network in tinnitus patients with a maladaptive coping style. Correlation analysis revealed that the changes in the DLPFC correlate primarily with maladaptive coping behavior, whereas the changes in the sgACC correlate with tinnitus severity and depression. Our findings are in line with previous research in the field of depression that during resting state a alpha band hyperconnectivity exists within the default network for patients who use a maladaptive coping style, with the sgACC as the dysfunctional node and that the strength of the connectivity is related to focusing on negative mood and catastrophizing about the consequences of tinnitus.
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Affiliation(s)
- Sven Vanneste
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, United States of America
| | - Kathleen Joos
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Wing Ting To
- Faculty of Social Work and Welfare Studies, University College Ghent, Ghent, Belgium
| | - Dirk De Ridder
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- BRAIN, Sint Augustinus Hospital, Antwerp, Belgium
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72
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De Ridder D, Vanneste S, Engineer ND, Kilgard MP. Safety and Efficacy of Vagus Nerve Stimulation Paired With Tones for the Treatment of Tinnitus: A Case Series. Neuromodulation 2013; 17:170-9. [DOI: 10.1111/ner.12127] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 08/15/2013] [Accepted: 09/06/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Dirk De Ridder
- Brai n, Tinnitus Research Initiative Clinic Antwerp & Department of Neurosurgery; University Hospital Antwerp; Belgium
- Department of Surgical Sciences, Dunedin School of Medicine; University of Otago; New Zealand
| | - Sven Vanneste
- Brai n, Tinnitus Research Initiative Clinic Antwerp & Department of Neurosurgery; University Hospital Antwerp; Belgium
- Department of Translational Neuroscience, Faculty of Medicine; University of Antwerp; Belgium
| | | | - Michael P. Kilgard
- School of Behavioral and Brain Sciences; University of Texas at Dallas; Richardson TX USA
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73
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Shekhawat GS, Searchfield GD, Stinear CM. Randomized Trial of Transcranial Direct Current Stimulation and Hearing Aids for Tinnitus Management. Neurorehabil Neural Repair 2013; 28:410-9. [DOI: 10.1177/1545968313508655] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background. The perception of sound in the absence of an external sound is tinnitus. Tinnitus can have a severe negative impact on quality of life. Objective. This trial investigated whether multisession anodal transcranial direct current stimulation (tDCS) of the left temporoparietal area would enhance sound therapy from hearing aids. Methods. Forty participants (mean age = 54 years) experiencing chronic tinnitus (minimum 2 years) completed a 7-month long double-blind randomized clinical trial. Participants were randomized into 2 groups: control receiving sham tDCS and experimental receiving tDCS. Each group underwent multisession (5 consecutive sessions with 24-hour gap) anodal tDCS (2 mA intensity and 20 minutes duration) of the left temporoparietal area, followed by hearing aid use for 6 months. The impact of tDCS and hearing aid use on tinnitus was assessed using questionnaires (primary measure: Tinnitus Functional Index) and minimum masking level measurement. Results. There was a significant reduction in the overall Tinnitus Functional Index score with time, F(2, 37) = 11.9, P = .0001, for both the groups. Similar patterns were seen for secondary measures. tDCS appeared to have a positive effect on minimum masking levels but not questionnaire responses. Conclusions. After 3 months of hearing aid use, there were significant improvements in tinnitus, which were sustained at 6 months of use. The hearing aid effects appeared independent of tDCS. Further investigations of tDCS or other neuromodulators priming the auditory system for sound therapy based tinnitus treatments are warranted.
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Affiliation(s)
| | - Grant D. Searchfield
- University of Auckland, Auckland, New Zealand
- Tinnitus Research Initiative, Regensburg, Germany
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Russell MJ, Goodman T, Pierson R, Shepherd S, Wang Q, Groshong B, Wiley DF. Individual differences in transcranial electrical stimulation current density. J Biomed Res 2013; 27:495-508. [PMID: 24285948 PMCID: PMC3841475 DOI: 10.7555/jbr.27.20130074] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/16/2013] [Accepted: 07/28/2013] [Indexed: 12/23/2022] Open
Abstract
Transcranial electrical stimulation (TCES) is effective in treating many conditions, but it has not been possible to accurately forecast current density within the complex anatomy of a given subject's head. We sought to predict and verify TCES current densities and determine the variability of these current distributions in patient-specific models based on magnetic resonance imaging (MRI) data. Two experiments were performed. The first experiment estimated conductivity from MRIs and compared the current density results against actual measurements from the scalp surface of 3 subjects. In the second experiment, virtual electrodes were placed on the scalps of 18 subjects to model simulated current densities with 2 mA of virtually applied stimulation. This procedure was repeated for 4 electrode locations. Current densities were then calculated for 75 brain regions. Comparison of modeled and measured external current in experiment 1 yielded a correlation of r = .93. In experiment 2, modeled individual differences were greatest near the electrodes (ten-fold differences were common), but simulated current was found in all regions of the brain. Sites that were distant from the electrodes (e.g. hypothalamus) typically showed two-fold individual differences. MRI-based modeling can effectively predict current densities in individual brains. Significant variation occurs between subjects with the same applied electrode configuration. Individualized MRI-based modeling should be considered in place of the 10-20 system when accurate TCES is needed.
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75
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Song JJ, Vanneste S, Schlee W, Van de Heyning P, De Ridder D. Onset-related differences in neural substrates of tinnitus-related distress: the anterior cingulate cortex in late-onset tinnitus, and the frontal cortex in early-onset tinnitus. Brain Struct Funct 2013; 220:571-84. [PMID: 24135769 DOI: 10.1007/s00429-013-0648-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-Gu, Gyeonggi-Do 463-707, Korea,
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76
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Piccirillo JF, Kallogjeri D, Nicklaus J, Wineland A, Spitznagel EL, Vlassenko AG, Benzinger T, Mathews J, Garcia KS. Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus: four-week stimulation trial. JAMA Otolaryngol Head Neck Surg 2013; 139:388-95. [PMID: 23599075 DOI: 10.1001/jamaoto.2013.233] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE This research examines the impact of 4 weeks of repetitive transcranial magnetic stimulation (rTMS) stimulation to the temporoparietal junction and compares the results of this longer duration of treatment with a similar stimulus protocol of only 2 weeks' duration. OBJECTIVE To examine the effectiveness and safety of 4 weeks of low-frequency rTMS to the left temporoparietal junction in a cohort of patients with bothersome tinnitus. DESIGN Crossover, double-blind, randomized controlled trial. SETTING Outpatient academic medical center. PARTICIPANTS The study population comprised 14 adults aged between 22 and 59 years with subjective, unilateral or bilateral, nonpulsatile tinnitus of 6 months' duration or greater and a score of 34 or greater on the Tinnitus Handicap Inventory (THI). INTERVENTIONS Low-frequency (1 Hz) 110% motor threshold rTMS or sham to the left temporoparietal junction for 4 weeks. MAIN OUTCOME AND MEASURE The difference of the change in the THI score between active rTMS and sham rTMS. RESULTS Active treatment was associated with a median reduction in THI score of 10 (range, -20 to +4) points, and sham treatment was associated with a median reduction of 6 (range, -24 to +12) points. The median difference in THI score between the change associated with active and sham rTMS was 4 (95% CI, -9 to 10; and range, -32 to +14) points. CONCLUSIONS AND RELEVANCE Daily low-frequency active rTMS to the left temporoparietal junction area for 4 weeks was no more effective than sham for patients with chronic bothersome tinnitus. Possible explanations for this negative study include the failure of rTMS to stimulate deeper parts of auditory cortex within the sylvian fissure and more widespread cortical network changes not amenable to localized rTMS effects. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00567892.
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Affiliation(s)
- Jay F Piccirillo
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, MO63110, USA.
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77
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Spiegel DP, Byblow WD, Hess RF, Thompson B. Anodal Transcranial Direct Current Stimulation Transiently Improves Contrast Sensitivity and Normalizes Visual Cortex Activation in Individuals With Amblyopia. Neurorehabil Neural Repair 2013; 27:760-9. [DOI: 10.1177/1545968313491006] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background. Amblyopia is a neurodevelopmental disorder of vision that is associated with abnormal patterns of neural inhibition within the visual cortex. This disorder is often considered to be untreatable in adulthood because of insufficient visual cortex plasticity. There is increasing evidence that interventions that target inhibitory interactions within the visual cortex, including certain types of noninvasive brain stimulation, can improve visual function in adults with amblyopia. Objective. We tested the hypothesis that anodal transcranial direct current stimulation (a-tDCS) would improve visual function in adults with amblyopia by enhancing the neural response to inputs from the amblyopic eye. Methods. Thirteen adults with amblyopia participated and contrast sensitivity in the amblyopic and fellow fixing eye was assessed before, during and after a-tDCS or cathodal tDCS (c-tDCS). Five participants also completed a functional magnetic resonance imaging (fMRI) study designed to investigate the effect of a-tDCS on the blood oxygen level–dependent response within the visual cortex to inputs from the amblyopic versus the fellow fixing eye. Results. A subgroup of 8/13 participants showed a transient improvement in amblyopic eye contrast sensitivity for at least 30 minutes after a-tDCS. fMRI measurements indicated that the characteristic cortical response asymmetry in amblyopes, which favors the fellow eye, was reduced by a-tDCS. Conclusions. These preliminary results suggest that a-tDCS deserves further investigation as a potential tool to enhance amblyopia treatment outcomes in adults.
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78
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Kuo MF, Paulus W, Nitsche MA. Therapeutic effects of non-invasive brain stimulation with direct currents (tDCS) in neuropsychiatric diseases. Neuroimage 2013; 85 Pt 3:948-60. [PMID: 23747962 DOI: 10.1016/j.neuroimage.2013.05.117] [Citation(s) in RCA: 278] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/30/2013] [Accepted: 05/23/2013] [Indexed: 12/19/2022] Open
Abstract
Neuroplasticity, which is the dynamic structural and functional reorganization of central nervous system connectivity due to environmental and internal demands, is recognized as a major physiological basis for adaption of cognition, and behavior, and thus of utmost importance for normal brain function. Pathological alterations of plasticity are increasingly explored as pathophysiological foundation of diverse neurological and psychiatric diseases. Non-invasive brain stimulation techniques (NIBS), such as repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), are able to induce and modulate neuroplasticity in humans. Therefore, they have potential to alter pathological plasticity on the one hand, and foster physiological plasticity on the other, in neuropsychiatric diseases to reduce symptoms, and enhance rehabilitation. tDCS is an emerging NIBS tool, which induces glutamatergic plasticity via application of relatively weak currents through the scalp in humans. In the last years its efficacy to treat neuropsychiatric diseases has been explored increasingly. In this review, we will give an overview of pathological alterations of plasticity in neuropsychiatric diseases, gather clinical studies involving tDCS to ameliorate symptoms, and discuss future directions of application, with an emphasis on optimizing stimulation effects.
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Affiliation(s)
- Min-Fang Kuo
- University Medical Center, Clinic for Clinical Neurophysiology, Georg-August-University, Robert-Koch-Str. 40, 37099 Goettingen, Germany.
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79
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De Ridder D, Song JJ, Vanneste S. Frontal Cortex TMS for Tinnitus. Brain Stimul 2013; 6:355-62. [DOI: 10.1016/j.brs.2012.07.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/03/2012] [Accepted: 07/07/2012] [Indexed: 01/10/2023] Open
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Silchenko AN, Adamchic I, Hauptmann C, Tass PA. Impact of acoustic coordinated reset neuromodulation on effective connectivity in a neural network of phantom sound. Neuroimage 2013; 77:133-47. [PMID: 23528923 DOI: 10.1016/j.neuroimage.2013.03.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 01/28/2013] [Accepted: 03/06/2013] [Indexed: 01/29/2023] Open
Abstract
Chronic subjective tinnitus is an auditory phantom phenomenon characterized by abnormal neuronal synchrony in the central auditory system. As recently shown in a proof of concept clinical trial, acoustic coordinated reset (CR) neuromodulation causes a significant relief of tinnitus symptoms combined with a significant decrease of pathological oscillatory activity in a network comprising auditory and non-auditory brain areas. The objective of the present study was to analyze whether CR therapy caused an alteration of the effective connectivity in a tinnitus related network of localized EEG brain sources. To determine which connections matter, in a first step, we considered a larger network of brain sources previously associated with tinnitus. To that network we applied a data-driven approach, combining empirical mode decomposition and partial directed coherence analysis, in patients with bilateral tinnitus before and after 12 weeks of CR therapy as well as in healthy controls. To increase the signal-to-noise ratio, we focused on the good responders, classified by a reliable-change-index (RCI). Prior to CR therapy and compared to the healthy controls, the good responders showed a significantly increased connectivity between the left primary cortex auditory cortex and the posterior cingulate cortex in the gamma and delta bands together with a significantly decreased effective connectivity between the right primary auditory cortex and the dorsolateral prefrontal cortex in the alpha band. Intriguingly, after 12 weeks of CR therapy most of the pathological interactions were gone, so that the connectivity patterns of good responders and healthy controls became statistically indistinguishable. In addition, we used dynamic causal modeling (DCM) to examine the types of interactions which were altered by CR therapy. Our DCM results show that CR therapy specifically counteracted the imbalance of excitation and inhibition. CR significantly weakened the excitatory connection between posterior cingulate cortex and primary auditory cortex and significantly strengthened inhibitory connections between auditory cortices and the dorsolateral prefrontal cortex. The overall impact of CR therapy on the entire tinnitus-related network showed up as a qualitative transformation of its spectral response, in terms of a drastic change of the shape of its averaged transfer function. Based on our findings we hypothesize that CR therapy restores a silence based cognitive auditory comparator function of the posterior cingulate cortex.
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Affiliation(s)
- Alexander N Silchenko
- Institute of Neuroscience and Medicine, Neuromodulation, Research Center Juelich, Juelich, Germany.
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Differences between a single session and repeated sessions of 1 Hz TMS by double-cone coil prefrontal stimulation for the improvement of tinnitus. Brain Stimul 2013; 6:155-9. [DOI: 10.1016/j.brs.2012.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 03/18/2012] [Accepted: 03/23/2012] [Indexed: 11/18/2022] Open
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Müller N, Lorenz I, Langguth B, Weisz N. rTMS induced tinnitus relief is related to an increase in auditory cortical alpha activity. PLoS One 2013; 8:e55557. [PMID: 23390539 PMCID: PMC3563643 DOI: 10.1371/journal.pone.0055557] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/27/2012] [Indexed: 01/04/2023] Open
Abstract
Chronic tinnitus, the continuous perception of a phantom sound, is a highly prevalent audiological symptom. A promising approach for the treatment of tinnitus is repetitive transcranial magnetic stimulation (rTMS) as this directly affects tinnitus-related brain activity. Several studies indeed show tinnitus relief after rTMS, however effects are moderate and vary strongly across patients. This may be due to a lack of knowledge regarding how rTMS affects oscillatory activity in tinnitus sufferers and which modulations are associated with tinnitus relief. In the present study we examined the effects of five different stimulation protocols (including sham) by measuring tinnitus loudness and tinnitus-related brain activity with Magnetoencephalography before and after rTMS. Changes in oscillatory activity were analysed for the stimulated auditory cortex as well as for the entire brain regarding certain frequency bands of interest (delta, theta, alpha, gamma). In line with the literature the effects of rTMS on tinnitus loudness varied strongly across patients. This variability was also reflected in the rTMS effects on oscillatory activity. Importantly, strong reductions in tinnitus loudness were associated with increases in alpha power in the stimulated auditory cortex, while an unspecific decrease in gamma and alpha power, particularly in left frontal regions, was linked to an increase in tinnitus loudness. The identification of alpha power increase as main correlate for tinnitus reduction sheds further light on the pathophysiology of tinnitus. This will hopefully stimulate the development of more effective therapy approaches.
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Affiliation(s)
- Nadia Müller
- Università degli Studi di Trento, Center for Mind/Brain Sciences, Mattarello, Italy.
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83
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Transcranial direct current stimulation treatment protocols: should stimulus intensity be constant or incremental over multiple sessions? Int J Neuropsychopharmacol 2013; 16:13-21. [PMID: 22310245 DOI: 10.1017/s1461145712000041] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Interest in transcranial direct current stimulation (tDCS) as a new tool in neuropsychiatry has led to the need to establish optimal treatment protocols. In an intra-individual randomized cross-over design, 11 healthy volunteers received five tDCS sessions to the left primary motor cortex on consecutive weekdays at a constant or gradually increasing current intensity, in two separate weeks of testing. Cortical excitability was assessed before and after tDCS at each session through peripheral electromyographic recordings of motor-evoked potentials. Both conditions led to significant cumulative increases in cortical excitability across the week but there were no significant differences between the two groups. Motor thresholds decreased significantly from Monday to Friday in both conditions. This study demonstrated that, in the motor cortex, administration of tDCS five times per week whether at a constant intensity or at a gradually increasing intensity was equally effective in increasing cortical excitability.
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Vanneste S, Walsh V, Van De Heyning P, De Ridder D. Comparing immediate transient tinnitus suppression using tACS and tDCS: a placebo-controlled study. Exp Brain Res 2013; 226:25-31. [PMID: 23314693 DOI: 10.1007/s00221-013-3406-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/02/2013] [Indexed: 11/26/2022]
Abstract
Tinnitus is an auditory phantom percept with a tone, hissing, or buzzing sound in the absence of any objective physical sound source. Two forms of low-intensity cranial electrical stimulation exist for clinical and research purposes: transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS). In a recent study, it was demonstrated that a single session of tDCS over the dorsolateral prefrontal cortex (DLPFC) (anode over right DLPFC) yields a transient improvement in subjects with chronic tinnitus and that repeated sessions can possibly be used as a treatment. In the present study, the effect of a single-session individual alpha-modulated tACS and tDCS applied at the DLPFC bilaterally is compared with tinnitus loudness and tinnitus annoyance. A total of fifty tinnitus patients were selected and randomly assigned to the tACS or tDCS treatment. Our main result was that bifrontal tDCS modulates tinnitus annoyance and tinnitus loudness, whereas individual alpha-modulated tACS does not yield a similar result. This study provides additional insights into the role of DLPFC in tinnitus modulation as well as the intersection between tinnitus and affective/attentional processing.
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Affiliation(s)
- Sven Vanneste
- Brai²n, TRI and Department of Neurosurgery, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
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85
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Neural correlates of tinnitus related distress: An fMRI-study. Hear Res 2013; 295:87-99. [DOI: 10.1016/j.heares.2012.03.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 02/24/2012] [Accepted: 03/05/2012] [Indexed: 11/21/2022]
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86
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Langguth B, De Ridder D. Tinnitus: therapeutic use of superficial brain stimulation. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:441-467. [PMID: 24112915 DOI: 10.1016/b978-0-444-53497-2.00036-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Tinnitus is a common disorder and traditional treatment approaches such as medication, active or passive sound enhancement, and cognitive behavioral therapy have limited efficacy. Thus, there is an urgent need for more effective treatment approaches. Functional imaging studies in patients with tinnitus have revealed alterations in neuronal activity of central auditory pathways, probably resulting as a consequence of sensory deafferentation. However, nonauditory brain areas are also involved. These nonauditory brain areas might represent both an "awareness" network involved in the conscious perception of the tinnitus signal as well as areas related to a nontinnitus-specific distress network consisting of the anterior cingulate cortex, anterior insula, and amygdala. Moreover, memory mechanisms involving the hippocampus and the parahippocampal region may play a role in the persistence of the awareness of the phantom percept, as well as in the reinforcement of the associated distress. All of these networks represent potential targets for treatment via pharmacological treatment or noninvasive and invasive brain stimulation. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method of applying electromagnetic fields to the brain that can induce alterations of neuronal activity that outlast the stimulation period. Single sessions of rTMS over the temporal or temporoparietal cortex have been successful in transiently reducing tinnitus perception. Repeated sessions of rTMS have resulted in tinnitus relief in a subgroup of patients, lasting from several days to several months. However, effect sizes of rTMS in the treatment of tinnitus are only moderate, and interindividual variability is high. Larger and longer lasting effects have been observed with direct electrical stimulation of the auditory cortex via implanted epidural electrodes. Transcranial direct current stimulation (tDCS) has also shown potential for the treatment of tinnitus. Both auditory and frontal tDCS have shown tinnitus reduction in a subgroup of patients. In spite of the promising results of the different brain stimulation approaches, further research is needed before these techniques can be recommended for routine clinical use.
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Affiliation(s)
- Berthold Langguth
- Interdisciplinary Tinnitus Clinic, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
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87
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Vanneste S, Fregni F, De Ridder D. Head-to-Head Comparison of Transcranial Random Noise Stimulation, Transcranial AC Stimulation, and Transcranial DC Stimulation for Tinnitus. Front Psychiatry 2013; 4:158. [PMID: 24391599 PMCID: PMC3866637 DOI: 10.3389/fpsyt.2013.00158] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/18/2013] [Indexed: 11/13/2022] Open
Abstract
Tinnitus is the perception of a sound in the absence of an external sound stimulus. This phantom sound has been related to plastic changes and hyperactivity in the auditory cortex. Different neuromodulation techniques such as transcranial magnetic stimulation and transcranial direct current stimulation (tDCS) have been used in an attempt to modify local and distant neuroplasticity as to reduce tinnitus symptoms. Recently, two techniques of pulsed electrical stimulation using weak electrical currents - transcranial alternating current stimulation (tACS) and transcranial random noise stimulation (tRNS) - have also shown significant neuromodulatory effects. In the present study we conducted the first head-to-head comparison of three different transcranial electrical stimulation (tES) techniques, namely tDCS, tACS, and tRNS in 111 tinnitus patients by placing the electrodes overlying the auditory cortex bilaterally. The results demonstrated that tRNS induced the larger transient suppressive effect on the tinnitus loudness and the tinnitus related distress as compared to tDCS and tACS. Both tDCS and tACS induced small and non-significant effects on tinnitus symptoms, supporting the superior effects of tRNS as a method for tinnitus suppression.
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Affiliation(s)
- Sven Vanneste
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp , Antwerp , Belgium ; Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA ; School of Behavioral and Brain Sciences, University of Texas at Dallas , Dallas, TX , USA
| | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA ; Center for Clinical Research Learning, Harvard Medical School , Boston, MA , USA
| | - Dirk De Ridder
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago , Otago , New Zealand
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88
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Song JJ, Vanneste S, Van de Heyning P, De Ridder D. Transcranial direct current stimulation in tinnitus patients: a systemic review and meta-analysis. ScientificWorldJournal 2012; 2012:427941. [PMID: 23133339 PMCID: PMC3483673 DOI: 10.1100/2012/427941] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/24/2012] [Indexed: 02/01/2023] Open
Abstract
Although transcranial direct current stimulation (tDCS) has already been used to manage tinnitus patients, paucity of reports and variations in protocols preclude a comprehensive understanding. Hence, we conducted a meta-analysis based on systemic review to assess effectiveness of tDCS in tinnitus management and to compare stimulation parameters. PubMed was searched for tDCS studies in tinnitus. For randomized controlled trials (RCTs), a meta-analysis was performed. A total of 17 studies were identified and 6 of them were included in the systemic review and 2 RCTs were included in the meta-analysis. Overall 39.5% responded to active tDCS with a mean tinnitus intensity reduction of 13.5%. Additionally, left temporal area (LTA) and bifrontal tDCS indicated comparable results. Active tDCS was found to be more effective than sham tDCS for tinnitus intensity reduction (Hedges' g = .77, 95% confidence interval 0.23-1.31). The efficacy of tDCS in tinnitus could not be fully confirmed by the current study because of the limited number of studies, but all studies included in the current systemic review and meta-analysis demonstrated significant tinnitus intensity improvement. Therefore, tDCS may be a promising tool for tinnitus management. Future RCTs in a large series regarding the efficacy as well as the comparison between LTA- and bifrontal tDCS are recommended.
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Affiliation(s)
- Jae-Jin Song
- Brain, TRI & Department of Neurosurgery, University Hospital Antwerp, Wilrijkstraat 10, Edegem, Belgium.
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89
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Shekhawat GS, Stinear CM, Searchfield GD. Transcranial direct current stimulation intensity and duration effects on tinnitus suppression. Neurorehabil Neural Repair 2012; 27:164-72. [PMID: 23032310 DOI: 10.1177/1545968312459908] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perception of sound in the absence of an external auditory source is called tinnitus, which may negatively affect quality of life. Anodal transcranial direct current stimulation (tDCS) of the left temporoparietal area (LTA) was explored for tinnitus relief. OBJECTIVE This pilot study examined tDCS dose (current intensity and duration) and response effects for tinnitus suppression. METHODS Twenty-five participants with chronic tinnitus and a mean age of 54 years took part. Anodal tDCS of LTA was carried out. Current intensity (1 mA and 2 mA) and duration (10 minutes, 15 minutes, and 20 minutes) were varied and their impact on tinnitus measured. RESULTS tDCS was well tolerated. Fifty-six percent of participants (14) experienced transient suppression of tinnitus, and 44% of participants (11) experienced long-term improvement of symptoms (overnight-less annoyance, more relaxed, and better sleep). There was an interaction between duration and intensity of the stimulus on the change in rated loudness of tinnitus, F(2, 48) = 4.355, P = .018, and clinical global improvement score, F(2, 48) = 3.193, P = .050, after stimulation. CONCLUSIONS Current intensity of 2 mA for 20 minutes was the more effective stimulus parameter for anodal tDCS of LTA. tDCS can be a potential clinical tool for reduction of tinnitus, although longer term trials are needed.
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90
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Disentangling depression and distress networks in the tinnitus brain. PLoS One 2012; 7:e40544. [PMID: 22808188 PMCID: PMC3395649 DOI: 10.1371/journal.pone.0040544] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 06/11/2012] [Indexed: 11/19/2022] Open
Abstract
Tinnitus is the continuous perception of an internal auditory stimulus. This permanent sound often affects a person's emotional state inducing distress and depressive feelings changes in 6–25% of the affected population. Distress and depression are two distinct emotional states. Whereas distress describes a transient aversive state, interfering with a person's ability to adequately adapt to stressors, depressive feelings should rather be considered as a more constant emotional state. Based on previous observations in chronic pain, posttraumatic stress disorder and depression, we assume that both states are related to separate neural circuits. We used the Dutch version of the Tinnitus Questionnaire to assess the global index of distress together with the Beck Depression Inventory to evaluate the depressive symptoms accompanying tinnitus. Furthermore sLORETA analysis was performed to correlate current density distribution with distress and depression scores, revealing a lateralization effect of depression versus distress. Distress is mainly correlated with alpha 2, beta 1 and beta 2 activity of the right frontopolar cortex and orbitofrontal cortex in combination with beta 2 activation of the anterior cingulate cortex. In contrast, the more permanent depressive alterations induced by tinnitus are associated with activity of alpha 2 activity in the left frontopolar and orbitofrontal cortex. These specific neural circuits are embedded in a greater neural network, with the parahippocampal region functioning as a crucial linkage between both tinnitus related pathways.
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91
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The involvement of the left ventrolateral prefrontal cortex in tinnitus: a TMS study. Exp Brain Res 2012; 221:345-50. [PMID: 22782483 DOI: 10.1007/s00221-012-3177-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 06/28/2012] [Indexed: 10/28/2022]
Abstract
Tinnitus is an auditory phantom percept with a tone, hissing or buzzing sound in the absence of any objective physical sound source. Tinnitus is considered to be an auditory phantom phenomenon analogous to somatosensory phantom pain. Controllable versus uncontrollable pain is characterized by an increased activity in the ventrolateral prefrontal cortex (VLPFC), and activation in the VLPFC correlating with perceived control over pain results in a decrease in subjective pain intensity. Depressed individuals show less activation than healthy controls in the left VLPFC in response to sad autobiographical scripts, and greater relative left prefrontal activation is related to a greater disposition to approach-related, positive affect with a greater ability to regulate negative affect. Based on the theory that non-pulsatile tinnitus can be considered the auditory analogue for deafferentation pain, we hypothesize that the left VLPFC might also be involved in control of tinnitus. We conducted a transcranial magnetic stimulation (TMS) study verifying whether modulating the left VLPFC by TMS can modulate the loudness of tinnitus. We studied 60 patients with chronic tinnitus of which 21 patients received in random order sham and 1-Hz stimulation, while 39 patients received in random order sham and 10-Hz stimulation. Our results show that 10-Hz stimulation can modulate tinnitus loudness, while 1-Hz stimulation does not seem to exert the same effect. Our findings give further support to the fact that non-auditory areas are involved in tinnitus.
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92
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Lee MH, Solowski N, Wineland A, Okuyemi O, Nicklaus J, Kallogjeri D, Piccirillo JF, Burton H. Functional connectivity during modulation of tinnitus with orofacial maneuvers. Otolaryngol Head Neck Surg 2012; 147:757-62. [PMID: 22675003 DOI: 10.1177/0194599812450680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine changes in cortical neural networks as defined by resting-state functional connectivity magnetic resonance imaging during voluntary modulation of tinnitus with orofacial maneuvers. STUDY DESIGN Cross-sectional study. SETTING Academic medical center. SUBJECTS AND METHODS Participants were scanned during the maneuver and also at baseline to serve as their own control. The authors chose, a priori, 58 seed regions to evaluate previously described cortical neural networks by computing temporal correlations between all seed region pairs. Seed regions whose correlations significantly differed between rest and maneuver (P < .05, uncorrected) entered into a second-stage analysis of computing the correlation coefficient between the seed region and time courses in each of the remaining brain voxels. A threshold-free cluster enhancement permutation analysis evaluated the distribution of these correlation coefficients after transformation to Fisher z scores and registration to a surface-based reconstruction using Freesurfer. RESULTS The median age for the 16 subjects was 54 years (range, 27-72 years), and all had subjective, unilateral or bilateral, nonpulsatile tinnitus for 6 months or longer. In 9 subjects who could voluntarily increase the loudness of their tinnitus, there were no significant differences in functional connectivity in any cortical networks. A separate analysis evaluated results from 3 patients who decreased the loudness of their tinnitus. Four subjects were excluded because of excessive motion in the scanner. CONCLUSION The absence of significant differences in functional connectivity due to voluntary orofacial maneuvers that increased tinnitus loudness failed to confirm prior reports of altered cerebral blood flows during somatomotor behaviors.
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Affiliation(s)
- Megan H Lee
- Washington University School of Medicine, St Louis, Missouri 63110, USA
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93
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De Ridder D, Vanneste S, Plazier M, Menovsky T, van de Heyning P, Kovacs S, Sunaert S. Dorsolateral Prefrontal Cortex Transcranial Magnetic Stimulation and Electrode Implant for Intractable Tinnitus. World Neurosurg 2012; 77:778-84. [DOI: 10.1016/j.wneu.2011.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 09/03/2011] [Indexed: 10/15/2022]
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94
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Vanneste S, De Ridder D. Noninvasive and Invasive Neuromodulation for the Treatment of Tinnitus: An Overview. Neuromodulation 2012; 15:350-60. [DOI: 10.1111/j.1525-1403.2012.00447.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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95
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Langguth B, Schecklmann M, Lehner A, Landgrebe M, Poeppl TB, Kreuzer PM, Schlee W, Weisz N, Vanneste S, De Ridder D. Neuroimaging and neuromodulation: complementary approaches for identifying the neuronal correlates of tinnitus. Front Syst Neurosci 2012; 6:15. [PMID: 22509155 PMCID: PMC3321434 DOI: 10.3389/fnsys.2012.00015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/01/2012] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
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96
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Parazzini M, Fiocchi S, Ravazzani P. Electric field and current density distribution in an anatomical head model during transcranial direct current stimulation for tinnitus treatment. Bioelectromagnetics 2012; 33:476-87. [DOI: 10.1002/bem.21708] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 01/09/2012] [Indexed: 11/11/2022]
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97
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Medeiros LF, de Souza ICC, Vidor LP, de Souza A, Deitos A, Volz MS, Fregni F, Caumo W, Torres ILS. Neurobiological effects of transcranial direct current stimulation: a review. Front Psychiatry 2012; 3:110. [PMID: 23293607 PMCID: PMC3531595 DOI: 10.3389/fpsyt.2012.00110] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/04/2012] [Indexed: 12/20/2022] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique that is affordable and easy to operate compared to other neuromodulation techniques. Anodal stimulation increases cortical excitability, while the cathodal stimulation decreases it. Although tDCS is a promising treatment approach for chronic pain as well as for neuropsychiatric diseases and other neurological disorders, several complex neurobiological mechanisms that are not well understood are involved in its effect. The purpose of this systematic review is to summarize the current knowledge regarding the neurobiological mechanisms involved in the effects of tDCS. The initial search resulted in 171 articles. After applying inclusion and exclusion criteria, we screened 32 full-text articles to extract findings about the neurobiology of tDCS effects including investigation of cortical excitability parameters. Overall, these findings show that tDCS involves a cascade of events at the cellular and molecular levels. Moreover, tDCS is associated with glutamatergic, GABAergic, dopaminergic, serotonergic, and cholinergic activity modulation. Though these studies provide important advancements toward the understanding of mechanisms underlying tDCS effects, further studies are needed to integrate these mechanisms as to optimize clinical development of tDCS.
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Affiliation(s)
- Liciane Fernandes Medeiros
- Post-Graduate Program in Biological Sciences, Department of Physiology, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil ; Pharmacology Department, Institute of Basic Health Science, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil ; Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre Porto Alegre, Brazil
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98
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De Ridder D, Vanneste S. EEG Driven tDCS Versus Bifrontal tDCS for Tinnitus. Front Psychiatry 2012; 3:84. [PMID: 23055986 PMCID: PMC3457073 DOI: 10.3389/fpsyt.2012.00084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 09/04/2012] [Indexed: 01/25/2023] Open
Abstract
Tinnitus is the perception of a sound in the absence of any objective physical sound source. Transcranial Direct Current Stimulation (tDCS) induces shifts in membrane resting potentials depending on the polarity of the stimulation: under the anode gamma band activity increases, whereas under the cathode the opposite occurs. Both single and multiple sessions of tDCS over the dorsolateral prefrontal cortex (DLPFC; anode over right DLPFC) yield a transient improvement in tinnitus intensity and tinnitus distress. The question arises whether optimization of the tDCS protocol can be obtained by using EEG driven decisions on where to place anode and cathode. Using gamma band functional connectivity could be superior to gamma band activity as functional connectivity determines the tinnitus network in many aspects of chronic tinnitus. Six-hundred-seventy-five patients were included in the study: 265 patients received tDCS with cathodal electrode placed over the left DLPFC and the anode placed overlying the right DLPFC, 380 patients received tDCS based on EEG connectivity, and 65 received no tDCS (i.e., waiting list control group). Repeated measures ANOVA revealed a significant main effect for pre versus post measurement. Bifrontal tDCS in comparison to EEG driven tDCS had a larger reduction for both tinnitus distress and tinnitus intensity. Whereas the results of the bifrontal tDCS seem to confirm previous studies, the use of gamma band functional connectivity seems not to bring any advantage to tDCS for tinnitus suppression. Using other potential biomarkers, such as gamma band activity, or theta functional connectivity could theoretically be of use. Further studies will have to elucidate whether brain state based tDCS has any advantages over "blind" bifrontal stimulation.
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Affiliation(s)
- Dirk De Ridder
- Brain and Translational Neuroscience, University Hospital Antwerp Antwerp, Belgium
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99
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Kreuzer PM, Landgrebe M, Schecklmann M, Poeppl TB, Vielsmeier V, Hajak G, Kleinjung T, Langguth B. 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 2011; 5:88. [PMID: 22069382 PMCID: PMC3208342 DOI: 10.3389/fnsys.2011.00088] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 10/12/2011] [Indexed: 11/22/2022] Open
Abstract
Objectives: Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex has been investigated as a new treatment tool for chronic tinnitus during the last years and has shown moderate efficacy. However, there is growing evidence that tinnitus is not a pathology of a specific brain region, but rather the result of network dysfunction involving both auditory and non-auditory brain regions. In functional imaging studies the right dorsolateral prefrontal cortex has been identified as an important hub in tinnitus related networks and has been shown to particularly reflect the affective components of tinnitus. Based on these findings we aimed to investigate whether the effects of left low-frequency rTMS can be enhanced by antecedent right prefrontal low-frequency rTMS. Study Design: Fifty-six patients were randomized to receive either low-frequency left temporal rTMS or a combination of low-frequency right prefrontal followed by low-frequency left temporal rTMS. The change of the tinnitus questionnaire (TQ) score was the primary outcome, secondary outcome parameters included the Tinnitus Handicap Inventory, numeric rating scales, and the Beck Depression Inventory. The study is registered in clinicaltrials.gov (NCT01261949). Results: Directly after therapy there was a significant improvement of the TQ-score in both groups. Comparison of both groups revealed a trend toward more pronounced effects for the combined group (effect size: Cohen’s d = 0.176), but this effect did not reach significance. A persistent trend toward better efficacy was also observed in all other outcome criteria. Conclusion: Additional stimulation of the right prefrontal cortex seems to be a promising strategy for enhancing TMS effects over the temporal cortex. These results further support the involvement of the right DLPFC in the pathophysiology of tinnitus. The small effect size might be due to the study design comparing the protocol to an active control condition.
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Affiliation(s)
- Peter Michael Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg , Regensburg, Germany
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100
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Garin P, Gilain C, Van Damme JP, de Fays K, Jamart J, Ossemann M, Vandermeeren Y. Short- and long-lasting tinnitus relief induced by transcranial direct current stimulation. J Neurol 2011; 258:1940-8. [PMID: 21509429 PMCID: PMC3214608 DOI: 10.1007/s00415-011-6037-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 03/30/2011] [Accepted: 03/31/2011] [Indexed: 11/28/2022]
Abstract
A significant proportion of the population suffers from tinnitus, a bothersome auditory phantom perception that can severely alter the quality of life. Numerous experimental studies suggests that a maladaptive plasticity of the auditory and limbic cortical areas may underlie tinnitus. Accordingly, repetitive transcranial magnetic stimulation (rTMS) has been repeatedly used with success to reduce tinnitus intensity. The potential of transcranial direct current stimulation (tDCS), another promising method of noninvasive brain stimulation, to relieve tinnitus has not been explored systematically. In a double-blind, placebo-controlled and balanced order design, 20 patients suffering from chronic untreatable tinnitus were submitted to 20 minutes of 1 mA anodal, cathodal and sham tDCS targeting the left temporoparietal area. The primary outcome measure was a change in tinnitus intensity or discomfort assessed with a Visual Analogic Scale (VAS) change-scale immediately after tDCS and 1 hour later. Compared to sham tDCS, anodal tDCS significantly reduced tinnitus intensity immediately after stimulation; whereas cathodal tDCS failed to do so. The variances of the tinnitus intensity and discomfort VAS change-scales increased dramatically after anodal and cathodal tDCS, whereas they remained virtually unchanged after sham tDCS. Moreover, several patients unexpectedly reported longer-lasting effects (at least several days) such as tinnitus improvement, worsening, or changes in tinnitus features, more frequently after real than sham tDCS. Anodal tDCS is a promising therapeutic tool for modulating tinnitus perception. Moreover, both anodal and cathodal tDCS seem able to alter tinnitus perception and could, thus, be used to trigger plastic changes.
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Affiliation(s)
- Pierre Garin
- Centre Universitaire d’Audiophonologie, Department of Otorhinolaryngology, CHU Mont-Godinne, Université Catholique de Louvain (UCL), Avenue Dr G. Therasse, 5530 Yvoir, Belgium
- Department of Anatomy, Faculty of Medicine, University of Namur, FUNDP, Namur, Belgium
| | - Chantal Gilain
- Centre Universitaire d’Audiophonologie, Department of Otorhinolaryngology, CHU Mont-Godinne, Université Catholique de Louvain (UCL), Avenue Dr G. Therasse, 5530 Yvoir, Belgium
| | - Jean-Philippe Van Damme
- Centre Universitaire d’Audiophonologie, Department of Otorhinolaryngology, CHU Mont-Godinne, Université Catholique de Louvain (UCL), Avenue Dr G. Therasse, 5530 Yvoir, Belgium
| | - Katalin de Fays
- Department of Neurology, CHU Mont-Godinne, Avenue Dr G. Therasse, 5530 Yvoir, Belgium
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCL), Avenue Hippocrate, 54 Bte 54.10, 1200 Brussels, Belgium
| | - Jacques Jamart
- Scientific Support Unit, CHU Mont-Godinne, 5530 Yvoir, Belgium
| | - Michel Ossemann
- Department of Neurology, CHU Mont-Godinne, Avenue Dr G. Therasse, 5530 Yvoir, Belgium
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCL), Avenue Hippocrate, 54 Bte 54.10, 1200 Brussels, Belgium
| | - Yves Vandermeeren
- Department of Neurology, CHU Mont-Godinne, Avenue Dr G. Therasse, 5530 Yvoir, Belgium
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCL), Avenue Hippocrate, 54 Bte 54.10, 1200 Brussels, Belgium
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