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Yadollahpour A, Rashidi S, Saki N, Kunwar PS, Mayo-Yáñez M. Repeated Bilateral Transcranial Direct Current Stimulation over Auditory Cortex for Tinnitus Treatment: A Double-Blinded Randomized Controlled Clinical Trial. Brain Sci 2024; 14:373. [PMID: 38672022 PMCID: PMC11048041 DOI: 10.3390/brainsci14040373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive and painless technique of brain neuromodulation that applies a low-intensity galvanic current to the scalp with the aim of stimulating specific areas of the brain. Preliminary investigations have indicated the potential therapeutic efficacy of multisession tDCS applied to the auditory cortex (AC) in the treatment of chronic tinnitus. The aim of this study was to explore the therapeutic effects of repeated sessions of bilateral tDCS targeting the AC on chronic tinnitus. A double-blinded randomized placebo-controlled trial was conducted on patients (n = 48) with chronic intractable tinnitus (>2 years duration). Participants were randomly allocated to two groups: one receiving tDCS (n = 26), with the anode/cathode placed over the left/right AC, and the other receiving a placebo treatment (n = 22). A 20 min daily session of 2 mA current was administered for five consecutive days per week over two consecutive weeks, employing 35 cm2 electrodes. Tinnitus handicap inventory (THI) scores, tinnitus loudness, and tinnitus distress were measured using a visual analogue scale (VAS), and were assessed before intervention, immediately after, and at one-month follow-up. Anodal tDCS significantly reduced THI from 72.93 ± 10.11 score to 46.40 ± 15.36 after the last session and 49.68 ± 14.49 at one-month follow-up in 18 out of 25 participants (p < 0.001). The risk ratio (RR) of presenting an improvement of ≥20 points in the THI after the last session was 10.8 in patients treated with tDCS. Statistically significant reductions were observed in distress VAS and loudness VAS (p < 0.001). No statistically significant differences in the control group were observed. Variables such as age, gender, duration of tinnitus, laterality of tinnitus, baseline THI scores, and baseline distress and loudness VAS scores did not demonstrate significant correlations with treatment response. Repeated sessions of bilateral AC tDCS may potentially serve as a therapeutic modality for chronic tinnitus.
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Affiliation(s)
- Ali Yadollahpour
- Department of Psychology, University of Sheffield, Sheffield S1 2LT, UK;
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357-15794, Iran
| | - Samaneh Rashidi
- Department of Psychology, University of Surrey, Guildford GU2 7XH, UK;
| | - Nader Saki
- Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357-15794, Iran;
| | - Pramod Singh Kunwar
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Mount Kenya University, Thika P.O. Box 342-01000, Kenya;
| | - Miguel Mayo-Yáñez
- Department of Otorhinolaryngology—Head and Neck Surgery, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
- Department of Otorhinolaryngology—Head and Neck Surgery, Hospital San Rafael (HSR), 15006 A Coruña, Spain
- Otorhinolaryngology—Head and Neck Surgery Research Group, Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC), 15006 A Coruña, Spain
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Ghodratitoostani I, Vaziri Z, Miranda Neto M, de Giacomo Carneiro Barros C, Delbem ACB, Hyppolito MA, Jalilvand H, Louzada F, Leite JP. Conceptual framework for tinnitus: a cognitive model in practice. Sci Rep 2024; 14:7186. [PMID: 38531913 DOI: 10.1038/s41598-023-48006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/21/2023] [Indexed: 03/28/2024] Open
Abstract
Tinnitus is a conscious attended awareness perception of sourceless sound. Widespread theoretical and evidence-based neurofunctional and psychological models have tried to explain tinnitus-related distress considering the influence of psychological and cognitive factors. However, tinnitus models seem to be less focused on causality, thereby easily misleading interpretations. Also, they may be incapable of individualization. This study proposes a Conceptual Cognitive Framework (CCF) providing insight into cognitive mechanisms involved in the predisposition, precipitation, and perpetuation of tinnitus and consequent cognitive-emotional disturbances. The current CCF for tinnitus relies on evaluative conditional learning and appraisal, generating negative valence (emotional value) and arousal (cognitive value) to annoyance, distress, and distorted perception. The suggested methodology is well-defined, reproducible, and accessible, which can help foster future high-quality clinical databases. Perceived tinnitus through the perpetual-learning process can always lead to annoyance, but only in the clinical stage directly cause annoyance. In the clinical stage, tinnitus perception can lead indirectly to distress only with experiencing annoyance either with ("I n d - 1 C " = 1.87; 95% CI 1.18-2.72)["1st indirect path in the Clinical stage model": Tinnitus Loudness → Attention Bias → Cognitive-Emotional Value → Annoyance → Clinical Distress]or without ("I n d - 2 C "= 2.03; 95% CI 1.02-3.32)[ "2nd indirect path in the Clinical stage model": Tinnitus Loudness → Annoyance → Clinical Distress] the perpetual-learning process. Further real-life testing of the CCF is expected to express a meticulous, decision-supporting platform for cognitive rehabilitation and clinical interventions. Furthermore, the suggested methodology offers a reliable platform for CCF development in other cognitive impairments and supports the causal clinical data models. It may also enhance our knowledge of psychological disorders and complicated comorbidities by supporting the design of different rehabilitation interventions and comprehensive frameworks in line with the "preventive medicine" policy.
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Affiliation(s)
- Iman Ghodratitoostani
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil.
- Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil.
- Adjunct Scholar, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Vaziri
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Milton Miranda Neto
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil
- Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil
| | - Camila de Giacomo Carneiro Barros
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil
- Department of Otorhinolaryngology, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Alexandre Cláudio Botazzo Delbem
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil
- Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil
| | - Miguel Angelo Hyppolito
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Hamid Jalilvand
- Department of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Francisco Louzada
- Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil
| | - Joao Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Potier M, Gallego S, Fournier P, Marx M, Noreña A. Amplification of the poorer ear by StereoBiCROS in case of asymmetric sensorineural hearing loss: effect on tinnitus. Front Neurosci 2023; 17:1141096. [PMID: 37304020 PMCID: PMC10248029 DOI: 10.3389/fnins.2023.1141096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Tinnitus is prevalent among patients suffering from Single-Sided Deafness (SSD) and Asymmetrical Hearing Loss (AHL). In addition to bothersome tinnitus in the poorer ear, these patients also report issues with understanding speech in noise and sound localization. The conventional treatment options offered to these patients to improve auditory abilities are cochlear implantation, bone conduction devices or Contralateral Routing Of Signal (CROS) hearing aids. It was recently found that the benefit of cochlear implantation for tinnitus associated with AHL/SSD was greater than the other two approaches. It is conceivable that the lack of stimulation provided to the poorer ear in these last approaches explains their modest impact on tinnitus perception. A new technology that combines the ability to reroute the sound from the poorer ear to the good ear (CROS system) while still stimulating the poorer ear with conventional sound amplification has recently been developed: the StereoBiCROS system. The aim of this study was to investigate the effects of this new device on tinnitus. Twelve AHL and two SSD patients aged 70.7 ± 7.9 years with tinnitus were fitted with bilateral hearing aids that included 3 programs: Stereophonic, BiCROS and StereoBiCROS (CROS + bilateral amplification). The short-and long-term effect of the approach on tinnitus was assessed using a tinnitus Loudness Visual Analog Scale (VAS) and the Tinnitus Handicap Inventory (THI), respectively. Both the VAS and the THI were used before and one month after the hearing aid fitting. Of the 14 patients who used their hearing aids daily (12.6 ± 1.6 h per day) the StereoBiCROS program was the most used program (81.8 ± 20.5% of the time). The average THI total score decreased from 47 (± 22) to 15 (± 16) (p = 0.002) and the VAS-Loudness score decreased from 7 (± 1) to 2 (± 2) (p < 0.001) after the one-month trial period. In conclusion, StereoBiCROS stimulation strategy seems to offer an effective alternative to reduce tinnitus handicap and loudness for patients with AHL/SSD and tinnitus. This effect may be driven by sound amplification of the poorer ear.
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Affiliation(s)
- Morgan Potier
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Laboratoire d’Audiologie Clinique, Narbonne, France
| | - Stéphane Gallego
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Institut des Sciences et Technologies de Réadaptation, Université de Lyon, Lyon, France
| | - Philippe Fournier
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Département de réadaptation, Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Mathieu Marx
- CNRS UMR, Centre de Recherche Cerveau et Cognition (CERCO), Université Paul Sabatier, Toulouse, France
| | - Arnaud Noreña
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
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Vaziri Z, Salmon CEG, Ghodratitoostani I, Santos ACD, Hyppolito MA, Delbem ACB, Leite JP. Down-Regulation of Tinnitus Negative Valence via Concurrent HD-tDCS and PEI Technique: A Pilot Study. Brain Sci 2023; 13:brainsci13050826. [PMID: 37239298 DOI: 10.3390/brainsci13050826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Around 30% of the general population experience subjective tinnitus, characterized by conscious attended awareness perception of sound without an external source. Clinical distress tinnitus is more than just experiencing a phantom sound, as it can be highly disruptive and debilitating, leading those affected to seek clinical help. Effective tinnitus treatments are crucial for psychological well-being, but our limited understanding of the underlying neural mechanisms and a lack of a universal cure necessitate further treatment development. In light of the neurofunctional tinnitus model predictions and transcranial electrical stimulation, we conducted an open-label, single-arm, pilot study that utilized high-definition transcranial direct current stimulation (HD-tDCS) concurrent with positive emotion induction (PEI) techniques for ten consecutive sessions to down-regulate tinnitus negative valence in patients with clinical distress tinnitus. We acquired resting-state functional magnetic resonance imaging scans of 12 tinnitus patients (7 females, mean age = 51.25 ± 12.90 years) before and after the intervention to examine resting-state functional connectivity (rsFC) alterations in specific seed regions. The results showed reduced rsFC at post-intervention between the attention and emotion processing regions as follows: (1) bilateral amygdala and left superior parietal lobule (SPL), (2) left amygdala and right SPL, (3) bilateral dorsolateral prefrontal cortex (dlPFC) and bilateral pregenual anterior cingulate cortex (pgACC), and (4) left dlPFC and bilateral pgACC (FWE corrected p < 0.05). Furthermore, the post-intervention tinnitus handicap inventory scores were significantly lower than the pre-intervention scores (p < 0.05). We concluded that concurrent HD-tDCS and PEI might be effective in reducing tinnitus negative valence, thus alleviating tinnitus distress.
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Affiliation(s)
- Zahra Vaziri
- Department of Neuroscience and Behavior, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Carlos E G Salmon
- InBrain Lab, Department of Physics, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto 14040-901, Brazil
| | - Iman Ghodratitoostani
- Neurocognitive Engineering Laboratory, Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of São Paulo, São Carlos 13566-590, Brazil
| | - Antonio Carlos Dos Santos
- Department of Medical Imaging, Hematology and Clinical Oncology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Miguel A Hyppolito
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Alexandre C B Delbem
- Neurocognitive Engineering Laboratory, Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of São Paulo, São Carlos 13566-590, Brazil
| | - João P Leite
- Department of Neuroscience and Behavior, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048-900, Brazil
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Havlík M, Hlinka J, Klírová M, Adámek P, Horáček J. Towards causal mechanisms of consciousness through focused transcranial brain stimulation. Neurosci Conscious 2023; 2023:niad008. [PMID: 37089451 PMCID: PMC10120840 DOI: 10.1093/nc/niad008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/10/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Conscious experience represents one of the most elusive problems of empirical science, namely neuroscience. The main objective of empirical studies of consciousness has been to describe the minimal sets of neural events necessary for a specific neuronal state to become consciously experienced. The current state of the art still does not meet this objective but rather consists of highly speculative theories based on correlates of consciousness and an ever-growing list of knowledge gaps. The current state of the art is defined by the limitations of past stimulation techniques and the emphasis on the observational approach. However, looking at the current stimulation technologies that are becoming more accurate, it is time to consider an alternative approach to studying consciousness, which builds on the methodology of causal explanations via causal alterations. The aim of this methodology is to move beyond the correlates of consciousness and focus directly on the mechanisms of consciousness with the help of the currently focused brain stimulation techniques, such as geodesic transcranial electric neuromodulation. This approach not only overcomes the limitations of the correlational methodology but will also become another firm step in the following science of consciousness.
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Affiliation(s)
- Marek Havlík
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
| | - Jaroslav Hlinka
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Pod Vodárenskou věží 271/2, Prague 182 07, Czech Republic
| | - Monika Klírová
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
| | - Petr Adámek
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
| | - Jiří Horáček
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
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Nikakhlagh S, Fatahiasl J, Saki Malehi A, Tabibzadeh SM. The Evaluation of Effects of Electrical Stimulation in Treatment of Patients with Chronic Tinnitus with Normal Hearing Sensitivity. Indian J Otolaryngol Head Neck Surg 2023; 75:409-415. [PMID: 37206773 PMCID: PMC10188872 DOI: 10.1007/s12070-023-03503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/14/2023] [Indexed: 02/09/2023] Open
Abstract
Tinnitus is usually associated with different comorbidities such as anxiety, annoyance and depression. Evidences have targeted two main places for tinnitus treatment, namely the auditory cortex and the dorsolateral prefrontal cortex (DLPFC). Transcranial direct current stimulation (tDCS) has been reportedly associated with improvement of cognitive functions in individuals. This study was conducted to evaluate the therapeutic effects of repeated sessions of anodal bifrontal tDCS on tinnitus symptoms. Furthermore, the tDCS impacts on the comorbid depression and anxiety of the patients were investigated. Forty-two voluntaries that suffers from chronic tinnitus were randomly assigned into "real tDCS" (n = 21) and "sham tDCS" (n = 21) groups. The tDCS group, received tDCS with the protocol consisted of 2 mA current, daily one session of 20 min, 6 consecutive days per week and for 4 consecutive weeks. The tinnitus handicap inventory (THI) scale, was measured before the first tDCS session and at one-week and two weeks follow-up. With the same intervals; the distress-related tinnitus was evaluated using visual analogue scale. Depression and anxiety scores were also measured using the Beck depression inventory and Beck anxiety inventory scales, respectively. Our findings indicated that THI score, depression and anxiety level has been gradually diminished across subsequent measurement intervals. We also find significant reduction of distress-related tinnitus in the real-tDCS group after treatment. We conclude that application of tDCS to the bilateral DLPFC region alleviates chronic tinnitus and it should be considered in patients with refractory tinnitus.
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Affiliation(s)
- Soheila Nikakhlagh
- Hearing Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Jafar Fatahiasl
- Hearing Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Amal Saki Malehi
- Hearing Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
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Chen S, Du M, Wang Y, Li Y, Tong B, Qiu J, Wu F, Liu Y. State of the art: non-invasive electrical stimulation for the treatment of chronic tinnitus. Ther Adv Chronic Dis 2023; 14:20406223221148061. [PMID: 36860934 PMCID: PMC9969452 DOI: 10.1177/20406223221148061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023] Open
Abstract
Subjective tinnitus is the perception of sound in the absence of external stimulation. Neuromodulation is a novel method with promising properties for application in tinnitus management. This study sought to review the types of non-invasive electrical stimulation in tinnitus to provide the foothold for further research. PubMed, EMBASE, and Cochrane databases were searched for studies on the modulation of tinnitus by non-invasive electrical stimulation. Among the four forms of non-invasive electrical modulation, transcranial direct current stimulation, transcranial random noise stimulation, and transauricular vagus nerve stimulation yielded promising results, whereas the effect of transcranial alternating current stimulation in the treatment of tinnitus has not been confirmed. Non-invasive electrical stimulation can effectively suppress tinnitus perception in some patients. However, the heterogeneity in parameter settings leads to scattered and poorly replicated findings. Further high-quality studies are needed to identify optimal parameters to develop more acceptable protocols for tinnitus modulation.
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Affiliation(s)
- Shanwen Chen
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Maoshan Du
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yang Wang
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yifan Li
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Busheng Tong
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Jianxin Qiu
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Feihu Wu
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Meishan Road, Hefei 230031, Anhui, P.R. China
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Huntley JH, Rezvani Habibabadi R, Vaishnavi S, Khoshpouri P, Kraut MA, Yousem DM. Transcranial Magnetic Stimulation and its Imaging Features in Patients With Depression, Post-traumatic Stress Disorder, and Traumatic Brain Injury. Acad Radiol 2023; 30:103-112. [PMID: 35437218 DOI: 10.1016/j.acra.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a type of noninvasive neurostimulation used increasingly often in clinical medicine. While most studies to date have focused on TMS's ability to treat major depressive disorder, it has shown promise in several other conditions including post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). As different treatment protocols are often used across studies, the ability to predict patient outcomes and evaluate immediate and long-term changes using imaging becomes increasingly important. Several imaging features, such as thickness, connectedness, and baseline activity of a variety of cortical and subcortical areas, have been found to be correlated with a greater response to TMS therapy. Intrastimulation imaging can reveal in real time how TMS applied to superficial areas activates or inhibits activity in deeper brain regions. Functional imaging performed weeks to months after treatment can offer an understanding of how long-term effects on brain activity relate to clinical improvement. Further work should be done to expand our knowledge of imaging features relevant to TMS therapy and how they vary across patients with different neurological and psychiatric conditions.
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Affiliation(s)
- Joseph H Huntley
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Roya Rezvani Habibabadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sandeep Vaishnavi
- MindPath Care Centers Clinical Research Institute, Raleigh, North Carolina
| | - Parisa Khoshpouri
- Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Michael A Kraut
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
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10 Minutes Frontal 40 Hz tACS-Effects on Working Memory Tested by Luck-Vogel Task. Behav Sci (Basel) 2022; 13:bs13010039. [PMID: 36661611 PMCID: PMC9855106 DOI: 10.3390/bs13010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Working memory is a cognitive process that involves short-term active maintenance, flexible updating, and processing of goal- or task-relevant information. All frequency bands are involved in working memory. The activities of the theta and gamma frequency bands in the frontoparietal network are highly involved in working memory processes; theta oscillations play a role in the temporal organization of working memory items, and gamma oscillations influence the maintenance of information in working memory. Transcranial alternating current stimulation (tACS) results in frequency-specific modulation of endogenous oscillations and has shown promising results in cognitive neuroscience. The electrophysiological and behavioral changes induced by the modulation of endogenous gamma frequency in the prefrontal cortex using tACS have not been extensively studied in the context of working memory. Therefore, we aimed to investigate the effects of frontal gamma-tACS on working memory outcomes. We hypothesized that a 10-min gamma tACS administered over the frontal cortex would significantly improve working memory outcomes. Young healthy participants performed Luck-Vogel cognitive behavioral tasks with simultaneous pre- and post-intervention EEG recording (Sham versus 40 Hz tACS). Data from forty-one participants: sham (15 participants) and tACS (26 participants), were used for the statistical and behavioral analysis. The relative changes in behavioral outcomes and EEG due to the intervention were analyzed. The results show that tACS caused an increase in the power spectral density in the high beta and low gamma EEG bands and a decrease in left-right coherence. On the other hand, tACS had no significant effect on success rates and response times. Conclusion: 10 min of frontal 40 Hz tACS was not sufficient to produce detectable behavioral effects on working memory, whereas electrophysiological changes were evident. The limitations of the current stimulation protocol and future directions are discussed in detail in the following sections.
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Cardon E, Jacquemin L, Vermeersch H, Joossen I, Moyaert J, Mertens G, Vanderveken OM, Lammers MJW, Van de Heyning P, Van Rompaey V, Gilles A. Dual-site transcranial direct current stimulation to treat tinnitus: a randomized controlled trial. Brain 2022; 145:4222-4231. [PMID: 36450310 PMCID: PMC9762937 DOI: 10.1093/brain/awac263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 12/03/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been proposed as a potential intervention for subjective tinnitus, but supporting evidence remains limited. We aimed to investigate the effect of anodal high-definition tDCS of the left temporal area and right dorsolateral prefrontal cortex on tinnitus severity. This double-blind randomized controlled trial included 77 patients (age range 18-79, 43 male) with chronic subjective tinnitus as their primary complaint. Thirty-eight subjects received six consecutive sessions of dual-site sequential high-definition-tDCS with electrodes positioned over the left temporal area and right dorsolateral prefrontal cortex. Both areas were stimulated for 15 min per session, with total stimulation time amounting to 30 min. Thirty-nine subjects received sham stimulation. The primary outcome measure was the change in tinnitus severity, as evaluated by the Tinnitus Functional Index, from baseline to a follow-up visit at 8 ± 2 weeks after treatment completion. Secondary outcomes included changes in perceived tinnitus loudness, as measured with a visual analogue scale and a tinnitus matching procedure, as well as scores on the Hospital Anxiety and Depression Scale, and the Hyperacusis Questionnaire. No differences in Tinnitus Functional Index change scores were identified between the active treatment and sham control groups (linear regression: P = 0.86). The Tinnitus Functional Index scores decreased significantly over time in both groups (P = 0.0012), indicating the presence of a considerable placebo effect. These change scores were significantly influenced by sex (linear regression: P = 0.037) and baseline symptoms of anxiety (linear regression: P = 0.049) in both groups. In general, Tinnitus Functional Index scores decreased more profoundly in males and in subjects with a higher degree of anxiety at baseline. None of the included secondary measures differed significantly between experimental arms. Our results suggest that dual-site sequential high-definition-tDCS of the left temporal area and right dorsolateral prefrontal cortex does not alleviate tinnitus severity. Interestingly, in our study population, fluctuations in tinnitus severity were influenced by gender and concurrent mental condition. It is therefore important to take these factors into account when conducting or planning randomized controlled trials in tinnitus populations.
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Affiliation(s)
- Emilie Cardon
- Correspondence to: Emilie Cardon Department of Translational Neuroscience, Faculty of Medicine and Health Science University of Antwerp, Campus Drie Eiken, Antwerp, Belgium E-mail:
| | - Laure Jacquemin
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Hanne Vermeersch
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Iris Joossen
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Julie Moyaert
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Griet Mertens
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J W Lammers
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium,Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
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11
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Short periods of bipolar anodal TDCS induce no instantaneous dose-dependent increase in cerebral blood flow in the targeted human motor cortex. Sci Rep 2022; 12:9580. [PMID: 35688875 PMCID: PMC9187751 DOI: 10.1038/s41598-022-13091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022] Open
Abstract
Anodal transcranial direct current stimulation (aTDCS) of primary motor hand area (M1-HAND) can enhance corticomotor excitability, but it is still unknown which current intensity produces the strongest effect on intrinsic neural firing rates and synaptic activity. Magnetic resonance imaging (MRI) combined with pseudo-continuous Arterial Spin Labeling (pcASL MRI) can map regional cortical blood flow (rCBF). The measured rCBF signal is sensitive to regional changes in neuronal activity due to neurovascular coupling. Therefore, concurrent TDCS and pcASL MRI may reveal the relationship between current intensity and TDCS-induced changes in overall firing rates and synaptic activity in the cortical target. Here we employed pcASL MRI to map acute rCBF changes during short-duration aTDCS of left M1-HAND. Using the rCBF response as a proxy for regional neuronal activity, we investigated if short-duration aTDCS produces an instantaneous dose-dependent rCBF increase in the targeted M1-HAND that may be useful for individual dosing. Nine healthy right-handed participants received 30 s of aTDCS at 0.5, 1.0, 1.5, and 2.0 mA with the anode placed over left M1-HAND and cathode over the right supraorbital region. Concurrent pcASL MRI at 3 T probed TDCS-related rCBF changes in the targeted M1-HAND. Movement-induced rCBF changes were also assessed. Apart from a subtle increase in rCBF at 0.5 mA, short-duration aTDCS did not modulate rCBF in the M1-HAND relative to no-stimulation periods. None of the participants showed a dose-dependent increase in rCBF during aTDCS, even after accounting for individual differences in TDCS-induced electrical field strength. In contrast, finger movements led to robust activation of left M1-HAND before and after aTDCS. Short-duration bipolar aTDCS does not produce consistant instantaneous dose-dependent rCBF increases in the targeted M1-HAND at conventional intensity ranges. Therefore, the regional hemodynamic response profile to short-duration aTDCS may not be suited to inform individual dosing of TDCS intensity.
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12
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Random Forest Classification to Predict Response to High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief: A Preliminary Feasibility Study. Ear Hear 2022; 43:1816-1823. [PMID: 35666538 PMCID: PMC9592176 DOI: 10.1097/aud.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex has been hypothesized to reduce tinnitus severity by modifying cortical activity in brain regions associated with the perception of tinnitus. However, individual response to tDCS has proven to be variable. We investigated the feasibility of using random forest classification to predict the response to high-definition (HD) tDCS for tinnitus relief. DESIGN A retrospective analysis was performed on a dataset consisting of 99 patients with subjective tinnitus receiving six consecutive sessions of HD-tDCS at the Antwerp University Hospital. A baseline assessment consisted of pure-tone audiometry and a set of questionnaires including the Tinnitus Functional Index (TFI), Hospital Anxiety and Depression Scale, and Edinburgh Handedness Inventory. Random forest classification was applied to predict, based on baseline questionnaire scores and hearing levels, whether each individual responded positively to the treatment (defined as a decrease of at least 13 points on the TFI). Further testing of the model was performed on an independent cohort of 32 patients obtained from the tinnitus center at the University of Regensburg. RESULTS Twenty-four participants responded positively to the HD-tDCS treatment. The random forest classifier predicted treatment response with an accuracy of 85.71% (100% sensitivity, 81.48% specificity), significantly outperforming a more traditional logistic regression approach. Performance of the classifier on an independent cohort was slightly but not significantly above chance level (71.88% accuracy, 66.67% sensitivity, 73.08% specificity). Feature importance analyses revealed that baseline tinnitus severity, co-occurrence of depressive symptoms and handedness were the most important predictors of treatment response. Baseline TFI scores were significantly higher in responders than in nonresponders. CONCLUSIONS The proposed random forest classifier predicted treatment response with a high accuracy, significantly outperforming a more traditional statistical approach. Machine learning methods to predict treatment response might ultimately be used in a clinical setting to guide targeted treatment recommendations for individual tinnitus patients.
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Martins ML, Souza DDS, Cavalcante MEDOB, Barboza HN, de Medeiros JF, Dos Santos Andrade SMM, Machado DGDS, da Rosa MRD. Effect of transcranial Direct Current Stimulation for tinnitus treatment: A systematic review and meta-analysis. Neurophysiol Clin 2022; 52:1-16. [PMID: 35027291 DOI: 10.1016/j.neucli.2021.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To evaluate the effect of tDCS on tinnitus distress, loudness and psychiatric symptoms. METHODS A systematic literature search of PubMed, Web of Science, Cochrane Library, VHL, EMBASE, PsycINFO, OVID, and CINAHL databases was carried out on articles published until July 2021. Inclusion criteria were published controlled trials using tDCS intervention with tinnitus patients, using a sham/control group, and measuring tinnitus loudness, distress and/or psychiatric symptoms. A meta-analysis was performed for the overall effect as well as to compare subgroups according to tDCS target (left temporoparietal area (LTA) and dorsolateral prefrontal cortex (DLPFC)). RESULTS Fourteen articles with 1031 participants were included. Six studies applied tDCS over the DLPFC, six over the LTA and two over both areas. Although the overall meta-analysis showed that tDCS significantly decreased tinnitus loudness (SMD=-0.35; 95%CI=-0.62 to -0.08, p = 0.01) and distress (SMD=-0.50, 95%CI=-0.91 to -0.10, p = 0.02).The subgroup analysis showed a significant effect only for tDCS over LTA for loudness (SMD=-0.46, 95%CI=-0.80 to -0.12, p = 0.009), and no other area resulted in significant change. There was no significant effect of treatment on psychiatric symptoms. CONCLUSION tDCS may improve tinnitus loudness and distress with a small to moderate effect size. Despite the overall positive effect, only LTA tDCS yielded a significant effect. Further well-controlled studies with larger sample sizes and broader exploration of tDCS montages and doses are warranted.
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Affiliation(s)
- Mariana Lopes Martins
- Department of Speech-Language Pathology, Federal University of Paraiba, João Pessoa, PB 58051-900, Brazil.
| | - Dayse da Silva Souza
- Department of Neuroscience and Cognition, Federal University of ABC, São Paulo, SP 09606-070, Brazil
| | | | - Hionara Nascimento Barboza
- Department of Speech-Language Pathology, Federal University of Paraiba, João Pessoa, PB 58051-900, Brazil
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14
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Vasudevan H, Palaniswamy HP, Praharaj SK. Transcranial direct current stimulation (tDCS), a treatment option for tinnitus in profound hearing loss. BMJ Case Rep 2021; 14:14/5/e240300. [PMID: 34045191 DOI: 10.1136/bcr-2020-240300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old man presented with a history of sudden sensory neural hearing loss and severe tinnitus in his left ear. Audiological investigations revealed a profound hearing loss on his left ear and mild conductive hearing loss on his right. Tinnitus pitch and loudness were matched to a 4 kHz narrow-band noise at 50dBHL and subjective tinnitus questionnaires revealed that he had a catastrophic handicap (grade IV). Traditional audiological treatment approaches (tinnitus maskers, hearing aid and sound therapy) that stimulate the cochlea to induce cortical reorganisation were futile. Hence, a top-down approach (transcranial direct current stimulation (tDCS)) to directly modulate the cortical centres was attempted. tDCS was provided for a sum of 15 sessions across 2 phases. There was a substantial improvement in the tinnitus loudness, distress and depression scores which maintained for 3 months post-treatment. tDCS is a potential treatment for phantom perceptions (tinnitus) in cases of profound sensory neural hearing loss where there is no residual sensory ability. Tailor-made approaches seem to be more appropriate until a standard protocol for tDCS in tinnitus is established.
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Affiliation(s)
- Harini Vasudevan
- Department of Speech and Hearing, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Hari Prakash Palaniswamy
- Department of Speech and Hearing, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College (KMC), Manipal, Karnataka, India
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15
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Partyka M, Neff P, Bacri T, Michels J, Weisz N, Schlee W. Gender differentiates effects of acoustic stimulation in patients with tinnitus. PROGRESS IN BRAIN RESEARCH 2021; 263:25-57. [PMID: 34243890 DOI: 10.1016/bs.pbr.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gender constitutes a major factor to consider when tailoring subtype-based therapies for tinnitus. Previous reports showed important differences between men and women concerning basic perceptual tinnitus characteristics (i.e., laterality, frequency, tinnitus loudness) as well as psychological reactions linked to this condition. Therapeutic approaches based on acoustic stimulation involve processes beyond a pure masking effect and consist of sound presentation temporarily altering or alleviating tinnitus perception via residual and/or lateral inhibition mechanisms. Presented stimuli may include pure tones, noise, and music adjusted to or modulated to filter out tinnitus pitch and therefore trigger reparative functional and structural changes in the auditory system. Furthermore, recent findings suggest that in tonal tinnitus, the presentation of pitch-adjusted sounds which were altered by a 10Hz modulation of amplitude was more efficient than unmodulated stimulation. In this paper, we investigate sex differences in the outcome of different variants of acoustic stimulation, looking for factors revealing predictive value in the efficiency of tinnitus relief.
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Affiliation(s)
- Marta Partyka
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Patrick Neff
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria; University of Zurich, Zurich, Switzerland
| | - Timothée Bacri
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Jakob Michels
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Nathan Weisz
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Winfried Schlee
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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16
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Rashidi S, Jones M, Murillo-Rodriguez E, Machado S, Hao Y, Yadollahpour A. Transcranial direct current stimulation for auditory verbal hallucinations: a systematic review of clinical trials. Neural Regen Res 2021; 16:666-671. [PMID: 33063718 PMCID: PMC8067931 DOI: 10.4103/1673-5374.295315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/14/2019] [Accepted: 06/28/2020] [Indexed: 12/14/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been reportedly beneficial for different neurodegenerative disorders. tDCS has been reported as a potential adjunctive or alternative treatment for auditory verbal hallucination (AVH). This study aims to review the effects of tDCS on AVH in patients with schizophrenia through combining the evidence from randomized clinical trials (RCTs). The databases of PsycINFO (2000-2019), PubMed (2000-2019), EMBASE (2000-2019), CINAHL (2000-2019), Web of Science (2000-2019), and Scopus (2000-2019) were systematically searched. The clinical trials with RCT design were selected for final analysis. A total of nine RCTs were eligible and included in the review. Nine RCTs were included in the final analysis. Among them, six RCTs reported a significant reduction of AVH after repeated sessions of tDCS, whereas three RCTs did not show any advantage of active tDCS over sham tDCS. The current studies showed an overall decrease of approximately 28% of AVH after active tDCS and 10% after sham tDCS. The tDCS protocols targeting the sensorimotor frontal-parietal network showed greater treatment effects compared with the protocols targeting other regions. In this regard, cathodal tDCS over the left temporoparietal area showed inhibitory effects on AVHs. The most effective tDCS protocol on AVHs was twice-daily sessions (2 mA, 20-minute duration) over 5 consecutive days (10 sessions) with the anode over the left dorsolateral prefrontal cortex and the cathode over the left temporal area. Some patient-specific and disease-specific factors such as young age, nonsmoking status, and higher frequencies of AVHs seemed to be the predictors of treatment response. Taken together, the results of tDCS as an alternative treatment option for AVH show controversy among current literatures, since not all studies were positive. However, the studies targeting the same site of the brain showed that the tDCS could be a promising treatment option to reduce AVH. Further RCTs, with larger sample sizes, should be conducted to reach a conclusion on the efficacy of tDCS for AVH and to develop an effective therapeutic protocol for clinical setting.
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Affiliation(s)
- Samaneh Rashidi
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Myles Jones
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Eric Murillo-Rodriguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Yucatán, México
| | - Sergio Machado
- Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University, Niterói, Brazil
| | - Youguo Hao
- Department of Rehabilitation, Shanghai Putuo People's Hospital, Shanghai, China
| | - Ali Yadollahpour
- Department of Psychology, University of Sheffield, Sheffield, UK
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17
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Labree B, Hoare DJ, Gascoyne LE, Sereda M. Determining the effects of transcranial direct current stimulation on tinnitus and tinnitus-related outcomes: protocol for a systematic review. BMJ Open 2021; 11:e047191. [PMID: 33771831 PMCID: PMC8006855 DOI: 10.1136/bmjopen-2020-047191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Tinnitus is the awareness of a sound in the ear or head in the absence of an external source. It affects around 10%-15% of people. About 20% of people with tinnitus also experience symptoms such as depression or anxiety that negatively affect their life. Transcranial direct current stimulation (tDCS) is a technique involving constant low-intensity direct current delivered via electrodes on the head. It is postulated to modulate (suppress or enhance) neural activity in the region between electrodes. As such, it represents a potential treatment option for tinnitus, as well as comorbid depression or anxiety. This systematic review will estimate the effects of tDCS on outcomes relevant to tinnitus. In addition, it will determine whether there is any relationship between stimulation parameters (electrode montage, current intensity, and length and frequency of stimulation sessions) and the effect of tDCS on these outcomes. METHODS AND ANALYSIS Electronic searches for peer-reviewed journal articles will be performed in the Cochrane Register of Studies online (the Cochrane Ear, Nose and Throat Disorders Group Register and CENTRAL, current issue), PubMed, EMBASE, CINAHL, LILACS, KoreaMed, IndMed, PakMediNet, CNKI, AMED, PsycINFO, Web of Science, ClinicalTrials.gov, ICTRP and Google Scholar using the following search terms: transcranial Direct Current Stimulation OR tDCS AND tinnitus OR depression OR anxiety OR quality of life OR adverse effects OR neurophys*.Searches were not limited by date. Methods are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Randomised controlled trials will be included if they report at least one of the following outcomes: tinnitus symptom severity, anxiety or depression as measured by relevant validated instruments. Where available, data on quality of life, adverse effects and neurophysiological changes will also be reviewed. In addition to an analysis of the effect of each parameter, an analysis will be performed to uncover any interactions between parameters. Where appropriate, meta-analyses will be performed. ETHICS AND DISSEMINATION This systematic review will make use of secondary data only. As no data will be obtained from participants directly, ethical approval has not been sought. No other ethical issues are foreseen. Findings will be submitted for peer-reviewed publication and presented at academic conferences. The results of this review will inform future research. PROSPERO REGISTRATION NUMBER CRD42020185567.
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Affiliation(s)
- Bas Labree
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Derek J Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Lauren E Gascoyne
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
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18
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Kreuzer PM, Poeppl TB, Vielsmeier V, Schecklmann M, Langguth B, Lehner A. The more the merrier? Preliminary results regarding treatment duration and stimulation frequency of multisite repetitive transcranial magnetic stimulation in chronic tinnitus. PROGRESS IN BRAIN RESEARCH 2021; 262:287-307. [PMID: 33931185 DOI: 10.1016/bs.pbr.2021.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The current study examines two different protocols of repetitive transcranial magnetic stimulation (rTMS) targeting three key hubs of cortical tinnitus networks. Patients chose whether they preferred to undergo rTMS treatment for 10 or 20 sessions and were randomized to the different rTMS protocols thereafter. Ninety patients were enrolled in the study with a total dropout rate of 10%. Both rTMS protocols were well tolerated by the patients without any serious adverse events. Overall treatment effects were small both for 2 weeks and 4 weeks of treatment. There was no significant interaction effect between measurement time point and treatment group for neither of the outcome measures nor any differences regarding the applied treatment regimens. The effects of this study contradict former observations suggesting multisite rTMS protocols as promising neuromodulatory strategies. This lack of effect could not be enhanced by increasing the number of treatment sessions in our study.
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Affiliation(s)
- Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - Timm B Poeppl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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19
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Comparison of Treatment Outcome between Repetitive Transcranial Magnetic Stimulation (rTMS) and Transcutaneous Direct Current Stimulation (tDCS) in Intractable Tinnitus. J Clin Med 2021; 10:jcm10040635. [PMID: 33562396 PMCID: PMC7916028 DOI: 10.3390/jcm10040635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) and transcutaneous direct current stimulation (tDCS) are non-invasive treatments for chronic tinnitus based on neuromodulation of cortical activity. Both are considered effective, but with heterogeneous results due to lack of established protocols. Because the target groups for both modalities overlap, it is difficult to recommend one of them. We tried to unify the inclusion criteria and treatment schedules to compare the two modalities. The medical charts of 36 patients who underwent rTMS as part of clinical routine were reviewed and data for 34 patients who underwent tDCS about 7 years later were collected prospectively. Both groups had chronic unilateral tinnitus refractory to medication. Patients were treated for 5 consecutive days, and tinnitus symptoms were evaluated by survey both at the end of the treatment schedule and 1 month after the treatment. The ratio of responders who showed >20% reduction in tinnitus handicap inventory scores were compared. At the end of the treatment, the rTMS group showed a rapid response compared to the tDCS group (rTMS, 30.6%; tDCS, 12.1%; p = 0.054). However, both groups showed a significant and similar reduction in tinnitus symptoms 1 month after the treatment (rTMS, 47.2%; tDCS, 36.4%; p = 0.618). As both groups showed comparable results for tinnitus reduction, tDCS may be superior in terms of cost-effectiveness.
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20
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Jacquemin L, Mertens G, Shekhawat GS, Van de Heyning P, Vanderveken OM, Topsakal V, De Hertogh W, Michiels S, Beyers J, Moyaert J, Van Rompaey V, Gilles A. High Definition transcranial Direct Current Stimulation (HD-tDCS) for chronic tinnitus: Outcomes from a prospective longitudinal large cohort study. PROGRESS IN BRAIN RESEARCH 2021; 263:137-152. [PMID: 34243886 DOI: 10.1016/bs.pbr.2020.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) aims to induce cortical plasticity by modulating the activity of brain structures. The broad stimulation pattern, which is one of the main limitations of tDCS, can be overcome with the recently developed technique called High-Definition tDCS (HD-tDCS). OBJECTIVE Investigation of the effect of HD-tDCS on tinnitus in a large patient cohort. METHODS This prospective study included 117 patients with chronic, subjective, non-pulsatile tinnitus who received six sessions of anodal HD-tDCS of the right Dorsolateral Prefrontal Cortex (DLPFC). Therapy effects were assessed by use of a set of standardized tinnitus questionnaires filled out at the pre-therapy (Tpre), post-therapy (T3w) and follow-up visit (T10w). Besides collecting the questionnaire data, the perceived effect (i.e., self-report) was also documented at T10w. RESULTS The Tinnitus Functional Index (TFI) and Tinnitus Questionnaire (TQ) total scores improved significantly over time (pTFI<0.01; pTQ<0.01), with the following significant post hoc comparisons: Tpre vs. T10w (pTFI<0.05; pTQ<0.05) and T3w vs. T10w (pTFI<0.01; pTQ<0.01). The percentage of patients reporting an improvement of their tinnitus at T10w was 47%. Further analysis revealed a significant effect of gender with female patients showing a larger improvement on the TFI and TQ (pTFI<0.01; pTQ<0.05). CONCLUSIONS The current study reported the effects of HD-tDCS in a large tinnitus population. HD-tDCS of the right DLPFC resulted in a significant improvement of the tinnitus perception, with a larger improvement for the female tinnitus patients.
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Affiliation(s)
- Laure Jacquemin
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.
| | - Griet Mertens
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Giriraj Singh Shekhawat
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Ear Institute, University College London, London, United Kingdom; Tinnitus Research Initiative, Regensburg, Germany
| | - Paul Van de Heyning
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Olivier M Vanderveken
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Vedat Topsakal
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Sarah Michiels
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Jolien Beyers
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Julie Moyaert
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Annick Gilles
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium; Department of Education, Health & Social Work, University College Ghent, Ghent, Belgium
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Riffle TL, Martel DT, Jones GR, Shore SE. Bimodal Auditory Electrical Stimulation for the Treatment of Tinnitus: Preclinical and Clinical Studies. Curr Top Behav Neurosci 2021; 51:295-323. [PMID: 33083999 PMCID: PMC8058117 DOI: 10.1007/7854_2020_180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tinnitus, or the phantom perception of sound, arises from pathological neural activity. Neurophysiological research has shown increased spontaneous firing rates and synchronization along the auditory pathway correlate strongly with behavioral measures of tinnitus. Auditory neurons are plastic, enabling external stimuli to be utilized to elicit long-term changes to spontaneous firing and synchrony. Pathological plasticity can thus be reversed using bimodal auditory plus nonauditory stimulation to reduce tinnitus. This chapter discusses preclinical and clinical evidence for efficacy of bimodal stimulation treatments of tinnitus, with highlights on sham-controlled, double-blinded clinical trials. The results from these studies have shown some efficacy in reducing the severity of tinnitus, based on subjective and objective outcome measures including tinnitus questionnaires and psychophysical tinnitus measurements. While results of some studies have been positive, the degree of benefit and the populations that respond to treatment vary across the studies. Directions and implications of future studies are discussed.
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Affiliation(s)
- Travis L Riffle
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - David T Martel
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Gerilyn R Jones
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Susan E Shore
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.
- Kresge Hearing Research Institute, Ann Arbor, MI, USA.
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Abstract
The pathophysiological mechanisms that underlie the generation and maintenance of tinnitus are being unraveled progressively. Based on this knowledge, a large variety of different neuromodulatory interventions have been developed and are still being designed, adapting to the progressive mechanistic insights in the pathophysiology of tinnitus. rTMS targeting the temporal, temporoparietal, and the frontal cortex has been the mainstay of non-invasive neuromodulation. Yet, the evidence is still unclear, and therefore systematic meta-analyses are needed for drawing conclusions on the effectiveness of rTMS in chronic tinnitus. Different forms of transcranial electrical stimulation (tDCS, tACS, tRNS), applied over the frontal and temporal cortex, have been investigated in tinnitus patients, also without robust evidence for universal efficacy. Cortex and deep brain stimulation with implanted electrodes have shown benefit, yet there is insufficient data to support their routine clinical use. Recently, bimodal stimulation approaches have revealed promising results and it appears that targeting different sensory modalities in temporally combined manners may be more promising than single target approaches.While most neuromodulatory approaches seem promising, further research is required to help translating the scientific outcomes into routine clinical practice.
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Souza DDS, Almeida AA, Andrade SMDS, Machado DGDS, Leitão M, Sanchez TG, Rosa MRDD. Transcranial direct current stimulation improves tinnitus perception and modulates cortical electrical activity in patients with tinnitus: A randomized clinical trial. Neurophysiol Clin 2020; 50:289-300. [PMID: 32863109 DOI: 10.1016/j.neucli.2020.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study aims to determine whether transcranial direct current stimulation (tDCS): a) is effective in the treatment of tinnitus by decreasing its annoyance and severity; b) modulates the cortical electrical activity of such individuals. METHODS A double-blind, placebo-controlled clinical trial was conducted with 24 patients with tinnitus, randomized into two groups: Group 1 (n = 12) received anodal tDCS over the left temporoparietal area (LTA) and cathodal tDCS over the right dorsolateral prefrontal cortex (DLPFC) and Group 2 (n = 12) received placebo intervention. Tinnitus perception using a visual analog scale (VAS) and the Tinnitus Handicap Inventory (THI) questionnaire, in addition to electroencephalogram (EEG) was measured with eyes opened and closed at baseline and after the intervention. For the treatment, patients were subjected to five consecutive sessions of tDCS with the anodal electrode over the LTA and cathodal electrode over the right DLPFC (7 × 5 cm, 2 mA for 20 min). tDCS was turned off after 30 s in the sham group. RESULTS Active tDCS significantly improved tinnitus annoyance and severity. It was associated with decreased beta and theta EEG frequency bands with eyes opened and decreased alpha frequency with eyes closed. sLORETA identified changes in frequency bands in the frontal, temporoparietal, and limbic regions. Finally, there were negative correlations between baseline EEG frequency bands and tDCS-induced change in tinnitus annoyance and severity. CONCLUSIONS These results demonstrate that tDCS modulates the EEG activity and alleviates tinnitus perception. This effect may be related to baseline EEG activity.
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Affiliation(s)
- Dayse da Silva Souza
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil.
| | - Alexandre Alex Almeida
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil
| | | | | | - Márcio Leitão
- Department of Classical and Vernacular Letters, Federal University of Paraíba, Brazil
| | - Tanit Ganz Sanchez
- University of São Paulo School of Medicine, São Paulo, Brazil; Ganz Sanches Institute of Integrated Otorhinolaryngology, São Paulo, Brazil
| | - Marine Raquel Diniz da Rosa
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil.
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24
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Langguth B. Non-Invasive Neuromodulation for Tinnitus. J Audiol Otol 2020; 24:113-118. [PMID: 32575951 PMCID: PMC7364190 DOI: 10.7874/jao.2020.00052] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/11/2020] [Indexed: 12/14/2022] Open
Abstract
Tinnitus is a prevalent disorder that has no cure currently. Within the last two decades, neuroscientific research has facilitated a better understanding of the pathophysiological mechanisms that underlie the generation and maintenance of tinnitus, and the brain and nerves have been identified as potential targets for its treatment using non-invasive brain stimulation methods. This article reviews studies on tinnitus patients using transcranial magnetic stimulation, transcranial electrical stimulation, such as transcranial direct current stimulation, alternating current stimulation, transcranial random noise stimulation as well as transcutaneous vagus nerve stimulation and bimodal combined auditory and somatosensory stimulation. Although none of these approaches has demonstrated effects that would justify its use in routine treatment, the studies have provided important insights into tinnitus pathophysiology. Moreover bimodal stimulation, which has only been developed recently, has shown promising results in pilot trials and is a candidate for further development into a valuable treatment procedure.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry, Psychotherapy, and Interdisciplinary Tinnitus Center, University of Regensburg, Regensburg, Germany
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25
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Elyssa Kok T, Schaette R, Shekhawat GS. Impact of tDCS and HD-tDCS on tinnitus perception: A scoping review. PROGRESS IN BRAIN RESEARCH 2020; 262:225-244. [PMID: 33931181 DOI: 10.1016/bs.pbr.2020.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tinnitus is the auditory phantom perception of a sound that severely affects the quality of life of over 300,000 people in the United Kingdom alone. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation tool, which has been investigated as a potential tinnitus management option since 2006. This study aimed to investigate the impact of tDCS and high-definition transcranial direct current stimulation (HD-tDCS) on tinnitus perception. A scoping review was undertaken using the framework by Arksey and O'malley (2005). After consideration of relevance, 38 primary research studies were included in the data charting to examine the impact of (HD-)tDCS on tinnitus. Twenty-two of the primary research studies reported significant therapeutic effects of (HD)-tDCS on tinnitus perception. However, only eight of these included a sham-control condition. The tDCS protocols in the studies were highly heterogeneous and sample sizes were generally small. More double-blind, sham-controlled trials are needed that use similar protocols and outcome measures before definitive conclusions about the efficacy of (HD-)tDCS for tinnitus can be drawn.
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Affiliation(s)
- Tori Elyssa Kok
- Ear Institute, University College London, London, United Kingdom
| | - Roland Schaette
- Ear Institute, University College London, London, United Kingdom
| | - Giriraj Singh Shekhawat
- Ear Institute, University College London, London, United Kingdom; Tinnitus Research Initiative, Regensburg, Germany.
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26
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Van der Wal A, Luyten T, Cardon E, Jacquemin L, Vanderveken OM, Topsakal V, Van de Heyning P, De Hertogh W, Van Looveren N, Van Rompaey V, Michiels S, Gilles A. Sex Differences in the Response to Different Tinnitus Treatment. Front Neurosci 2020; 14:422. [PMID: 32477049 PMCID: PMC7235341 DOI: 10.3389/fnins.2020.00422] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Tinnitus is a complex symptom requiring a thorough multidisciplinary assessment to construct an individual’s tinnitus profile. The Antwerp University Hospital hosts a tertiary tinnitus clinic providing intensive, multidisciplinary tinnitus care in the form of combinational psychological treatment with either Tinnitus Retraining Therapy (TRT)/Cognitive Behavioral Therapy (CBT) or TRT/eye movement desensitization and reprocessing therapy (EMDR), high-definition transcranial direct current stimulation (HD-tDCS), and physical therapy treatment (in cases of somatic influence of the neck or the temporomandibular area). Several factors may contribute to therapy effect of which the role of gender has recently gained more interest. As such, the current manuscript explores gender differences in the outcome of different tinnitus treatments. Methods Data on treatment outcome of four distinct tinnitus treatments (1. HD-tDCS; 2. orofacial physical therapy; 3. combination TRT + CBT; and 4. combination TRT + EMDR) were pooled and compared. Treatment outcome was assessed via the Tinnitus Functional Index (TFI). Participants completed the TFI at baseline, immediately after treatment and after 9 weeks (±3 weeks) follow-up. To explore the effect of gender on different treatment outcomes, a linear mixed model was designed including Time point, Gender, and Therapy Group as fixed factors as well as all interactions between these factors. Results TFI scores improved significantly over time regardless of therapy group (p < 0.0001). A mean TFI decrease of at least 13 points was obtained by all participants except by those in the HD-tDCS. Significant interactions between Gender and Time point were identified in all groups except for the TRT +EMDR group. Female subjects improved more extensively than males in the HD-tDCS (p = 0.0009) and orofacial therapy group (p = 0.0299). Contrarily, in the TRT +CBT group, male participants showed a significant improvement whereas the mean TFI scores of female subjects remained on baseline levels (p = 0.0138). Conclusion Our data suggest that male and female tinnitus patients seem to react differently to different therapy options. We strongly encourage further prospective studies to discern the relevance of gender in therapy outcome.
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Affiliation(s)
- Annemarie Van der Wal
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Antwerp University, Antwerp, Belgium
| | - Tine Luyten
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium
| | - Emilie Cardon
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium
| | - Laure Jacquemin
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium
| | - Olivier M Vanderveken
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium
| | - Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Antwerp University, Antwerp, Belgium
| | | | - Vincent Van Rompaey
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium
| | - Sarah Michiels
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Antwerp University, Antwerp, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Antwerp University, Antwerp, Belgium.,Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
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27
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Lumsden SC, Clarkson AN, Cakmak YO. Neuromodulation of the Pineal Gland via Electrical Stimulation of Its Sympathetic Innervation Pathway. Front Neurosci 2020; 14:264. [PMID: 32300290 PMCID: PMC7145358 DOI: 10.3389/fnins.2020.00264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/09/2020] [Indexed: 12/11/2022] Open
Abstract
Stimulation of the pineal gland via its sympathetic innervation pathway results in the production of N-acetylserotonin and melatonin. Melatonin has many therapeutic roles and is heavily implicated in the regulation of the sleep-wake cycle. In addition, N-acetylserotonin has recently been reported to promote neurogenesis in the brain. Upregulation of these indoleamines is possible via neuromodulation of the pineal gland. This is achieved by electrical stimulation of structures or fibres in the pineal gland sympathetic innervation pathway. Many studies have performed such pineal neuromodulation using both invasive and non-invasive methods. However, the effects of various experimental variables and stimulation paradigms has not yet been reviewed and evaluated. This review summarises these studies and presents the optimal experimental protocols and stimulation parameters necessary for maximal upregulation of melatonin metabolic output.
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Affiliation(s)
- Susannah C. Lumsden
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Brain Health Research Centre, Dunedin, New Zealand
| | - Andrew N. Clarkson
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Brain Research New Zealand, Dunedin, New Zealand
- Medical Technologies Centre of Research Excellence, Auckland, New Zealand
| | - Yusuf Ozgur Cakmak
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Brain Health Research Centre, Dunedin, New Zealand
- Medical Technologies Centre of Research Excellence, Auckland, New Zealand
- Centre for Health Systems and Technology, Dunedin, New Zealand
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28
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Mohsen S, Pourbakht A, Farhadi M, Mahmoudian S. The efficacy and safety of multiple sessions of multisite transcranial random noise stimulation in treating chronic tinnitus. Braz J Otorhinolaryngol 2019; 85:628-635. [PMID: 30528654 PMCID: PMC9443048 DOI: 10.1016/j.bjorl.2018.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/24/2018] [Accepted: 05/21/2018] [Indexed: 01/15/2023] Open
Abstract
Introduction Objective Methods Results Conclusions
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29
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Zheng W, Peng Z, Pengfei Z, Jing L, Heyu D, Hongxia Y, Yawen L, Zhengyu Z, Shusheng G, Zhenghan Y, Han L, Zhenchang W. Long-term reactions to pulsatile tinnitus are marked by weakened short-range functional connectivity within a brain network in the right temporal lobe. J Magn Reson Imaging 2018; 49:1629-1637. [PMID: 30575157 DOI: 10.1002/jmri.26545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There have been recent efforts to characterize brain functional activity features in patients with pulsatile tinnitus (PT). These efforts have revealed evidence of aberrant functional connectivity (FC) of the right middle temporal gyrus (MTG) in PT patients with prolonged disease duration. PURPOSE To assess the possible predictive effect of aberrant FC of MTG in PT patients with prolonged disease duration. STUDY TYPE Retrospective. POPULATION Thirty-four patients with recent-onset PT (RPTIN), 24 patients with long-term PT (LPTIN), and 35 age-, gender-, and education-matched healthy controls were enrolled. FIELD STRENGTH/SEQUENCE 3.0T MRI system and echo-planar imaging (EPI) sequence, 3D brain volume imaging (BRAVO) sequence. ASSESSMENT Functional MRI data preprocessing was performed in Data Processing & Analysis for Brain Imaging (DPABI) and Statistical Parametric Mapping (SPM) 8. The FC analyses were conducted using the software REST. STATISTICAL TESTS One-way analysis of covariance was conducted between three groups with age and gender as covariates, and post-hoc analysis was used to identify the sources of group effects. Pearson's correlation analysis was conducted for the z-values of altered FC strength in the PT group and the clinical data. RESULTS Among hubs belonging to the executive control network, the default mode network (DMN), and limbic network, the strength of FC was mainly decreased in the patient groups compared with normal controls (P < 0.05). Relative to RPTIN patients and normal controls, LPTIN patients were further characterized by significantly decreased FC between several short-range brain regions adjacent to the seed (P < 0.05). Finally, disease duration was negatively correlated with decreased FC between the seed and right fusiform gyrus/parahippocampal gyrus, right inferior frontal gyrus, and right MTG (a brain area adjacent to the seed region). DATA CONCLUSION Long-term reactions to PT mainly involved weakened short-range FC, especially within a functional network in the right temporal lobe. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Wang Zheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhang Peng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhao Pengfei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Li Jing
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Ding Heyu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Yin Hongxia
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Liu Yawen
- School of Biological Science and Medical Engineering, Beihang University, Beijing, P.R. China
| | - Zhang Zhengyu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Gong Shusheng
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Yang Zhenghan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Lv Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Wang Zhenchang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
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Haider HF, Bojić T, Ribeiro SF, Paço J, Hall DA, Szczepek AJ. Pathophysiology of Subjective Tinnitus: Triggers and Maintenance. Front Neurosci 2018; 12:866. [PMID: 30538616 PMCID: PMC6277522 DOI: 10.3389/fnins.2018.00866] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/06/2018] [Indexed: 01/07/2023] Open
Abstract
Tinnitus is the conscious perception of a sound without a corresponding external acoustic stimulus, usually described as a phantom perception. One of the major challenges for tinnitus research is to understand the pathophysiological mechanisms triggering and maintaining the symptoms, especially for subjective chronic tinnitus. Our objective was to synthesize the published literature in order to provide a comprehensive update on theoretical and experimental advances and to identify further research and clinical directions. We performed literature searches in three electronic databases, complemented by scanning reference lists from relevant reviews in our included records, citation searching of the included articles using Web of Science, and manual searching of the last 6 months of principal otology journals. One-hundred and thirty-two records were included in the review and the information related to peripheral and central mechanisms of tinnitus pathophysiology was collected in order to update on theories and models. A narrative synthesis examined the main themes arising from this information. Tinnitus pathophysiology is complex and multifactorial, involving the auditory and non-auditory systems. Recent theories assume the necessary involvement of extra-auditory brain regions for tinnitus to reach consciousness. Tinnitus engages multiple active dynamic and overlapping networks. We conclude that advancing knowledge concerning the origin and maintenance of specific tinnitus subtypes origin and maintenance mechanisms is of paramount importance for identifying adequate treatment.
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Affiliation(s)
- Haúla Faruk Haider
- ENT Department, Hospital Cuf Infante Santo - NOVA Medical School, Lisbon, Portugal
| | - Tijana Bojić
- Laboratory of Radiobiology and Molecular Genetics, Vinča Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Sara F Ribeiro
- ENT Department, Hospital Cuf Infante Santo - NOVA Medical School, Lisbon, Portugal
| | - João Paço
- ENT Department, Hospital Cuf Infante Santo - NOVA Medical School, Lisbon, Portugal
| | - Deborah A Hall
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,University of Nottingham Malaysia, Semeniyh, Malaysia
| | - Agnieszka J Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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31
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Yuan T, Yadollahpour A, Salgado-Ramírez J, Robles-Camarillo D, Ortega-Palacios R. Transcranial direct current stimulation for the treatment of tinnitus: a review of clinical trials and mechanisms of action. BMC Neurosci 2018; 19:66. [PMID: 30359234 PMCID: PMC6202858 DOI: 10.1186/s12868-018-0467-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/23/2018] [Indexed: 12/27/2022] Open
Abstract
Background Tinnitus is the perception of sound in the absence of any external acoustic stimulation. Transcranial direct current stimulation (tDCS) has shown promising though heterogeneous therapeutic outcomes for tinnitus. The present study aims to review the recent advances in applications of tDCS for tinnitus treatment. In addition, the clinical efficacy and main mechanisms of action of tDCS on suppressing tinnitus are discussed. Methods The study was performed in accordance with the PRISMA guidelines. The databases of the PubMed (1980–2018), Embase (1980–2018), PsycINFO (1850–2018), CINAHL, Web of Science, BIOSIS Previews (1990–2018), Cambridge Scientific Abstracts (1990–2018), and google scholar (1980–2018) using the set search terms. The date of the most recent search was 20 May, 2018. The randomized controlled trials that have assessed at least one therapeutic outcome measured before and after tDCS intervention were included in the final analysis. Results Different tDCS protocols were used for tinnitus ranging single to repeated sessions (up to 10) consisting of daily single session of 15 to 20-min and current intensities ranging 1–2 mA. Dorsolateral prefrontal cortex (DLPFC) and auditory cortex are the main targets of stimulation. Both single and repeated sessions showed moderate to significant treatment effects on tinnitus symptoms. In addition to improvements in tinnitus symptoms, the tDCS interventions particularly bifrontal DLPFC showed beneficial outcomes on depression and anxiety comorbid with tinnitus. Heterogeneities in the type of tinnitus, tDCS devices, protocols, and site of stimulation made the systematic reviews of the literature difficult. However, the current evidence shows that tDCS can be developed as an adjunct or complementary treatment for intractable tinnitus. TDCS may be a safe and cost-effective treatment for tinnitus in the short-term application. Conclusions The current literature shows moderate to significant therapeutic efficacy of tDCS on tinnitus symptoms. Further randomized placebo-controlled double-blind trials with large sample sizes are needed to reach a definitive conclusion on the efficacy of tDCS for tinnitus. Future studies should further focus on developing efficient disease- and patient-specific protocols.
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Affiliation(s)
- Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Ali Yadollahpour
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd, Ahvaz, 61357-33118, Iran.
| | - Julio Salgado-Ramírez
- Biomedical Engineering Department, Polytechnic University of Pachuca, Zempoala, Mexico
| | | | - Rocío Ortega-Palacios
- Biomedical Engineering Department, Polytechnic University of Pachuca, Zempoala, Mexico
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Yadollahpour A, Mayo M, Saki N, Rashidi S, Bayat A. A chronic protocol of bilateral transcranial direct current stimulation over auditory cortex for tinnitus treatment: Dataset from a double-blinded randomized controlled trial. F1000Res 2018; 7:733. [PMID: 30356442 PMCID: PMC6178906 DOI: 10.12688/f1000research.14971.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 11/30/2022] Open
Abstract
Preliminary studies have demonstrated the therapeutic potential of transcranial direct current stimulation (tDCS) for chronic tinnitus. However, the findings are controversial and most of the studies investigated effects of a single session of tDCS and short after-effects, ranging from hours to days. To our knowledge, there is no published study investigating the effects of a chronic protocol of bilateral tDCS over auditory cortex (AC) with one month follow-up in a double blinded randomized clinical trial. This dataset presents the results of a double-blinded placebo controlled trial investigating the effects of chronic protocol (10 sessions) of tDCS over AC with 1 month follow-up. The data of the two groups, real tDCS (n=25) and sham tDCS (n=15), are reported. The dataset includes three main data groups: patient- and tinnitus-specific data, data of the primary and secondary outcomes, and data on the adverse effects of and tolerability to tDCS. The first group includes demographic information, audiometric assessments, and tinnitus-specific characteristics. The second group includes tinnitus handicap inventory (THI) scores, tinnitus loudness, and tinnitus related distress based on 0-10 numerical visual analogue scale (VAS) scores. The values of the primary and secondary outcomes for pre-intervention and at different time points following interventions are presented. THI scores pre-intervention and immediately post-intervention and at 1 month follow-up; the scores of tinnitus loudness and distress scores for pre-intervention, and immediately, 1 hour, 1 week, and at 1 month after the last stimulation session are presented. Moreover, the adverse effects of and tolerability to the tDCS were assessed using a customized questionnaire after the last tDCS session. This dataset can be used alone or in combination with other datasets using advanced statistical analyses and modeling to investigate the treatment efficacy of tDCS in chronic intractable tinnitus.
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Affiliation(s)
- Ali Yadollahpour
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Miguel Mayo
- Department of Otorhinolaryngology, A Coruña University Hospital Complex, A Coruña, Spain
| | - Nader Saki
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samaneh Rashidi
- Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arash Bayat
- Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Shekhawat GS, Vanneste S. Optimization of Transcranial Direct Current Stimulation of Dorsolateral Prefrontal Cortex for Tinnitus: A Non-Linear Dose-Response Effect. Sci Rep 2018; 8:8311. [PMID: 29844532 PMCID: PMC5974180 DOI: 10.1038/s41598-018-26665-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 05/09/2018] [Indexed: 01/23/2023] Open
Abstract
Neuromodulation is defined as the process of augmenting neuroplasticity via invasive or non-invasive methods. Tinnitus is the perception of sound in the absence of its external source. The objective of this study was to optimize the parameters of transcranial direct current stimulation (tDCS) of dorsolateral prefrontal cortex (DLPFC) for tinnitus suppression. The following factors were optimized in the dose-response design (n = 111): current intensity (1.5 mA or 2 mA), stimulation duration (20 min or 30 min), and number of stimulation sessions (2, 4, 6, 8, or 10), with a 3-4 day washout period between each session. Participants underwent a minimum of 2 sessions in 1 week or maximum of 10 sessions in 5 weeks' time. Tinnitus loudness was measured in pre-post design using a 10-point numeric rating scale. There was a significant reduction in tinnitus loudness after tDCS of DLPFC. There was no significant difference between the intensity and duration of stimulation. As the number of sessions increased, there was a higher reduction in the tinnitus loudness; however, this effect plateaued after 6 sessions.
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Affiliation(s)
- Giriraj Singh Shekhawat
- Section of Audiology and Health Systems, University of Auckland, Auckland, New Zealand
- Center for Brain Research, University of Auckland, Auckland, New Zealand
- Tinnitus Research Initiative, Regensburg, Germany
| | - Sven Vanneste
- Lab for Clinical & Integrative Neuroscience, School of Behavioral and Brain Sciences, University of Texas, Dallas, USA.
- Center for Brain Health, University of Texas at Dallas, Richardson, TX, USA.
- Callier Center of Communication Disorders, University of Texas at Dallas, Richardson, TX, USA.
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To WT, De Ridder D, Hart J, Vanneste S. Changing Brain Networks Through Non-invasive Neuromodulation. Front Hum Neurosci 2018; 12:128. [PMID: 29706876 PMCID: PMC5908883 DOI: 10.3389/fnhum.2018.00128] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/19/2018] [Indexed: 01/10/2023] Open
Abstract
Background/Objective: Non-invasive neuromodulation techniques, such as repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS), have increasingly been investigated for their potential as treatments for neurological and psychiatric disorders. Despite widespread dissemination of these techniques, the underlying therapeutic mechanisms and the ideal stimulation site for a given disorder remain unknown. Increasing evidence support the possibility of non-invasive neuromodulation affecting a brain network rather than just the local stimulation target. In this article, we present evidence in a clinical setting to support the idea that non-invasive neuromodulation changes brain networks. Method: This article addresses the idea that non-invasive neuromodulation modulates brain networks, rather than just the local stimulation target, using neuromodulation studies in tinnitus and major depression as examples. We present studies that support this hypothesis from different perspectives. Main Results/Conclusion: Studies stimulating the same brain region, such as the dorsolateral prefrontal cortex (DLPFC), have shown to be effective for several disorders and studies using different stimulation sites for the same disorder have shown similar results. These findings, as well as results from studies investigating brain network connectivity on both macro and micro levels, suggest that non-invasive neuromodulation affects a brain network rather than just the local stimulation site targeted. We propose that non-invasive neuromodulation should be approached from a network perspective and emphasize the therapeutic potential of this approach through the modulation of targeted brain networks.
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Affiliation(s)
- Wing Ting To
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John Hart
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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Bayat A, Mayo M, Rashidi S, Saki N, Yadollahpour A. Repeated sessions of bilateral transcranial direct current stimulation on intractable tinnitus: a study protocol for a double-blind randomized controlled trial. F1000Res 2018; 7:317. [PMID: 29707203 PMCID: PMC5887075 DOI: 10.12688/f1000research.13558.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Transcranial Direct Current Stimulation (tDCS) is reportedly a potential treatment option for chronic tinnitus. The main drawbacks of previous studies are short term follow up and focusing on the efficacy of single session tDCS. This study aims to investigate the therapeutic efficacy, adverse effects (AEs) and tolerability of repeated sessions of bilateral tDCS over auditory cortex (AC) on tinnitus symptoms Methods: This will be a double-blinded randomized placebo controlled parallel trial on patients (n=90) with intractable chronic tinnitus (> 2 years) randomly divided into three groups of anodal, cathodal, and sham tDCS. In the sham treatment, after 30 sec the device will be turned OFF without informing the patients. The tDCS protocol consists of 10 sessions (daily 20 min session; 2 mA current for 5 consecutive days per week and 2 consecutive weeks) applied through 35 cm 2 electrodes. The primary outcome is tinnitus handicap inventory (THI) which will be assessed pre- and post-intervention and at one month follow-up. The secondary outcomes are tinnitus loudness and distress to be assessed using a visual analogue scale (VAS) pre-intervention, and immediately, one hour, one week, and one month after last stimulation. The AEs and tolerability of patients will be evaluated after each session using a customized questionnaire. Possible interactions between the disease features and treatment response will be evaluated. Discussion: To our knowledge this is the first study to investigate the effects of repeated sessions of tDCS on chronic tinnitus symptoms with one month follow-up. In addition, the AEs, and tolerability of patients will be studied. In addition, the possible interactions between the disease specific features including the hearing loss, laterality, type of tinnitus, and treatment response will be evaluated. Trial registration: The study has been registered as a clinical trial in Iranian Registry of Clinical Trial ( IRCT2016110124635N6) on the 01/06/2017.
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Affiliation(s)
- Arash Bayat
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61357-15794, Iran
| | - Miguel Mayo
- Department of Otorhinolaryngology, A Coruña University Hospital Complex, A Coruña, 15006, Spain
| | - Samaneh Rashidi
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61936-73111, Iran
| | - Nader Saki
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61357-15794, Iran
| | - Ali Yadollahpour
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61936-73111, Iran.,Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61357-33118, Iran
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Peter N, Kleinjung T. Neuromodulation for tinnitus treatment: an overview of invasive and non-invasive techniques. J Zhejiang Univ Sci B 2018; 20:116-130. [PMID: 29770647 DOI: 10.1631/jzus.b1700117] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Tinnitus is defined as a perception of sound without any external sound source. Chronic tinnitus is a frequent condition that can affect the quality of life. So far, no causal cure for tinnitus has been documented, and most pharmacologic and psychosomatic treatment modalities aim to diminish tinnitus' impact on the quality of life. Neuromodulation, a novel therapeutic modality, which aims at alternating nerve activity through a targeted delivery of a stimulus, has emerged as a potential option in tinnitus treatment. This review provides a brief overview of the current neuromodulation techniques as tinnitus treatment options. The main intention is to provide updated knowledge especially for medical professionals counselling tinnitus patients in this emerging field of medicine. Non-invasive methods such as repetitive transcranial magnetic stimulation, transcranial electrical stimulation, neurofeedback, and transcutaneous vagus nerve stimulation were included, as well as invasive methods such as implanted vagus nerve stimulation and invasive brain stimulation. Some of these neuromodulation techniques revealed promising results; nevertheless, further research is needed, especially regarding the pathophysiological principle as to how these neuromodulation techniques work and what neuronal change they induce. Various studies suggest that individually different brain states and networks are involved in the generation and perception of tinnitus. Therefore, in the future, individually tailored neuromodulation strategies could be a promising approach in tinnitus treatment for achieving a more substantial and longer lasting improvement of complaints.
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Affiliation(s)
- Nicole Peter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich 8091, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich 8091, Switzerland
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Santos ADHM, Santos APS, Santos HS, Silva ACD. The use of tDCS as a therapeutic option for tinnitus: a systematic review. Braz J Otorhinolaryngol 2018; 84:653-659. [PMID: 29573997 PMCID: PMC9452266 DOI: 10.1016/j.bjorl.2018.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Due to the subjectivity of the tinnitus diagnosis and its diverse etiologies, establishing an effective treatment is complex. In this context, transcranial direct current stimulation, a noninvasive option, is available for most patients and has shown good results in the treatment of other symptoms such as chronic pain. Objective To evaluate the therapeutic response of tinnitus to transcranial direct current stimulation. Methods A systematic review of the literature was performed using the following descriptors: tinnitus, transcranial direct current stimulation and randomized clinical trial. The research was carried out in the MEDLINE/PUBMED, Lilacs, and Scielo databases. The inclusion criteria were: patients over 18 years of age with no associated comorbidities, who had a diagnosis established by a specialist or through the application of previously validated scales and criteria applied by a non-specialist physician. Results A total of 4165 studies were found, and a total of six were selected after the inclusion criteria were applied, obtaining a sample of 602 patients. Based on the defined criteria, there was a positive response to transcranial direct current stimulation in 14.86% of the participants. Conclusion Based on literature studied, there is no therapeutic response of tinnitus to transcranial direct current stimulation.
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Affiliation(s)
- Amanda Dos Humildes Maia Santos
- Escola Bahiana de Medicina e Saúde Pública, Medicina, Salvador, BA, Brazil; Pesquisa da Liga Acadêmica de Neurocirurgia, Salvador, BA, Brazil; Hospital Geral Roberto Santos, Neurocirurgia, Salvador, BA, Brazil; Grupo de Ensino e Pesquisa em Endocrinologia (GEPEN), Salvador, BA, Brazil; Linha de Pesquisa "Comportamento e Aprendizado Motor", Salvador, BA, Brazil; Grupo de Ensino em Neuroanatomia, Salvador, BA, Brazil.
| | - Afonso Paranhos Silva Santos
- Escola Bahiana de Medicina e Saúde Pública, Medicina, Salvador, BA, Brazil; Linha de Pesquisa "Comportamento e Aprendizado Motor", Salvador, BA, Brazil; Grupo de Ensino em Neuroanatomia, Salvador, BA, Brazil
| | - Henrique Souza Santos
- Escola Bahiana de Medicina e Saúde Pública, Medicina, Salvador, BA, Brazil; Linha de Pesquisa "Comportamento e Aprendizado Motor", Salvador, BA, Brazil; Grupo de Ensino em Neuroanatomia, Salvador, BA, Brazil
| | - Adriana Campos da Silva
- Escola Bahiana de Medicina e Saúde Pública, Fisioterapia, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Gerontologia, Salvador, BA, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Ciências Morfológicas, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia (UFBA), Ciências da Saúde, Salvador, BA, Brazil
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Abtahi H, Okhovvat A, Heidari S, Gharagazarloo A, Mirdamadi M, Nilforoush MH, Ghazavi H. Effect of transcranial direct current stimulation on short-term and long-term treatment of chronic tinnitus. Am J Otolaryngol 2018; 39:94-96. [PMID: 29336898 DOI: 10.1016/j.amjoto.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/04/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was conducted to investigate the effectiveness of anodal and cathodal methods in reducing the intensity of tinnitus and to compare them with the control. METHODOLOGY This randomized double-blind clinical trial with case and control groups was conducted in Al-Zahra Hospital in Isfahan between 2015 and 2016. In this trial, 51 patients with tinnitus, for at least one year, were selected among those outpatients visiting the throat, nose and ear clinic within this period. Inclusion criteria were patients on electrical stimulation prohibition, with Ménière's disease, otosclerosis, chronic headache, and pulsatile tinnitus. Patients were randomly divided in three equal-sized groups: anodal stimulation group, cathodal stimulation group, and control group. The subjects received 20-min current stimulation (2 mA). Five subjects were selected from those with a significant difference between the stimulated states (anodal or cathodal) and/or control. They received weekly transcranial electrical stimulation for two months, and their long-term recovery from tinnitus was investigated. Data analysis was done with SPSS20. RESULTS Findings showed no significant between-groups difference in mean scores of tinnitus before the intervention (p = .68); whereas, this difference was significant immediately after the intervention (p = .02) and 1 h after it (p = .03). The mean score of tinnitus in the anodal stimulation group was significantly lower than the control; whereas, no significant difference was observed between the anodal and cathodal stimulation groups, and between the cathodal and control groups (p < .05). Findings also showed that the mean scores of tinnitus in two cathodal stimulation groups (p = .24) and control group (p = .62) were not significantly different at three different points of time; whereas, this score was significantly different in the anodal group at these time points (p = .01). CONCLUSION In conclusion, anodal stimulation was more effective than the cathodal and control stimulation in reducing the intensity of tinnitus in the short term.
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Affiliation(s)
- Hamidreza Abtahi
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Okhovvat
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somaiie Heidari
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azar Gharagazarloo
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Motahare Mirdamadi
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Nilforoush
- Communication Disorders Research Center, Rehabilitation Sciences Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Ghazavi
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
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Wang TC, Tyler RS, Chang TY, Chen JC, Lin CD, Chung HK, Tsou YA. Effect of Transcranial Direct Current Stimulation in Patients With Tinnitus: A Meta-Analysis and Systematic Review. Ann Otol Rhinol Laryngol 2017; 127:79-88. [PMID: 29192507 DOI: 10.1177/0003489417744317] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tang-Chuan Wang
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Richard S. Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Ta-Yuan Chang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Jui-Cheng Chen
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiung-Kwang Chung
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
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High-definition transcranial direct current stimulation of the dorsolateral prefrontal cortex for tinnitus modulation: a preliminary trial. J Neural Transm (Vienna) 2017; 125:163-171. [DOI: 10.1007/s00702-017-1808-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/31/2017] [Indexed: 11/27/2022]
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Rabau S, Shekhawat GS, Aboseria M, Griepp D, Van Rompaey V, Bikson M, Van de Heyning P. Comparison of the Long-Term Effect of Positioning the Cathode in tDCS in Tinnitus Patients. Front Aging Neurosci 2017; 9:217. [PMID: 28804455 PMCID: PMC5532430 DOI: 10.3389/fnagi.2017.00217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 06/21/2017] [Indexed: 01/30/2023] Open
Abstract
Objective: Transcranial direct current stimulation (tDCS) is one of the methods described in the literature to decrease the perceived loudness and distress caused by tinnitus. However, the main effect is not clear and the number of responders to the treatment is variable. The objective of the present study was to investigate the effect of the placement of the cathode on the outcome measurements. Methods: Patients considered for the trial were chronic non-pulsatile tinnitus patients with complaints for more than 3 months and a Tinnitus Functional Index (TFI) score that exceeded 25. The anode was placed on the right dorsolateral prefrontal cortex (DLPFC). In the first group-"bifrontal"-the cathode was placed on the left DLPFC, while in the second group-"shoulder"-the cathode was placed on the shoulder. Each patient received two sessions of tDCS weekly and eight sessions in total. Evaluations took place on the first visit for an ENT consultation, at the start of therapy, after eight sessions of tDCS and at the follow-up visit, which took place 84 days after the start of the therapy. Subjective outcome measures such as TFI, Visual Analog Scales (VAS) for loudness and percentage of consciousness of tinnitus were administered in every patient. Results: There was no difference in the results for tinnitus loudness and the distress experienced between the placement of the cathode on the left DLPFC or on the shoulder. In addition, no statistically significant overall effect was found between the four test points. However, up to 39.1% of the patients experienced a decrease in loudness, measured by the VAS for loudness. Moreover, 72% of those in the bifrontal group, but only 46.2% of those in the shoulder group reported some improvement in distress. Conclusion: While some improvement was noted, this was not statistically significant. Both electrode placements stimulated the right side of the hippocampus, which could be responsible for the effect found in both groups. Further research should rule out the placebo effect and investigate alternative electrode positions.
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Affiliation(s)
- Sarah Rabau
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University HospitalEdegem, Belgium.,Faculty of Medicine, Campus Drie Eiken, University of AntwerpAntwerp, Belgium
| | - Giriraj S Shekhawat
- Section of Audiology/Health Systems, University of AucklandAuckland, New Zealand.,Centre for Brain Research, University of AucklandAuckland, New Zealand.,Tinnitus Research InitiativeRegensburg, Germany
| | - Mohamed Aboseria
- Department of Biomedical Engineering, City College of New York, The City University of New YorkNew York, NY, United States
| | - Daniel Griepp
- Department of Biomedical Engineering, City College of New York, The City University of New YorkNew York, NY, United States
| | - Vincent Van Rompaey
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University HospitalEdegem, Belgium.,Faculty of Medicine, Campus Drie Eiken, University of AntwerpAntwerp, Belgium
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, The City University of New YorkNew York, NY, United States
| | - Paul Van de Heyning
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University HospitalEdegem, Belgium.,Faculty of Medicine, Campus Drie Eiken, University of AntwerpAntwerp, Belgium
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Kreuzer PM, Poeppl TB, Rupprecht R, Vielsmeier V, Lehner A, Langguth B, Schecklmann M. Individualized Repetitive Transcranial Magnetic Stimulation Treatment in Chronic Tinnitus? Front Neurol 2017; 8:126. [PMID: 28428769 PMCID: PMC5382205 DOI: 10.3389/fneur.2017.00126] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/16/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Prefrontal and temporo-parietal repetitive transcranial magnetic stimulation (rTMS) in patients suffering from chronic tinnitus have shown significant but only moderate effectiveness with high interindividual variability in treatment response. This open-label pilot study was designed to examine the general feasibility of an individualized fronto-temporal rTMS protocol and to explore what criteria are needed for a more detailed evaluation in randomized clinical studies. METHODS During the first session of a 2-week rTMS protocol, we applied different rTMS protocols to the left and right temporo-parietal and dorsolateral prefrontal cortex (DLPFC) in 25 tinnitus patients. Short trains of 1, 5, 10, and 20 Hz and continuous theta burst stimulation were applied, and patients were asked for immediate tinnitus reductions after each train. If a patient reported such improvements, rTMS treatment was applied over nine sessions with a combined protocol consisting of the most effective frontal and the most effective temporo-parietal stimulation protocol. Those patients who did not improve after the test session were treated with a standard prefrontal plus temporo-parietal protocol (20 Hz over left DLPFC + 1 Hz over temporo-parietal cortex). RESULTS Almost half of the patients (12 of 25) reported immediate tinnitus reductions during the test session. In this group, the mean pre- to post-treatment amelioration in the tinnitus questionnaire was higher (medium to high effect sizes) in contrast to the patients who did not respond to the test session. Treatment outcome remained stable over a follow-up period of 10 weeks. DISCUSSION Individualized rTMS was shown to be feasible and effective in chronic tinnitus. The results obtained from this study provide tentative evidence in support of an individualized rTMS treatment approach and might provide a basis for a "tailored" application of rTMS in tinnitus and other neuropsychiatric disorders.
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Affiliation(s)
- Peter M. Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Timm B. Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Veronika Vielsmeier
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
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Huang Y, Liu AA, Lafon B, Friedman D, Dayan M, Wang X, Bikson M, Doyle WK, Devinsky O, Parra LC. Measurements and models of electric fields in the in vivo human brain during transcranial electric stimulation. eLife 2017; 6:18834. [PMID: 28169833 PMCID: PMC5370189 DOI: 10.7554/elife.18834] [Citation(s) in RCA: 321] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 02/06/2017] [Indexed: 11/13/2022] Open
Abstract
Transcranial electric stimulation aims to stimulate the brain by applying weak electrical currents at the scalp. However, the magnitude and spatial distribution of electric fields in the human brain are unknown. We measured electric potentials intracranially in ten epilepsy patients and estimated electric fields across the entire brain by leveraging calibrated current-flow models. When stimulating at 2 mA, cortical electric fields reach 0.8 V/m, the lower limit of effectiveness in animal studies. When individual whole-head anatomy is considered, the predicted electric field magnitudes correlate with the recorded values in cortical (r = 0.86) and depth (r = 0.88) electrodes. Accurate models require adjustment of tissue conductivity values reported in the literature, but accuracy is not improved when incorporating white matter anisotropy or different skull compartments. This is the first study to validate and calibrate current-flow models with in vivo intracranial recordings in humans, providing a solid foundation to target stimulation and interpret clinical trials. DOI:http://dx.doi.org/10.7554/eLife.18834.001
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Affiliation(s)
- Yu Huang
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Anli A Liu
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Belen Lafon
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Daniel Friedman
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Michael Dayan
- Department of Neurology, Mayo Clinic, Rochester, United States
| | - Xiuyuan Wang
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Marom Bikson
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Werner K Doyle
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Lucas C Parra
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
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Hesse G. Evidence and evidence gaps in tinnitus therapy. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc04. [PMID: 28025604 PMCID: PMC5169077 DOI: 10.3205/cto000131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A nearly endless number of procedures has been tried and in particular sold for the treatment of tinnitus, unfortunately they have not been evaluated appropriately in an evidence-based way. A causal therapy, omitting the tinnitus still does not exist, actually it cannot exist because of the various mechanisms of its origin. However or perhaps because of that, medical interventions appear and reappear like fashion trends that can never be proven by stable and reliable treatment success. This contribution will discuss and acknowledge all current therapeutic procedures and the existing or non-existing evidence will be assessed. Beside external evidence, the term of evidence also encompasses the internal evidence, i.e. the experience of the treating physician and the patient's needs shall be included. While there is no evidence for nearly all direct procedures that intend modulating or stimulating either the cochlea or specific cervical regions such as the auditory cortex, there are therapeutic procedures that are acknowledged in clinical practice and have achieved at least a certain degree of evidence and generate measurable effect sizes. Those are in particular habituation therapy and psychotherapeutic measures, especially if they are combined with concrete measures for improved audio perception (hearing aids, CI, hearing therapies).
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Affiliation(s)
- Gerhard Hesse
- Tinnitus-Klinik, Bad Arolsen, Germany; University of Witten-Herdecke, Germany
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Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2016; 128:56-92. [PMID: 27866120 DOI: 10.1016/j.clinph.2016.10.087] [Citation(s) in RCA: 1034] [Impact Index Per Article: 129.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022]
Abstract
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
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The added value of auditory cortex transcranial random noise stimulation (tRNS) after bifrontal transcranial direct current stimulation (tDCS) for tinnitus. J Neural Transm (Vienna) 2016; 124:79-88. [PMID: 27761741 DOI: 10.1007/s00702-016-1634-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
Tinnitus is the perception of a sound in the absence of a corresponding external sound source. Research has suggested that functional abnormalities in tinnitus patients involve auditory as well as non-auditory brain areas. Transcranial electrical stimulation (tES), such as transcranial direct current stimulation (tDCS) to the dorsolateral prefrontal cortex and transcranial random noise stimulation (tRNS) to the auditory cortex, has demonstrated modulation of brain activity to transiently suppress tinnitus symptoms. Targeting two core regions of the tinnitus network by tES might establish a promising strategy to enhance treatment effects. This proof-of-concept study aims to investigate the effect of a multisite tES treatment protocol on tinnitus intensity and distress. A total of 40 tinnitus patients were enrolled in this study and received either bifrontal tDCS or the multisite treatment of bifrontal tDCS before bilateral auditory cortex tRNS. Both groups were treated on eight sessions (two times a week for 4 weeks). Our results show that a multisite treatment protocol resulted in more pronounced effects when compared with the bifrontal tDCS protocol or the waiting list group, suggesting an added value of auditory cortex tRNS to the bifrontal tDCS protocol for tinnitus patients. These findings support the involvement of the auditory as well as non-auditory brain areas in the pathophysiology of tinnitus and demonstrate the idea of the efficacy of network stimulation in the treatment of neurological disorders. This multisite tES treatment protocol proved to be save and feasible for clinical routine in tinnitus patients.
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Imaging transcranial direct current stimulation (tDCS) of the prefrontal cortex—correlation or causality in stimulation-mediated effects? Neurosci Biobehav Rev 2016; 69:333-56. [DOI: 10.1016/j.neubiorev.2016.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 02/03/2023]
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Hyvärinen P, Mäkitie A, Aarnisalo AA. Self-Administered Domiciliary tDCS Treatment for Tinnitus: A Double-Blind Sham-Controlled Study. PLoS One 2016; 11:e0154286. [PMID: 27124116 PMCID: PMC4849783 DOI: 10.1371/journal.pone.0154286] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/10/2016] [Indexed: 11/26/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has shown potential for providing tinnitus relief, although positive effects have usually been observed only during a short time period after treatment. In recent studies the focus has turned from one-session experiments towards multi-session treatment studies investigating long-term outcomes with double-blinded and sham-controlled study designs. Traditionally, tDCS has been administered in a clinical setting by a healthcare professional but in studies involving multiple treatment sessions, often a trade-off has to be made between sample size and the amount of labor needed to run the trial. Also, as the number of required visits to the clinic increases, the dropout rate is likely to rise proportionally.The aim of the current study was to find out if tDCS treatment for tinnitus could be patient-administered in a domiciliary setting and whether the results would be comparable to those from in-hospital treatment studies. Forty-three patients with chronic (> 6 months) tinnitus were involved in the study, and data on 35 out of these patients were included in final analysis. Patients received 20 minutes of left temporal area anodal (LTA) or bifrontal tDCS stimulation (2 mA) or sham stimulation (0.3 mA) for ten consecutive days. An overall reduction in the main outcome measure, Tinnitus Handicap Inventory (THI), was found (mean change −5.0 points, p < 0.05), but there was no significant difference between active and sham treatment outcomes. Patients found the tDCS treatment easy to administer and they all tolerated it well. In conclusion, self-administered domiciliary tDCS treatment for tinnitus was found safe and feasible and gave outcome results similar to recent randomized controlled long-term treatment trials. The results suggest better overall treatment response—as measured by THI—with domiciliary treatment than with in-hospital treatment, but this advantage is not related to the tDCS variant. The study protocol demonstrated in the current study is not restricted to tinnitus only.
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Affiliation(s)
- Petteri Hyvärinen
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki 1, P.O. Box 220, FI-00029 HUS, Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O. Box 12200, FI-00076 AALTO, Espoo, Finland
- * E-mail:
| | - Antti Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki 1, P.O. Box 220, FI-00029 HUS, Helsinki, Finland
| | - Antti A. Aarnisalo
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki 1, P.O. Box 220, FI-00029 HUS, Helsinki, Finland
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Heimrath K, Fiene M, Rufener KS, Zaehle T. Modulating Human Auditory Processing by Transcranial Electrical Stimulation. Front Cell Neurosci 2016; 10:53. [PMID: 27013969 PMCID: PMC4779894 DOI: 10.3389/fncel.2016.00053] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/18/2016] [Indexed: 12/31/2022] Open
Abstract
Transcranial electrical stimulation (tES) has become a valuable research tool for the investigation of neurophysiological processes underlying human action and cognition. In recent years, striking evidence for the neuromodulatory effects of transcranial direct current stimulation, transcranial alternating current stimulation, and transcranial random noise stimulation has emerged. While the wealth of knowledge has been gained about tES in the motor domain and, to a lesser extent, about its ability to modulate human cognition, surprisingly little is known about its impact on perceptual processing, particularly in the auditory domain. Moreover, while only a few studies systematically investigated the impact of auditory tES, it has already been applied in a large number of clinical trials, leading to a remarkable imbalance between basic and clinical research on auditory tES. Here, we review the state of the art of tES application in the auditory domain focussing on the impact of neuromodulation on acoustic perception and its potential for clinical application in the treatment of auditory related disorders.
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Affiliation(s)
| | | | | | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke University MagdeburgMagdeburg, Germany
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