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Azcona Ganuza G, Alegre M. Static magnetic stimulation of human auditory cortex: a feasibility study. Neuroreport 2022; 33:487-494. [PMID: 35767229 PMCID: PMC9245555 DOI: 10.1097/wnr.0000000000001809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
There is a growing interest about the effects of static transcranial magnetic stimulation (tSMS) over different cortical areas, being the motor cortex the most widely studied region. Previous experiments have shown that noninvasive magnetic static stimulation of the human brain may change its excitability in a reversible way for a period that outlasts the time of application of the magnetic field. However, evidence about the effects over the auditory cortex are poor and this is the purpose of the present study. Twelve voluntary subjects were studied in two different sessions, immediately before and 20 min after the placement of a magnet or a sham over the left primary auditory cortex, for 30 min. No significant effects of the magnet were observed on auditory responses, including onset and offset potentials and oscillatory responses to stimulus frequency modulation. A reduction in the amplitude of the cortical onset and offset potentials was observed after the two sessions, both with the magnet and with the false magnet (sham). No effects of unilateral static magnetic stimulation on cortical auditory responses have been observed. However, we probe the feasibility and tolerability of the protocol performed and suggest the use of different stimulation protocols.
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Affiliation(s)
- Gurutzi Azcona Ganuza
- Clinical Neurophysiology Section, Department of Neurology, Clínica Universidad de Navarra
- Clinical Neurophysiology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Manuel Alegre
- Clinical Neurophysiology Section, Department of Neurology, Clínica Universidad de Navarra
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2
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Noccaro A, Mioli A, D'Alonzo M, Pinardi M, Pino GD, Formica D. Development and Validation of a Novel Calibration Methodology and Control Approach for Robot-Aided Transcranial Magnetic Stimulation (TMS). IEEE Trans Biomed Eng 2021; 68:1589-1600. [PMID: 33513096 DOI: 10.1109/tbme.2021.3055434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This article presents the development and validation of a new robotic system for Transcranial Magnetic Stimulation (TMS), characterized by a new control approach, and an ad-hoc calibration methodology, specifically devised for the TMS application. METHODS The robotic TMS platform is composed of a 7 dof manipulator, controlled by an impedance control, and a camera-based neuronavigation system. The proposed calibration method was optimized on the workspace useful for the specific TMS application (spherical shell around the subject's head), and tested on three different hand-eye and robot-world calibration algorithms. The platform functionality was tested on six healthy subjects during a real TMS procedure, over the left primary motor cortex. RESULTS employing our method significantly decreases ( ) the calibration error by 34% for the position and 19% for the orientation. The robotic TMS platform achieved greater orientation accuracy than the expert operators, significantly reducing orientation errors by 46% ( ). No significant differences were found in the position errors and in the amplitude of the motor evoked potentials (MEPs) between the robot-aided TMS and the expert operators. CONCLUSION The proposed calibration represents a valid method to significantly reduce the calibration errors in robot-aided TMS applications. Results showed the efficacy of the proposed platform (including the control algorithm) in administering a real TMS procedure, achieving better coil positioning than expert operators, and similar results in terms of MEPs. SIGNIFICANCE This article spotlights how to improve the performance of a robotic TMS platform, providing a reproducible and low-cost alternative to the few devices commercially available.
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3
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Talluri S, Palaparthi SM, Michelogiannakis D, Khan J. Efficacy of photobiomodulation in the management of tinnitus: A systematic review of randomized control trials. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:83-90. [PMID: 33685826 DOI: 10.1016/j.anorl.2020.10.013] [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: 07/07/2020] [Revised: 10/03/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022]
Abstract
There is a controversy in regards to the efficacy of photobiomodulation (PBM) in the management of tinnitus. The aim was to systematically review randomized controlled trials (RCTs) that assessed the efficacy of PBM (low-level laser therapy) in the management of tinnitus. The focused question was "Is PBM effective in the management of tinnitus?". Indexed databases were searched up to and including June 2020 using different combinations of the following key words: (a) laser; (b) diode; (c) low-level laser therapy; (d) photobiomodulation; (e) tinnitus; (f) medium-level laser; (g) photo-biomodulation; and (h) low-power laser; and RCTs performed on humans were included. Letters to the editor; case reports/series; commentaries; experimental studies and historic reviews were excluded. The risk of bias was assessed using the modified cochrane collaboration tool. The format of the current systematic review was personalized to summarize the appropriate information. Ten RCTs (2 single-blinded and 8 double-blinded) were included. One study reported 30% and 100% resolution of tinnitus using diode and Neodymium-doped Yttrium Aluminum Garnet lasers; respectively. One study reported that PBM was effective in relieving tinnitus for up to 3 months. Eight studies reported that PBM was ineffective in the management of chronic tinnitus. The risk of bias was high; medium and low in 4; 5 and 1 studies; respectively. The effectiveness of PBM in the management of tinnitus remains debatable. Further power-adjusted and well-designed RCTs with long-term follow-up are needed.
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Affiliation(s)
- S Talluri
- Orofacial Pain and TMJD, Eastman Institute for Oral Health, Rochester, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - S M Palaparthi
- Vijay Super Specialty Dental Hospital, Guptha's square, Ongole, AP 530013, India
| | - D Michelogiannakis
- Department of Orthodontics, Eastman Institute for Oral Health, Rochester, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - J Khan
- Orofacial Pain and TMJD, Eastman Institute for Oral Health, Rochester, 625 Elmwood Ave, Rochester, NY 14620, USA.
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Maffei C, Sarubbo S, Jovicich J. A Missing Connection: A Review of the Macrostructural Anatomy and Tractography of the Acoustic Radiation. Front Neuroanat 2019; 13:27. [PMID: 30899216 PMCID: PMC6416820 DOI: 10.3389/fnana.2019.00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/15/2019] [Indexed: 12/13/2022] Open
Abstract
The auditory system of mammals is dedicated to encoding, elaborating and transporting acoustic information from the auditory nerve to the auditory cortex. The acoustic radiation (AR) constitutes the thalamo-cortical projection of this system, conveying the auditory signals from the medial geniculate nucleus (MGN) of the thalamus to the transverse temporal gyrus on the superior temporal lobe. While representing one of the major sensory pathways of the primate brain, the currently available anatomical information of this white matter bundle is quite limited in humans, thus constituting a notable omission in clinical and general studies on auditory processing and language perception. Tracing procedures in humans have restricted applications, and the in vivo reconstruction of this bundle using diffusion tractography techniques remains challenging. Hence, a more accurate and reliable reconstruction of the AR is necessary for understanding the neurobiological substrates supporting audition and language processing mechanisms in both health and disease. This review aims to unite available information on the macroscopic anatomy and topography of the AR in humans and non-human primates. Particular attention is brought to the anatomical characteristics that make this bundle difficult to reconstruct using non-invasive techniques, such as diffusion-based tractography. Open questions in the field and possible future research directions are discussed.
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Affiliation(s)
- Chiara Maffei
- Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.,Center for Mind/Brain Sciences - CIMeC, University of Trento, Trento, Italy
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, S. Chiara Hospital, Trento Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Jorge Jovicich
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Trento, Italy.,Department of Psychology and Cognitive Sciences, University of Trento, Trento, Italy
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Sahlsten H, Holm A, Rauhala E, Takala M, Löyttyniemi E, Karukivi M, Nikkilä J, Ylitalo K, Paavola J, Johansson R, Taiminen T, Jääskeläinen SK. Neuronavigated Versus Non-navigated Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus: A Randomized Study. Trends Hear 2019; 23:2331216518822198. [PMID: 30803387 PMCID: PMC6327327 DOI: 10.1177/2331216518822198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has shown variable effect on tinnitus. A prospective, randomized 6-month follow-up study on parallel groups was conducted to compare the effects of neuronavigated rTMS to non-navigated rTMS in chronic tinnitus. Forty patients (20 men, 20 women), mean age of 52.9 years (standard deviation [ SD] = 11.7), with a mean tinnitus duration of 5.8 years ( SD = 3.2) and a mean tinnitus intensity of 62.2/100 ( SD = 12.8) on Visual Analog Scale (VAS 0-100) participated. Patients received 10 sessions of 1-Hz rTMS to the left temporal area overlying auditory cortex with or without neuronavigation. The main outcome measures were VAS scores for tinnitus intensity, annoyance, and distress, and Tinnitus Handicap Inventory (THI) immediately and at 1, 3, and 6 months after treatment. The mean tinnitus intensity (hierarchical linear mixed model: F3 = 7.34, p = .0006), annoyance ( F3 = 4.45, p = .0093), distress ( F3 = 5.04, p = .0051), and THI scores ( F4 = 17.30, p < .0001) decreased in both groups with non-significant differences between the groups, except for tinnitus intensity ( F3 = 2.96, p = .0451) favoring the non-navigated rTMS. Reduction in THI scores persisted for up to 6 months in both groups. Cohen's d for tinnitus intensity ranged between 0.33 and 0.47 in navigated rTMS and between 0.55 and 1.07 in non-navigated rTMS. The responder rates for VAS or THI ranged between 35% and 85% with no differences between groups ( p = .054-1.0). In conclusion, rTMS was effective for chronic tinnitus, but the method of coil localization was not a critical factor for the treatment outcome.
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Affiliation(s)
| | - Anu Holm
- Department of Clinical Neurophysiology, SataDiag, Satakunta Hospital District, Pori, Finland
| | - Esa Rauhala
- Department of Clinical Neurophysiology, SataDiag, Satakunta Hospital District, Pori, Finland
| | - Mari Takala
- Department of Clinical Neurophysiology, SataDiag, Satakunta Hospital District, Pori, Finland
| | | | - Max Karukivi
- Unit of Adolescent Psychiatry, Satakunta Hospital District, Pori, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, Finland
| | - Johanna Nikkilä
- Unit of Adolescent Psychiatry, Satakunta Hospital District, Pori, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, Finland
| | - Kirsi Ylitalo
- Department of Ear, Nose and Throat, Satakunta Hospital District, Pori, Finland
| | - Janika Paavola
- Department of Medical Physics, Turku University Hospital, Finland
| | - Reijo Johansson
- Department of Ear, Nose and Throat, Turku University Hospital, Finland
| | - Tero Taiminen
- Department of Psychiatry, Turku University Hospital, Finland
| | - Satu K. Jääskeläinen
- Department of Clinical Neurophysiology, Division of Medical Imaging, Turku University Hospital and University of Turku, Finland
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Londero A, Bonfils P, Lefaucheur J. Transcranial magnetic stimulation and subjective tinnitus. A review of the literature, 2014–2016. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:51-58. [DOI: 10.1016/j.anorl.2017.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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7
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Noh TS, Rah YC, Kyong JS, Kim JS, Park MK, Lee JH, Oh SH, Chung CK, Suh MW. Comparison of treatment outcomes between 10 and 20 EEG electrode location system-guided and neuronavigation-guided repetitive transcranial magnetic stimulation in chronic tinnitus patients and target localization in the Asian brain. Acta Otolaryngol 2017; 137:945-951. [PMID: 28471721 DOI: 10.1080/00016489.2017.1316870] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE rTMS is a non-invasive method that applies a brief magnetic pulse to the cortex and is regarded as a possible therapeutic method for tinnitus control. However, it remains unclear whether the rTMS treatment effect would be the same in tinnitus patients receiving the 10-20 EEG-based target localization as in those receiving imaging-based neuronavigation target localization. METHODS We compared the treatment outcome of the 10-20 EEG-guided rTMS (Group 1) with that of the neuronavigation-guided rTMS (Group 2). Using the individual subject's MRI data and neuronavigation system, the coordinates of the AC relative to the 10-20 EEG system were identified in Asian and compared with those of Caucasian. RESULTS There was significant improvement in the THI and VAS scores in Group 1 and 2. However, there was no significant difference between the two groups. The location of the AC in Asians was significantly different to that in Caucasians. CONCLUSION The 10-20 EEG coordinates of the AC in Asians were significantly different to those in Caucasians. To accurately aim for the AC in Asians, it is recommended that the rTMS be located 1.8 cm superior to the T3 and 0.6 cm posterior to the T3-Cz line. However, because the spatial resolution of the TMS is rather low, this difference probably was not reflected in the treatment outcome.
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Affiliation(s)
- Tae-Soo Noh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoon-Chan Rah
- Department of Otorhinolaryngology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jeong Sug Kyong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - June Sic Kim
- Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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8
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Sahlsten H, Virtanen J, Joutsa J, Niinivirta-Joutsa K, Löyttyniemi E, Johansson R, Paavola J, Taiminen T, Sjösten N, Salonen J, Holm A, Rauhala E, Jääskeläinen SK. Electric field-navigated transcranial magnetic stimulation for chronic tinnitus: a randomized, placebo-controlled study. Int J Audiol 2017; 56:692-700. [DOI: 10.1080/14992027.2017.1313461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Hanna Sahlsten
- Faculty of Medicine, University of Turku, Turku, Finland,
| | - Juuso Virtanen
- Faculty of Medicine, University of Turku, Turku, Finland,
| | - Juho Joutsa
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland,
| | - Katri Niinivirta-Joutsa
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland,
| | | | - Reijo Johansson
- Department of Ear, Nose and Throat, Turku University Hospital, Turku, Finland,
| | - Janika Paavola
- Department of Medical Physics, Turku University Hospital, Turku, Finland,
| | - Tero Taiminen
- Department of Psychiatry, Turku University Hospital, Turku, Finland, and
| | - Noora Sjösten
- Department of Ear, Nose and Throat, Turku University Hospital, Turku, Finland,
| | - Jaakko Salonen
- Department of Ear, Nose and Throat, Turku University Hospital, Turku, Finland,
| | - Anu Holm
- Department of Clinical Neurophysiology, Satakunta Central Hospital, Pori, Finland
| | - Esa Rauhala
- Department of Clinical Neurophysiology, Satakunta Central Hospital, Pori, Finland
| | - Satu K. Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland,
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9
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Schecklmann M, Giani A, Tupak S, Langguth B, Raab V, Polak T, Várallyay C, Großmann W, Herrmann MJ, Fallgatter AJ. Neuronavigated left temporal continuous theta burst stimulation in chronic tinnitus. Restor Neurol Neurosci 2016; 34:165-75. [PMID: 26890094 DOI: 10.3233/rnn-150518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Clinical effects of repetitive transcranial magnetic stimulation (rTMS) in chronic tinnitus are moderate. More precise coil localisation strategies, innovative stimulation protocols, and identification of predictors for treatment response were proposed as promising attempts to enhance treatment efficacy. In this pilot study we investigated neuronavigated continuous theta burst TMS (cTBS). METHODS Twenty-three patients received neuronavigated cTBS over the left primary auditory cortex in a randomized sham-controlled trial (verum = 12; sham = 11). Treatment response was evaluated with tinnitus questionnaires and numeric rating scales. Immediate change in numeric rating scales during the first session was used as predictor for treatment response. RESULTS Tinnitus was significantly reduced after treatment, but there were no superior effects between verum vs. sham treatment. Immediate change in the first treatment session predicted the response to treatment only in the verum group. CONCLUSIONS In our study, verum cTBS was not superior to sham which highlights the persistent need for improving non-invasive brain stimulation techniques for the treatment of tinnitus. Future research should focus on the transfer of positive single session effects to daily treatment trials.
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Affiliation(s)
- Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Anette Giani
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Sara Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Vincent Raab
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Thomas Polak
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Csanád Várallyay
- Department of Neuroradiology, University of Würzburg, Würzburg, Germany.,Departments of Neurology/Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Wilma Großmann
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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Factor Analysis of Low-Frequency Repetitive Transcranial Magnetic Stimulation to the Temporoparietal Junction for Tinnitus. Neural Plast 2016; 2016:2814056. [PMID: 27847647 PMCID: PMC5101393 DOI: 10.1155/2016/2814056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives. We investigated factors that contribute to suppression of tinnitus after repetitive transcranial magnetic stimulation (rTMS). Methods. A total of 289 patients with tinnitus underwent active 1 Hz rTMS in the left temporoparietal region. A visual analog scale (VAS) was used to assess tinnitus loudness. All participants were interviewed regarding age, gender, tinnitus duration, laterality and pitch, audiometric parameters, sleep, and so forth. The resting motor thresholds (RMTs) were measured in all patients and 30 age- and gender-matched volunteers. Results. With respect to different factors that contribute to tinnitus suppression, we found improvement in the following domains: shorter duration, normal hearing (OR: 3.25, 95%CI: 2.01-5.27, p = 0.001), and without sleep disturbance (OR: 2.51, 95%CI: 1.56-4.1, p = 0.005) adjusted for age and gender. The patients with tinnitus lasting less than 1 year were more likely to show suppression of tinnitus (OR: 2.77, 95%CI: 1.48-5.19, p = 0.002) compared to those with tinnitus lasting more than 5 years. Tinnitus patients had significantly lower RMTs compared with healthy volunteers. Conclusion. Active low-frequency rTMS results in a significant reduction in the loudness of tinnitus. Significant tinnitus suppression was shown in subjects with shorter tinnitus duration, with normal hearing, and without sleep disturbance.
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11
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Labar D, Labar AS, Edwards D. Long-Term Distributed Repetitive Transcranial Magnetic Stimulation for Tinnitus: A Feasibility Study. Neuromodulation 2016; 19:249-53. [DOI: 10.1111/ner.12390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Douglas Labar
- Non-invasive Brain Stimulation Laboratory; Burke Medical Research Institute; White Plains NY USA
- Division of Clinical Neurophysiology; Weill-Cornell Medical College; New York NY USA
| | - Amy S. Labar
- Non-invasive Brain Stimulation Laboratory; Burke Medical Research Institute; White Plains NY USA
- Division of Clinical Neurophysiology; Weill-Cornell Medical College; New York NY USA
| | - Dylan Edwards
- Non-invasive Brain Stimulation Laboratory; Burke Medical Research Institute; White Plains NY USA
- Division of Clinical Neurophysiology; Weill-Cornell Medical College; New York NY USA
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12
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Schecklmann M, Lehner A, Gollmitzer J, Schmidt E, Schlee W, Langguth B. Repetitive transcranial magnetic stimulation induces oscillatory power changes in chronic tinnitus. Front Cell Neurosci 2015; 9:421. [PMID: 26557055 PMCID: PMC4617176 DOI: 10.3389/fncel.2015.00421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/04/2015] [Indexed: 11/13/2022] Open
Abstract
Chronic tinnitus is associated with neuroplastic changes in auditory and non-auditory cortical areas. About 10 years ago, repetitive transcranial magnetic stimulation (rTMS) of auditory and prefrontal cortex was introduced as potential treatment for tinnitus. The resulting changes in tinnitus loudness are interpreted in the context of rTMS induced activity changes (neuroplasticity). Here, we investigate the effect of single rTMS sessions on oscillatory power to probe the capacity of rTMS to interfere with tinnitus-specific cortical plasticity. We measured 20 patients with bilateral chronic tinnitus and 20 healthy controls comparable for age, sex, handedness, and hearing level with a 63-channel electroencephalography (EEG) system. Educational level, intelligence, depressivity and hyperacusis were controlled for by analysis of covariance. Different rTMS protocols were tested: Left and right temporal and left and right prefrontal cortices were each stimulated with 200 pulses at 1 Hz and with an intensity of 60% stimulator output. Stimulation of central parietal cortex with 6-fold reduced intensity (inverted passive-cooled coil) served as sham condition. Before and after each rTMS protocol 5 min of resting state EEG were recorded. The order of rTMS protocols was randomized over two sessions with 1 week interval in between. Analyses on electrode level showed that people with and without tinnitus differed in their response to left temporal and right frontal stimulation. In tinnitus patients left temporal rTMS decreased frontal theta and delta and increased beta2 power, whereas right frontal rTMS decreased right temporal beta3 and gamma power. No changes or increases were observed in the control group. Only non-systematic changes in tinnitus loudness were induced by single sessions of rTMS. This is the first study to show tinnitus-related alterations of neuroplasticity that were specific to stimulation site and oscillatory frequency. The observed effects can be interpreted within the thalamocortical dysrhythmia model assuming that slow waves represent processes of deafferentiation and that high frequencies might be indicators for tinnitus loudness. Moreover our findings confirm the role of the left temporal and the right frontal areas as relevant hubs in tinnitus related neuronal network. Our results underscore the value of combined TMS-EEG measurements for investigating disease related changes in neuroplasticity.
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Affiliation(s)
- Martin Schecklmann
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Judith Gollmitzer
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Eldrid Schmidt
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
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13
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Pal N, Maire R, Stephan MA, Herrmann FR, Benninger DH. Transcranial Direct Current Stimulation for the Treatment of Chronic Tinnitus: A Randomized Controlled Study. Brain Stimul 2015. [PMID: 26198363 DOI: 10.1016/j.brs.2015.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Tinnitus is an often disabling condition for which there is no effective therapy. Current research suggests that tinnitus may develop due to maladaptive plastic changes and altered activity in the auditory and prefrontal cortex. Transcranial direct current stimulation (tDCS) modulates brain activity and has been shown to transiently suppress tinnitus in trials. OBJECTIVE To investigate the efficacy and safety of tDCS in the treatment of chronic subjective tinnitus. METHODS In a randomized, parallel, double-blind, sham-controlled study, the efficacy and safety of cathodal tDCS to the auditory cortex with anode over the prefrontal cortex was investigated in five sessions over five consecutive days. Tinnitus was assessed after the last session on day 5, and at follow-up visits 1 and 3 months post stimulation using the Tinnitus Handicap Inventory (THI, primary outcome measure), Subjective Tinnitus Severity Scale, Hospital Anxiety and Depression scale, Visual Analogue Scale, and Clinical Global Impression scale. RESULTS 42 patients were investigated, 21 received tDCS and 21 sham stimulation. There were no beneficial effects of tDCS on tinnitus as assessed by primary and secondary outcome measures. Effect size assessed with Cohen's d amounted to 0.08 (95% CI: -0.52 to 0.69) at 1 month and 0.18 (95% CI: -0.43 to 0.78) at 3 months for the THI. CONCLUSION tDCS of the auditory and prefrontal cortices is safe, but does not improve tinnitus. Different tDCS protocols might be beneficial.
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Affiliation(s)
- Natassja Pal
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Raphael Maire
- Clinic of Otolaryngology, Head Neck & Ear Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marianne A Stephan
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - David H Benninger
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Sahlsten H, Isohanni J, Haapaniemi J, Salonen J, Paavola J, Löyttyniemi E, Johansson R, Jääskeläinen SK. Electric field navigated transcranial magnetic stimulation for chronic tinnitus: A pilot study. Int J Audiol 2015; 54:899-909. [DOI: 10.3109/14992027.2015.1054041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Soleimani R, Jalali MM, Hasandokht T. Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2015; 273:1663-75. [DOI: 10.1007/s00405-015-3642-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
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16
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Gorelick DA, Zangen A, George MS. Transcranial magnetic stimulation in the treatment of substance addiction. Ann N Y Acad Sci 2014; 1327:79-93. [PMID: 25069523 DOI: 10.1111/nyas.12479] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive method of brain stimulation used to treat a variety of neuropsychiatric disorders, but is still in the early stages of study as addiction treatment. We identified 19 human studies using repetitive TMS (rTMS) to manipulate drug craving or use, which exposed a total of 316 adults to active rTMS. Nine studies involved tobacco, six alcohol, three cocaine, and one methamphetamine. The majority of studies targeted high-frequency (5-20 Hz; expected to stimulate neuronal activity) rTMS pulses to the dorsolateral prefrontal cortex. Only five studies were controlled clinical trials: two of four nicotine trials found decreased cigarette smoking; the cocaine trial found decreased cocaine use. Many aspects of optimal treatment remain unknown, including rTMS parameters, duration of treatment, relationship to cue-induced craving, and concomitant treatment. The mechanisms of rTMS potential therapeutic action in treating addictions are poorly understood, but may involve increased dopamine and glutamate function in corticomesolimbic brain circuits and modulation of neural activity in brain circuits that mediate cognitive processes relevant to addiction, such as response inhibition, selective attention, and reactivity to drug-associated cues. rTMS treatment of addiction must be considered experimental at this time, but appears to have a promising future.
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Affiliation(s)
- David A Gorelick
- Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipović SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014; 125:2150-2206. [PMID: 25034472 DOI: 10.1016/j.clinph.2014.05.021] [Citation(s) in RCA: 1267] [Impact Index Per Article: 126.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022]
Abstract
A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic use of rTMS should be able to develop in the coming years.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France.
| | - Nathalie André-Obadia
- Neurophysiology and Epilepsy Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France; Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France
| | - Andrea Antal
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Samar S Ayache
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Roberto M Cantello
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | | | - Mamede de Carvalho
- Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - Dirk De Ridder
- Brai(2)n, Tinnitus Research Initiative Clinic Antwerp, Belgium; Department of Neurosurgery, University Hospital Antwerp, Belgium
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Hospital, Lille, France; ULCO, Lille-Nord de France University, Lille, France
| | - Vincenzo Di Lazzaro
- Department of Neurosciences, Institute of Neurology, Campus Bio-Medico University, Rome, Italy
| | - Saša R Filipović
- Department of Neurophysiology, Institute for Medical Research, University of Belgrade, Beograd, Serbia
| | - Friedhelm C Hummel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Emmanuel Poulet
- Department of Emergency Psychiatry, CHU Lyon, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; EAM 4615, Lyon-1 University, Bron, France
| | - Simone Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Rome, Italy; Institute of Neurology, Catholic University, Rome, Italy
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | | | - Hartwig R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Charlotte J Stagg
- Oxford Centre for Functional MRI of the Brain (FMRIB), Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Josep Valls-Sole
- EMG Unit, Neurology Service, Hospital Clinic, Department of Medicine, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Luis Garcia-Larrea
- Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France; Pain Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France
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Langguth B, Landgrebe M, Frank E, Schecklmann M, Sand PG, Vielsmeier V, Hajak G, Kleinjung T. Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies. World J Biol Psychiatry 2014; 15:276-85. [PMID: 22909265 DOI: 10.3109/15622975.2012.708438] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Tinnitus is related to alterations in neuronal activity of auditory and nonauditory brain areas. Targeted modulation of these areas by repetitive transcranial magnetic stimulation (rTMS) has been proposed as a new therapeutic approach for chronic tinnitus. METHODS Two randomized, double-blind, parallel-group, controlled clinical trials were performed subsequently and pooled for analysis. A total of 192 tinnitus patients were randomly allocated to receive 10 stimulation sessions of either sham rTMS, PET-based neuronavigated 1 Hz rTMS, 1Hz r TMS over the left auditory cortex, or combined 20 Hz rTMS over the left frontal cortex, followed by 1 Hz rTMS over the left auditory cortex. RESULTS rTMS treatment was well tolerated and no severe side effects were observed. All active rTMS treatments resulted in significant reduction of the TQ as compared to baseline. The comparison between treatment groups failed to reach significant differences. The number of treatment responders was higher for temporal rTMS(38%) and combined frontal and temporal rTMS (43%), as compared to sham (6%). CONCLUSIONS This large study demonstrates the safety and tolerability of rTMS treatment in patients with chronic tinnitus. While the overall effect did not prove superior to placebo, secondary outcome parameters argue in favour of the active stimulation groups, and specifically the combined frontal and temporal rTMS protocol.
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Affiliation(s)
- B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg , Regensburg , Germany
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19
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A comparison study of repetitive transcranial magnetic stimulation for tinnitus treatment in an Asian population. Clin Neurol Neurosurg 2014; 119:96-9. [DOI: 10.1016/j.clineuro.2014.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 01/07/2014] [Accepted: 01/11/2014] [Indexed: 11/21/2022]
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20
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Geven L, de Kleine E, Willemsen A, van Dijk P. Asymmetry in primary auditory cortex activity in tinnitus patients and controls. Neuroscience 2014; 256:117-25. [DOI: 10.1016/j.neuroscience.2013.10.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/04/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
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Efficacy of low-level laser therapy in the management of tinnitus due to noise-induced hearing loss: a double-blind randomized clinical trial. ScientificWorldJournal 2013; 2013:596076. [PMID: 24288494 PMCID: PMC3830897 DOI: 10.1155/2013/596076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 09/12/2013] [Indexed: 12/28/2022] Open
Abstract
Background. Several remedial modalities for the treatment of tinnitus have been proposed, but an effective standard treatment is still to be confirmed. In the present study, we aimed to evaluate the effect of low-level laser therapy on tinnitus accompanied by noise-induced hearing loss. Methods. This was a double-blind randomized clinical trial on subjects suffering from tinnitus accompanied by noise-induced hearing loss. The study intervention was 20 sessions of low-level laser therapy every other day, 20 minutes each session. Tinnitus was assessed by three methods (visual analog scale, tinnitus handicap inventory, and tinnitus loudness) at baseline, immediately and 3 months after the intervention. Results. All subjects were male workers with age range of 30–51 years. The mean tinnitus duration was 1.85 ± 0.78 years. All three measurement methods have shown improved values after laser therapy compared with the placebo both immediately and 3 months after treatment. Laser therapy revealed a U-shaped efficacy throughout the course of follow-up. Nonresponse rate of the intervention was 57% and 70% in the two assessment time points, respectively. Conclusion. This study found low-level laser therapy to be effective in alleviating tinnitus in patients with noise-induced hearing loss, although this effect has faded after 3 months of follow-up. This trial is registered with the Australian New Zealand clinical trials registry with identifier ACTRN12612000455864).
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Javad F, Warren JD, Micallef C, Thornton JS, Golay X, Yousry T, Mancini L. Auditory tracts identified with combined fMRI and diffusion tractography. Neuroimage 2013; 84:562-74. [PMID: 24051357 PMCID: PMC3898984 DOI: 10.1016/j.neuroimage.2013.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/16/2013] [Accepted: 09/09/2013] [Indexed: 01/08/2023] Open
Abstract
The auditory tracts in the human brain connect the inferior colliculus (IC) and medial geniculate body (MGB) to various components of the auditory cortex (AC). While in non-human primates and in humans, the auditory system is differentiated in core, belt and parabelt areas, the correspondence between these areas and anatomical landmarks on the human superior temporal gyri is not straightforward, and at present not completely understood. However it is not controversial that there is a hierarchical organization of auditory stimuli processing in the auditory system. The aims of this study were to demonstrate that it is possible to non-invasively and robustly identify auditory projections between the auditory thalamus/brainstem and different functional levels of auditory analysis in the cortex of human subjects in vivo combining functional magnetic resonance imaging (fMRI) with diffusion MRI, and to investigate the possibility of differentiating between different components of the auditory pathways (e.g. projections to areas responsible for sound, pitch and melody processing). We hypothesized that the major limitation in the identification of the auditory pathways is the known problem of crossing fibres and addressed this issue acquiring DTI with b-values higher than commonly used and adopting a multi-fibre ball-and-stick analysis model combined with probabilistic tractography. Fourteen healthy subjects were studied. Auditory areas were localized functionally using an established hierarchical pitch processing fMRI paradigm. Together fMRI and diffusion MRI allowed the successful identification of tracts connecting IC with AC in 64 to 86% of hemispheres and left sound areas with homologous areas in the right hemisphere in 86% of hemispheres. The identified tracts corresponded closely with a three-dimensional stereotaxic atlas based on postmortem data. The findings have both neuroscientific and clinical implications for delineation of the human auditory system in vivo.
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Affiliation(s)
- Faiza Javad
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
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Klirova M, Horacek J, Novak T, Cermak J, Spaniel F, Skrdlantova L, Mohr P, Höschl C. Individualized rTMS neuronavigated according to regional brain metabolism ((18)FGD PET) has better treatment effects on auditory hallucinations than standard positioning of rTMS: a double-blind, sham-controlled study. Eur Arch Psychiatry Clin Neurosci 2013; 263:475-84. [PMID: 22983355 DOI: 10.1007/s00406-012-0368-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/06/2012] [Indexed: 01/18/2023]
Abstract
Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) of the left temporo-parietal cortex (LTPC) has been proposed as a useful therapeutic method for auditory hallucinations (AHs). Stereotactic neuronavigation enables the magnetic coil to be targeted according to the individual parameters obtained from neuroimaging. Individualized rTMS neuronavigated according to 18-fluorodeoxyglucose positron emission tomography ((18)FDG PET) allows us to focus the coil explicitly on a given area with detected maxima of specific abnormalities, thus presuming a higher therapeutic effect of the method. The objective of this study is to test clinical efficacy of neuronavigated LF-rTMS administered according to the local maxima of (18)FDG PET uptake of LTPC and to compare it with treatment effects of standard and sham rTMS. In a double-blind, sham-controlled design, patients with AHs underwent a 10-day series of LF-rTMS using (1) (18)FDG PET-guided "neuronavigation," (2) "standard" anatomically guided positioning, and (3) sham coil. The effect of different rTMS conditions was assessed by the Auditory Hallucinations Rating Scale (AHRS) and the Positive and Negative Syndrome Scale (PANSS). Fifteen patients were randomized to a treatment sequence and ten of them completed all three treatment conditions. The intention-to-treat analysis of AHRS score change revealed superiority of the (18)FDG PET-guided rTMS over both the standard and the sham rTMS. The analyses of the PANSS scores failed to detect significant difference among the treatments. Our data showed acute efficacy of (18)FDG PET-guided rTMS in the treatment of AHs. Neuronavigated rTMS was found to be more effective than standard, anatomically guided rTMS.
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Affiliation(s)
- Monika Klirova
- Prague Psychiatric Center, Ústavní 91, Prague 8, 181 03, Czech Republic.
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Short term effects of repetitive transcranial magnetic stimulation in patients with catastrophic intractable tinnitus: preliminary report. Clin Exp Otorhinolaryngol 2013; 6:63-7. [PMID: 23799161 PMCID: PMC3687063 DOI: 10.3342/ceo.2013.6.2.63] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/20/2012] [Accepted: 08/21/2012] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The short-term effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) in the patients with catastrophic and intractable tinnitus were investigated. METHODS Fifteen participants were recruited among patients with catastrophic intractable tinnitus to receive 1 Hz rTMS treatment. Tinnitus severity was assessed before rTMS and directly after sham or real rTMS using the tinnitus handicap inventory (THI) and visual analog scale (VAS). RESULTS There was no statistical difference in the THI score before and after sham stimulation. However, after 5 replications of real rTMS there was statistically significant reduction in THI score. Eight patients showed a decrease of more than 10 in THI score. Patients who showed a vast change in THI score after rTMS also showed a large decrease in their VAS score (r=0.879, P<0.001). Duration of tinnitus and change of THI score showed statistically significant moderate negative correlation (r=-0.637, P=0.011). But in case of VAS, there was no significant difference between VAS and duration of tinnitus. CONCLUSION Among total 15 patients with catastrophic intractable chronic tinnitus, eight patients showed some improvement in symptoms after 1 Hz rTMS. rTMS can be considered management modality for intractable tinnitus even with distress as severe as catastrophic stage.
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Richter L, Trillenberg P, Schweikard A, Schlaefer A. Stimulus Intensity for Hand Held and Robotic Transcranial Magnetic Stimulation. Brain Stimul 2013; 6:315-21. [DOI: 10.1016/j.brs.2012.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/01/2012] [Accepted: 06/03/2012] [Indexed: 10/28/2022] Open
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Richter L, Neumann G, Oung S, Schweikard A, Trillenberg P. Optimal coil orientation for transcranial magnetic stimulation. PLoS One 2013; 8:e60358. [PMID: 23593200 PMCID: PMC3623976 DOI: 10.1371/journal.pone.0060358] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 02/26/2013] [Indexed: 01/21/2023] Open
Abstract
We study the impact of coil orientation on the motor threshold (MT) and present an optimal coil orientation for stimulation of the foot. The result can be compared to results of models that predict this orientation from electrodynamic properties of the media in the skull and from orientations of cells, respectively. We used a robotized TMS system for precise coil placement and recorded motor-evoked potentials with surface electrodes on the abductor hallucis muscle of the right foot in 8 healthy control subjects. First, we performed a hot-spot search in standard (lateral) orientation and then rotated the coil in steps of 10° or 20°. At each step we estimated the MT. For navigated stimulation and for correlation with the underlying anatomy a structural MRI scan was obtained. Optimal coil orientation was 33.1±18.3° anteriorly in relation to the standard lateral orientation. In this orientation the threshold was 54±18% in units of maximum stimulator output. There was a significant difference of 8.0±5.9% between the MTs at optimal and at standard orientation. The optimal coil orientations were significantly correlated with the direction perpendicular to the postcentral gyrus (). Robotized TMS facilitates sufficiently precise coil positioning and orientation to study even small variations of the MT with coil orientation. The deviations from standard orientation are more closely matched by models based on field propagation in media than by models based on orientations of pyramidal cells.
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Affiliation(s)
- Lars Richter
- Institute for Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany.
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27
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Differences between a single session and repeated sessions of 1 Hz TMS by double-cone coil prefrontal stimulation for the improvement of tinnitus. Brain Stimul 2013; 6:155-9. [DOI: 10.1016/j.brs.2012.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 03/18/2012] [Accepted: 03/23/2012] [Indexed: 11/18/2022] Open
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Abstract
PURPOSE OF REVIEW Tinnitus is the sensation of hearing a sound when no external auditory stimulus is present. Most individuals experience tinnitus for brief, unobtrusive periods. However, chronic sensation of tinnitus affects approximately 17% (44 million people) of the general US population. Tinnitus, usually a benign symptom, can be constant, loud and annoying to the point that it causes significant emotional distress, poor sleep, less efficient activities of daily living, anxiety, depression and suicidal ideation/attempts. Tinnitus remains a major challenge to physicians because its pathophysiology is poorly understood and there are few management options to offer to patients. The purpose of this article is to describe the current understanding of central neural mechanisms in tinnitus and to summarize recent developments in clinical approaches to tinnitus patients. RECENT FINDINGS Recently developed animal models of tinnitus provide the possibility to determine neuronal mechanisms of tinnitus generation and to test the effects of various treatments. The latest research using animal models has identified a number of abnormal changes, in both auditory and nonauditory brain regions, that underlie tinnitus. Furthermore this research sheds light on cellular mechanisms that are responsible for development of these abnormal changes. SUMMARY Tinnitus remains a challenging disorder for patients, physicians, audiologists and scientists studying tinnitus-related brain changes. This article reviews recent findings of brain changes in animal models associated with tinnitus and a brief review of clinical approach to tinnitus patients.
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Mennemeier M, Munn T, Allensworth M, Lenow JK, Brown G, Allen S, Dornhoffer J, Williams DK. Laterality, frequency and replication of rTMS treatment for chronic tinnitus: pilot studies and a review of maintenance treatment. Hear Res 2013; 295:30-7. [PMID: 22486989 PMCID: PMC3538962 DOI: 10.1016/j.heares.2012.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 03/15/2012] [Accepted: 03/21/2012] [Indexed: 11/29/2022]
Abstract
This manuscript reports on findings of three open-label, pilot studies and it reviews studies using rTMS as a maintenance treatment for any disorder. The first pilot study examined whether a patient's original treatment response to 1 Hz rTMS over temporal cortex could be replicated by stimulating a homologous region of the opposite hemisphere. The second study examined whether a patient's response to 1 Hz rTMS could be replicated by applying 10 Hz rTMS over the same treatment site. The third study applied a 3-day course of maintenance rTMS, either at 1 or 10 Hz, when subjects indicated that the benefit of their last course of treatment was waning. Patients with bilateral subjective tinnitus of at least 6 months duration were recruited from a prior, sham controlled study with treatment crossover that applied 1 Hz rTMS over temporal cortex. Both treatment responders and non-responders were recruited. Results indicated, first, that the original treatment response, both positive and negative, is replicated after stimulating a homologous region of the opposite hemisphere; second, patients respond similarly to 1 and 10 Hz stimulation of the same treatment site (an exception was one patient who initially failed 1 Hz stimulation but responded positively to 10 Hz stimulation); and, third, maintenance rTMS had a sustained and additive benefit for tinnitus among treatment responders. Conclusions are that rTMS-induced effects on tinnitus are neither hemisphere specific nor frequency dependent; although, different frequencies of rTMS may have greater potency for a given subject. Maintenance treatment is a well tolerated approach with demonstrated feasibility for managing chronic tinnitus in persons who respond positively to an initial course of treatment.
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Affiliation(s)
- M Mennemeier
- Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot #826, Little Rock, AR 72205-7199, USA.
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Tringali S, Perrot X, Collet L, Moulin A. Exposition sonore et répercussions auditives au cours de la stimulation magnétique transcrânienne répétitive : données récentes et revue de la littérature. Neurophysiol Clin 2013; 43:19-33. [DOI: 10.1016/j.neucli.2012.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 04/16/2012] [Accepted: 07/07/2012] [Indexed: 12/12/2022] Open
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A neuronal network model for simulating the effects of repetitive transcranial magnetic stimulation on local field potential power spectra. PLoS One 2012; 7:e49097. [PMID: 23145082 PMCID: PMC3492306 DOI: 10.1371/journal.pone.0049097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 10/07/2012] [Indexed: 11/19/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) holds promise as a non-invasive therapy for the treatment of neurological disorders such as depression, schizophrenia, tinnitus, and epilepsy. Complex interdependencies between stimulus duration, frequency and intensity obscure the exact effects of rTMS stimulation on neural activity in the cortex, making evaluation of and comparison between rTMS studies difficult. To explain the influence of rTMS on neural activity (e.g. in the motor cortex), we use a neuronal network model. The results demonstrate that the model adequately explains experimentally observed short term effects of rTMS on the band power in common frequency bands used in electroencephalography (EEG). We show that the equivalent local field potential (eLFP) band power depends on stimulation intensity rather than on stimulation frequency. Additionally, our model resolves contradictions in experiments.
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Peng Z, Chen XQ, Gong SS. Effectiveness of Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus. Otolaryngol Head Neck Surg 2012; 147:817-25. [PMID: 22941756 DOI: 10.1177/0194599812458771] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This systematic review aimed to assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) treatment for chronic tinnitus. Data Sources Relevant electronic databases and a reference list of articles published up to January 2012 were searched. Randomized controlled clinical trials of all types of rTMS treatment for patients with chronic tinnitus were included. Review Methods A literature search was conducted with structured criteria to select studies evaluated for systematic review. Results Five trials (160 participants) were included in this review. Repetitive transcranial magnetic stimulation treatment showed benefits in the short term, but the long-term effects are questionable. The Tinnitus Handicap Inventory (THI) and the visual analog scale (VAS) were the major assessment methods used. After active TMS stimulation, the reduction in the THI total score and VAS was significant compared with baseline at the first time point assessed and in the short term (2 weeks and 4 weeks). The longest follow-up time was 26 weeks after treatment, and the shortest follow-up time was 2 weeks. No severe side effects were reported from the use of rTMS. Differences in age, hearing level, duration of tinnitus of the included patients, and the condition of sham treatment may influence the effect. Conclusion Repetitive transcranial magnetic stimulation could be a new therapeutic tool for the treatment of chronic tinnitus, and thus far we have not been able to demonstrate any substantial risk from rTMS treatment. However, the long-term effects of rTMS treatment for tinnitus are not clear and will require further study.
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Affiliation(s)
- Zhe Peng
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China, and Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otolaryngology, Beijing, China
| | - Xiu-Qi Chen
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Shu-Sheng Gong
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China, and Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otolaryngology, Beijing, China
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Landgrebe M, Azevedo A, Baguley D, Bauer C, Cacace A, Coelho C, Dornhoffer J, Figueiredo R, Flor H, Hajak G, van de Heyning P, Hiller W, Khedr E, Kleinjung T, Koller M, Lainez JM, Londero A, Martin WH, Mennemeier M, Piccirillo J, De Ridder D, Rupprecht R, Searchfield G, Vanneste S, Zeman F, Langguth B. Methodological aspects of clinical trials in tinnitus: a proposal for an international standard. J Psychosom Res 2012; 73:112-21. [PMID: 22789414 PMCID: PMC3897200 DOI: 10.1016/j.jpsychores.2012.05.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/05/2012] [Accepted: 05/09/2012] [Indexed: 11/15/2022]
Abstract
Chronic tinnitus is a common condition with a high burden of disease. While many different treatments are used in clinical practice, the evidence for the efficacy of these treatments is low and the variance of treatment response between individuals is high. This is most likely due to the great heterogeneity of tinnitus with respect to clinical features as well as underlying pathophysiological mechanisms. There is a clear need to find effective treatment options in tinnitus, however, clinical trials differ substantially with respect to methodological quality and design. Consequently, the conclusions that can be derived from these studies are limited and jeopardize comparison between studies. Here, we discuss our view of the most important aspects of trial design in clinical studies in tinnitus and make suggestions for an international methodological standard in tinnitus trials. We hope that the proposed methodological standard will stimulate scientific discussion and will help to improve the quality of trials in tinnitus.
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Affiliation(s)
- Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany.
| | - Andréia Azevedo
- Department of Otolaryngology, Otosul-Otorrinolaringologia Sul-Fluminense, Volta Redonda, Brasil
| | - David Baguley
- Audiology Department, Cambridge University Hospitals, Cambridge, UK
| | - Carol Bauer
- Division of Otolaryngology Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Anthony Cacace
- Department of Communications Sciences & Disorders, Wayne State University, Detroit, Michigan, USA
| | - Claudia Coelho
- Instituto de Avaliação de Tecnologia em Saúde and Grupo de Pesquisa em Neurotologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - John Dornhoffer
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ricardo Figueiredo
- Department of Otolaryngology, Otosul-Otorrinolaringologia Sul-Fluminense, Volta Redonda, Brasil
| | - Herta Flor
- Institute of Neuropsychology, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Goeran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Germany
| | - Paul van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Belgium
| | - Wolfgang Hiller
- Clinical Psychology and Psychotherapy, Psychological Institute, University of Mainz, Germany
| | - Eman Khedr
- Department of Neurology, Assiut University Hospital, Assiut, Egypt
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Zurich, Switzerland
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Germany
| | | | - Alain Londero
- Service ORL et CCF, Hôpital Européen G. Pompidou, Paris, France
| | - William H. Martin
- Department of Otolaryngology, Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark Mennemeier
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, USA
| | - Jay Piccirillo
- Department of Otolaryngology-Head and Neck and Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Dirk De Ridder
- TRI Tinnitus Clinic Antwerp, University Hospital Antwerp, Belgium
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Grant Searchfield
- Section of Audiology, School of Population Health, The University of Auckland, New Zealand
| | - Sven Vanneste
- TRI Tinnitus Clinic Antwerp, University Hospital Antwerp, Belgium
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany,Interdisciplinary Tinnitus Clinic, University of Regensburg, Germany
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The involvement of the left ventrolateral prefrontal cortex in tinnitus: a TMS study. Exp Brain Res 2012; 221:345-50. [PMID: 22782483 DOI: 10.1007/s00221-012-3177-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 06/28/2012] [Indexed: 10/28/2022]
Abstract
Tinnitus is an auditory phantom percept with a tone, hissing or buzzing sound in the absence of any objective physical sound source. Tinnitus is considered to be an auditory phantom phenomenon analogous to somatosensory phantom pain. Controllable versus uncontrollable pain is characterized by an increased activity in the ventrolateral prefrontal cortex (VLPFC), and activation in the VLPFC correlating with perceived control over pain results in a decrease in subjective pain intensity. Depressed individuals show less activation than healthy controls in the left VLPFC in response to sad autobiographical scripts, and greater relative left prefrontal activation is related to a greater disposition to approach-related, positive affect with a greater ability to regulate negative affect. Based on the theory that non-pulsatile tinnitus can be considered the auditory analogue for deafferentation pain, we hypothesize that the left VLPFC might also be involved in control of tinnitus. We conducted a transcranial magnetic stimulation (TMS) study verifying whether modulating the left VLPFC by TMS can modulate the loudness of tinnitus. We studied 60 patients with chronic tinnitus of which 21 patients received in random order sham and 1-Hz stimulation, while 39 patients received in random order sham and 10-Hz stimulation. Our results show that 10-Hz stimulation can modulate tinnitus loudness, while 1-Hz stimulation does not seem to exert the same effect. Our findings give further support to the fact that non-auditory areas are involved in tinnitus.
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Pantev C, Okamoto H, Teismann H. Music-induced cortical plasticity and lateral inhibition in the human auditory cortex as foundations for tonal tinnitus treatment. Front Syst Neurosci 2012; 6:50. [PMID: 22754508 PMCID: PMC3384223 DOI: 10.3389/fnsys.2012.00050] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/05/2012] [Indexed: 11/13/2022] Open
Abstract
Over the past 15 years, we have studied plasticity in the human auditory cortex by means of magnetoencephalography (MEG). Two main topics nurtured our curiosity: the effects of musical training on plasticity in the auditory system, and the effects of lateral inhibition. One of our plasticity studies found that listening to notched music for 3 h inhibited the neuronal activity in the auditory cortex that corresponded to the center-frequency of the notch, suggesting suppression of neural activity by lateral inhibition. Subsequent research on this topic found that suppression was notably dependent upon the notch width employed, that the lower notch-edge induced stronger attenuation of neural activity than the higher notch-edge, and that auditory focused attention strengthened the inhibitory networks. Crucially, the overall effects of lateral inhibition on human auditory cortical activity were stronger than the habituation effects. Based on these results we developed a novel treatment strategy for tonal tinnitus-tailor-made notched music training (TMNMT). By notching the music energy spectrum around the individual tinnitus frequency, we intended to attract lateral inhibition to auditory neurons involved in tinnitus perception. So far, the training strategy has been evaluated in two studies. The results of the initial long-term controlled study (12 months) supported the validity of the treatment concept: subjective tinnitus loudness and annoyance were significantly reduced after TMNMT but not when notching spared the tinnitus frequencies. Correspondingly, tinnitus-related auditory evoked fields (AEFs) were significantly reduced after training. The subsequent short-term (5 days) training study indicated that training was more effective in the case of tinnitus frequencies ≤ 8 kHz compared to tinnitus frequencies >8 kHz, and that training should be employed over a long-term in order to induce more persistent effects. Further development and evaluation of TMNMT therapy are planned. A goal is to transfer this novel, completely non-invasive and low-cost treatment approach for tonal tinnitus into routine clinical practice.
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Affiliation(s)
- Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University of Münster Münster, Germany
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Zhang J. Auditory cortex stimulation to suppress tinnitus: mechanisms and strategies. Hear Res 2012; 295:38-57. [PMID: 22683861 DOI: 10.1016/j.heares.2012.05.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/06/2012] [Accepted: 05/14/2012] [Indexed: 01/08/2023]
Abstract
Brain stimulation is an important method used to modulate neural activity and suppress tinnitus. Several auditory and non-auditory brain regions have been targeted for stimulation. This paper reviews recent progress on auditory cortex (AC) stimulation to suppress tinnitus and its underlying neural mechanisms and stimulation strategies. At the same time, the author provides his opinions and hypotheses on both animal and human models. The author also proposes a medial geniculate body (MGB)-thalamic reticular nucleus (TRN)-Gating mechanism to reflect tinnitus-related neural information coming from upstream and downstream projection structures. The upstream structures include the lower auditory brainstem and midbrain structures. The downstream structures include the AC and certain limbic centers. Both upstream and downstream information is involved in a dynamic gating mechanism in the MGB together with the TRN. When abnormal gating occurs at the thalamic level, the spilled-out information interacts with the AC to generate tinnitus. The tinnitus signals at the MGB-TRN-Gating may be modulated by different forms of stimulations including brain stimulation. Each stimulation acts as a gain modulator to control the level of tinnitus signals at the MGB-TRN-Gate. This hypothesis may explain why different types of stimulation can induce tinnitus suppression. Depending on the tinnitus etiology, MGB-TRN-Gating may be different in levels and dynamics, which cause variability in tinnitus suppression induced by different gain controllers. This may explain why the induced suppression of tinnitus by one type of stimulation varies across individual patients.
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Affiliation(s)
- Jinsheng Zhang
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, School of Medicine, 5E-UHC, 4201 Saint Antoine, Detroit, MI 48201, USA.
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Phillips N, El Refaie A. What is the evidence that 1Hz rTMS positively affects chronic tinnitus? ACTA ACUST UNITED AC 2012. [DOI: 10.3109/1651386x.2012.684497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ernst F, Richter L, Matthäus L, Martens V, Bruder R, Schlaefer A, Schweikard A. Non-orthogonal tool/flange and robot/world calibration. Int J Med Robot 2012; 8:407-20. [DOI: 10.1002/rcs.1427] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Lars Matthäus
- Eemagine Medical Imaging Solutions GmbH; 10243; Berlin; Germany
| | - Volker Martens
- Institute for Robotics and Cognitive Systems; University of Lübeck; Ratzeburger Allee 160; 23538; Lübeck; Germany
| | - Ralf Bruder
- Institute for Robotics and Cognitive Systems; University of Lübeck; Ratzeburger Allee 160; 23538; Lübeck; Germany
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Vanneste S, De Ridder D. Noninvasive and Invasive Neuromodulation for the Treatment of Tinnitus: An Overview. Neuromodulation 2012; 15:350-60. [DOI: 10.1111/j.1525-1403.2012.00447.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Langguth B, Schecklmann M, Lehner A, Landgrebe M, Poeppl TB, Kreuzer PM, Schlee W, Weisz N, Vanneste S, De Ridder D. Neuroimaging and neuromodulation: complementary approaches for identifying the neuronal correlates of tinnitus. Front Syst Neurosci 2012; 6:15. [PMID: 22509155 PMCID: PMC3321434 DOI: 10.3389/fnsys.2012.00015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/01/2012] [Indexed: 11/13/2022] Open
Abstract
An inherent limitation of functional imaging studies is their correlational approach. More information about critical contributions of specific brain regions can be gained by focal transient perturbation of neural activity in specific regions with non-invasive focal brain stimulation methods. Functional imaging studies have revealed that tinnitus is related to alterations in neuronal activity of central auditory pathways. Modulation of neuronal activity in auditory cortical areas by repetitive transcranial magnetic stimulation (rTMS) can reduce tinnitus loudness and, if applied repeatedly, exerts therapeutic effects, confirming the relevance of auditory cortex activation for tinnitus generation and persistence. Measurements of oscillatory brain activity before and after rTMS demonstrate that the same stimulation protocol has different effects on brain activity in different patients, presumably related to interindividual differences in baseline activity in the clinically heterogeneous study cohort. In addition to alterations in auditory pathways, imaging techniques also indicate the involvement of non-auditory brain areas, such as the fronto-parietal "awareness" network and the non-tinnitus-specific distress network consisting of the anterior cingulate cortex, anterior insula, and amygdale. Involvement of the hippocampus and the parahippocampal region putatively reflects the relevance of memory mechanisms in the persistence of the phantom percept and the associated distress. Preliminary studies targeting the dorsolateral prefrontal cortex, the dorsal anterior cingulate cortex, and the parietal cortex with rTMS and with transcranial direct current stimulation confirm the relevance of the mentioned non-auditory networks. Available data indicate the important value added by brain stimulation as a complementary approach to neuroimaging for identifying the neuronal correlates of the various clinical aspects of tinnitus.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
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Lefaucheur JP, Brugières P, Guimont F, Iglesias S, Franco-Rodrigues A, Liégeois-Chauvel C, Londero A. Navigated rTMS for the treatment of tinnitus: A pilot study with assessment by fMRI and AEPs. Neurophysiol Clin 2012; 42:95-109. [DOI: 10.1016/j.neucli.2011.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 12/03/2011] [Accepted: 12/18/2011] [Indexed: 10/14/2022] Open
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Hand-assisted positioning and contact pressure control for motion compensated robotized transcranial magnetic stimulation. Int J Comput Assist Radiol Surg 2012; 7:845-52. [DOI: 10.1007/s11548-012-0677-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 02/28/2012] [Indexed: 11/27/2022]
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Lehner A, Schecklmann M, Landgrebe M, Kreuzer PM, Poeppl TB, Frank E, Vielsmeier V, Kleinjung T, Rupprecht R, Langguth B. Predictors for rTMS response in chronic tinnitus. Front Syst Neurosci 2012; 6:11. [PMID: 22383902 PMCID: PMC3284861 DOI: 10.3389/fnsys.2012.00011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 02/09/2012] [Indexed: 11/13/2022] Open
Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) has been studied as a treatment option for chronic tinnitus for almost 10 years now. Although most of these studies have demonstrated beneficial effects, treatment results show high interindividual variability and yet, little is known about predictors for treatment response. Methods: Data from 538 patients with chronic tinnitus were analyzed. Patients received either low-frequency rTMS over the left temporal cortex (n = 345, 1 Hz, 110% motor threshold, 2000 stimuli/day) or combined temporal and frontal stimulation (n = 193, 110% motor threshold, 2000 stimuli at 20 Hz over left dorsolateral prefrontal cortex plus 2000 stimuli at 1 Hz over temporal cortex). Numerous demographic, clinical, and audiological variables as well as different tinnitus characteristics were analyzed as potential predictors for treatment outcome, which was defined as change in the tinnitus questionnaire (TQ) score. Results: Both stimulation protocols resulted in a significant decrease of TQ scores. Effect sizes were small, however. In the group receiving combined treatment, patients with comorbid temporomandibular complaints benefited more from rTMS than patients without those complaints. In addition, patients with higher TQ scores at baseline had more pronounced TQ reductions than patients with low TQ baseline scores. Also, patients who had already improved from screening to baseline benefited less than patients without initial improvement. Conclusions: The results from this large sample demonstrate that rTMS shows only small but clinically significant effects in the treatment of chronic tinnitus. There are no good demographic or clinical predictors for treatment outcome.
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Affiliation(s)
- Astrid Lehner
- Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
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Chung HK, Tsai CH, Lin YC, Chen JM, Tsou YA, Wang CY, Lin CD, Jeng FC, Chung JG, Tsai MH. Effectiveness of Theta-Burst Repetitive Transcranial Magnetic Stimulation for Treating Chronic Tinnitus. ACTA ACUST UNITED AC 2012; 17:112-20. [DOI: 10.1159/000330882] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lefaucheur JP, André-Obadia N, Poulet E, Devanne H, Haffen E, Londero A, Cretin B, Leroi AM, Radtchenko A, Saba G, Thai-Van H, Litré CF, Vercueil L, Bouhassira D, Ayache SS, Farhat WH, Zouari HG, Mylius V, Nicolier M, Garcia-Larrea L. [French guidelines on the use of repetitive transcranial magnetic stimulation (rTMS): safety and therapeutic indications]. Neurophysiol Clin 2011; 41:221-95. [PMID: 22153574 DOI: 10.1016/j.neucli.2011.10.062] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 12/31/2022] Open
Abstract
During the past decade, a large amount of work on transcranial magnetic stimulation (TMS) has been performed, including the development of new paradigms of stimulation, the integration of imaging data, and the coupling of TMS techniques with electroencephalography or neuroimaging. These accumulating data being difficult to synthesize, several French scientific societies commissioned a group of experts to conduct a comprehensive review of the literature on TMS. This text contains all the consensual findings of the expert group on the mechanisms of action, safety rules and indications of TMS, including repetitive TMS (rTMS). TMS sessions have been conducted in thousands of healthy subjects or patients with various neurological or psychiatric diseases, allowing a better assessment of risks associated with this technique. The number of reported side effects is extremely low, the most serious complication being the occurrence of seizures. In most reported seizures, the stimulation parameters did not follow the previously published recommendations (Wassermann, 1998) [430] and rTMS was associated to medication that could lower the seizure threshold. Recommendations on the safe use of TMS / rTMS were recently updated (Rossi et al., 2009) [348], establishing new limits for stimulation parameters and fixing the contraindications. The recommendations we propose regarding safety are largely based on this previous report with some modifications. By contrast, the issue of therapeutic indications of rTMS has never been addressed before, the present work being the first attempt of a synthesis and expert consensus on this topic. The use of TMS/rTMS is discussed in the context of chronic pain, movement disorders, stroke, epilepsy, tinnitus and psychiatric disorders. There is already a sufficient level of evidence of published data to retain a therapeutic indication of rTMS in clinical practice (grade A) in chronic neuropathic pain, major depressive episodes, and auditory hallucinations. The number of therapeutic indications of rTMS is expected to increase in coming years, in parallel with the optimisation of stimulation parameters.
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Affiliation(s)
- J-P Lefaucheur
- EA 4391, faculté de médecine, université Paris-Est-Créteil, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Schecklmann M, Volberg G, Frank G, Hadersdorfer J, Steffens T, Weisz N, Landgrebe M, Hajak G, Greenlee M, Classen J, Langguth B. Paired associative stimulation of the auditory system: a proof-of-principle study. PLoS One 2011; 6:e27088. [PMID: 22073259 PMCID: PMC3206892 DOI: 10.1371/journal.pone.0027088] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 10/10/2011] [Indexed: 11/20/2022] Open
Abstract
Background Paired associative stimulation (PAS) consisting of repeated application of transcranial magnetic stimulation (TMS) pulses and contingent exteroceptive stimuli has been shown to induce neuroplastic effects in the motor and somatosensory system. The objective was to investigate whether the auditory system can be modulated by PAS. Methods Acoustic stimuli (4 kHz) were paired with TMS of the auditory cortex with intervals of either 45 ms (PAS(45 ms)) or 10 ms (PAS(10 ms)). Two-hundred paired stimuli were applied at 0.1 Hz and effects were compared with low frequency repetitive TMS (rTMS) at 0.1 Hz (200 stimuli) and 1 Hz (1000 stimuli) in eleven healthy students. Auditory cortex excitability was measured before and after the interventions by long latency auditory evoked potentials (AEPs) for the tone (4 kHz) used in the pairing, and a control tone (1 kHz) in a within subjects design. Results Amplitudes of the N1-P2 complex were reduced for the 4 kHz tone after both PAS(45 ms) and PAS(10 ms), but not after the 0.1 Hz and 1 Hz rTMS protocols with more pronounced effects for PAS(45 ms). Similar, but less pronounced effects were observed for the 1 kHz control tone. Conclusion These findings indicate that paired associative stimulation may induce tonotopically specific and also tone unspecific human auditory cortex plasticity.
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Affiliation(s)
- Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
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Burger J, Frank E, Kreuzer P, Kleinjung T, Vielsmeier V, Landgrebe M, Hajak G, Langguth B. Transcranial magnetic stimulation for the treatment of tinnitus: 4-year follow-up in treatment responders—a retrospective analysis. Brain Stimul 2011; 4:222-7. [DOI: 10.1016/j.brs.2010.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/08/2010] [Accepted: 11/26/2010] [Indexed: 01/28/2023] Open
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Richter L, Ernst F, Schlaefer A, Schweikard A. Robust real-time robot-world calibration for robotized transcranial magnetic stimulation. Int J Med Robot 2011; 7:414-22. [PMID: 21834131 DOI: 10.1002/rcs.411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND For robotized transcranial magnetic stimulation (TMS), the magnetic coil is placed on the patient's head by a robot. As the robotized TMS system requires tracking of head movements, robot and tracking camera need to be calibrated. However, for robotized TMS in a clinical setting, such calibration is required frequently. Mounting/unmounting a marker to the end effector and moving the robot into different poses is impractical. Moreover, if either system is moved during treatment, recalibration is required. METHODS To overcome this limitation, we propose to directly track a marker at link three of the articulated arm. Using forward kinematics and a constant marker transform to link three, the calibration can be performed instantly. RESULTS Our experimental results indicate an accuracy similar to standard hand-eye calibration approaches. It also outperforms classical hand-held navigated TMS systems. CONCLUSION This robust online calibration greatly enhances the system's user-friendliness and safety.
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Affiliation(s)
- Lars Richter
- Institute for Robotics and Cognitive Systems, University of Lübeck, Germany.
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Bystritsky A, Korb AS, Douglas PK, Cohen MS, Melega WP, Mulgaonkar AP, DeSalles A, Min BK, Yoo SS. A review of low-intensity focused ultrasound pulsation. Brain Stimul 2011; 4:125-36. [PMID: 21777872 DOI: 10.1016/j.brs.2011.03.007] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/20/2011] [Accepted: 03/20/2011] [Indexed: 01/16/2023] Open
Abstract
With the recent approval by the Food and Drug Administration (FDA) of Deep Brain Stimulation (DBS) for Parkinson's Disease, dystonia and obsessive compulsive disorder (OCD), vagus nerve stimulation (VNS) for epilepsy and depression, and repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression, neuromodulation has become increasingly relevant to clinical research. However, these techniques have significant drawbacks (eg, lack of special specificity and depth for the rTMS, and invasiveness and cumbersome maintenance for DBS). This article reviews the background, rationale, and pilot studies to date, using a new brain stimulation method-low-intensity focused ultrasound pulsation (LIFUP). The ability of ultrasound to be focused noninvasively through the skull anywhere within the brain, together with concurrent imaging (ie, functional magnetic resonance imaging [fMRI]) techniques, may create a role for research and clinical use of LIFUP. This technique is still in preclinical testing and needs to be assessed thoroughly before being advanced to clinical trials. In this study, we review over 50 years of research data on the use of focused ultrasound (FUS) in neuronal tissue and live brain, and propose novel applications of this noninvasive neuromodulation method.
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Affiliation(s)
- Alexander Bystritsky
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 90095, USA.
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