Kleinjung T, Steffens T, Langguth B, Eichhammer P, Marienhagen J, Hajak G, Strutz J
Klinik für HNO-Heilkunde der Universität Regensburg, Regensburg.
HNO. 2006 Jun;54(6):439-44. doi: 10.1007/s00106-005-1329-8.
Idiopathic tinnitus is a frequent and debilitating disorder of largely unknown pathophysiology. Focal brain activation in the auditory cortex has recently been demonstrated in chronic tinnitus. Low-frequency rTMS can reduce cortical hyperexcitability.
In 12 patients with chronic tinnitus, fusion of [18F]deoxyglucose-PET and structural MRI (T1, MPRAGE) scans allowed the area of increased metabolic activity in the auditory cortex to be exactly identified; this area was selected as the target for rTMS. A neuronavigational system adapted for TMS positioning enabled the relative positions of the figure-8 coil and the target area to be monitored. Repetitive TMS (110% motor threshold; 1 Hz; 2000 stimuli per day over 5 days) was performed using a placebo-controlled crossover design. A sham coil system was used for the placebo stimulation. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller).
In all 12 patients an asymmetrically increased metabolic activation of the gyrus of Heschl was detected. The tinnitus score was significantly improved after 5 days of active rTMS, an effect not seen after placebo stimulation.
These preliminary results show that neuronavigated rTMS may improve our understanding and treatment of chronic tinnitus.
特发性耳鸣是一种常见且使人衰弱的疾病，其病理生理学在很大程度上尚不清楚。最近已证实在慢性耳鸣患者中听觉皮层存在局灶性脑激活。低频重复经颅磁刺激（rTMS）可降低皮层的过度兴奋性。
对12例慢性耳鸣患者进行[18F]脱氧葡萄糖正电子发射断层扫描（PET）与结构磁共振成像（T1加权像、磁化准备快速梯度回波序列）扫描融合，从而能够精确识别听觉皮层代谢活动增加的区域；该区域被选为rTMS的靶点。一种适用于TMS定位的神经导航系统可监测8字形线圈与目标区域的相对位置。采用安慰剂对照交叉设计进行重复经颅磁刺激（110%运动阈值；1赫兹；5天内每天2000次刺激）。使用假线圈系统进行安慰剂刺激。采用特定的耳鸣问卷（戈贝尔和希勒）评估治疗效果。
在所有12例患者中均检测到赫氏回代谢激活不对称增加。主动rTMS治疗5天后耳鸣评分显著改善，而安慰剂刺激后未观察到这种效果。
这些初步结果表明，神经导航rTMS可能会增进我们对慢性耳鸣的理解和治疗。
