正电子发射断层扫描导航下重复经颅磁刺激治疗慢性耳鸣的中度疗效：一项随机对照试验性研究
Moderate therapeutic efficacy of positron emission tomography-navigated repetitive transcranial magnetic stimulation for chronic tinnitus: a randomised, controlled pilot study.
作者信息
Plewnia C, Reimold M, Najib A, Reischl G, Plontke S K, Gerloff C
机构信息
Brain-Stimulation Laboratory, Department of Psychiatry, University of Tuebingen, Tuebingen, Germany.
出版信息
J Neurol Neurosurg Psychiatry. 2007 Feb;78(2):152-6. doi: 10.1136/jnnp.2006.095612. Epub 2006 Aug 4.
BACKGROUND
Tinnitus has been shown to respond to modulations of cortical activity by high-frequency and low-frequency repetitive transcranial magnetic stimulation (rTMS).
OBJECTIVE
To determine the tinnitus-attenuating effects of a 2-week daily regimen of rTMS, navigated to the maximum of tinnitus-related increase in regional cerebral blood flow.
METHODS
Six patients with chronic tinnitus were enrolled in this sham-controlled crossover study and treated with 2x2 weeks of suprathreshold 1 Hz rTMS (30 min) applied to the region with maximal tinnitus-related increase in regional cerebral blood flow delineated by functional imaging with [15O]H2O positron emission tomography and a control area. Tinnitus-related distress was assessed before and after each treatment and 2 weeks after the end of the 4-week course of stimulation using a validated tinnitus questionnaire. Additional self-assessment scores of tinnitus change, loudness and annoyance were obtained.
RESULTS
In five of six patients, rTMS induced greater reduction of the tinnitus questionnaire score than sham stimulation. In two patients, all parameters measured (tinnitus change score, tinnitus loudness, tinnitus annoyance) showed unequivocal improvement. At the group level, the degree of response in the tinnitus questionnaire score was correlated with tinnitus-associated activation of the anterior cingulate cortex. Two weeks after the final stimulation, tinnitus had returned to baseline in all patients but one.
CONCLUSION
Tinnitus can be attenuated by low-frequency rTMS navigated to each person's maximum tinnitus-related cortical hyperactivity. The effects are only moderate; interindividual responsiveness varies and the attenuation seems to wear off within 2 weeks after the last stimulation session. Notably, tinnitus-related anterior cingulate cortex activation seems to predict the response to rTMS treatment.
背景
高频和低频重复经颅磁刺激（rTMS）已被证明可调节皮质活动，从而改善耳鸣。
目的
确定每日进行2周的rTMS治疗方案对耳鸣的减轻效果，该治疗方案以耳鸣相关的局部脑血流增加最大值为靶点。
方法
6例慢性耳鸣患者纳入这项假刺激对照交叉研究，接受2×2周的阈上1Hz rTMS（30分钟）治疗，刺激部位为通过[15O]H2O正电子发射断层扫描功能成像确定的耳鸣相关局部脑血流增加最大值区域以及一个对照区域。在每次治疗前后以及4周刺激疗程结束后2周，使用经过验证的耳鸣问卷评估耳鸣相关痛苦。还获得了耳鸣变化、响度和烦恼程度的额外自我评估分数。
结果
6例患者中有5例，rTMS比假刺激更能降低耳鸣问卷评分。2例患者的所有测量参数（耳鸣变化评分、耳鸣响度、耳鸣烦恼程度）均有明显改善。在组水平上，耳鸣问卷评分的反应程度与前扣带回皮质的耳鸣相关激活相关。最后一次刺激后2周，除1例患者外，所有患者的耳鸣均恢复至基线水平。
结论
以每个人最大的耳鸣相关皮质活动亢进为靶点的低频rTMS可减轻耳鸣。效果仅为中度；个体反应性不同，且在最后一次刺激疗程后2周内，耳鸣减轻效果似乎消失。值得注意的是，耳鸣相关的前扣带回皮质激活似乎可预测对rTMS治疗的反应。
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