θ波、α波和β波爆发式经颅磁刺激：耳鸣中的脑调制
Theta, alpha and beta burst transcranial magnetic stimulation: brain modulation in tinnitus.
作者信息
De Ridder Dirk, van der Loo Elsa, Van der Kelen Karolien, Menovsky Tomas, van de Heyning Paul, Moller Aage
机构信息
Dept of Neurosurgery, ENT, University Hospital Antwerp, Edegem, Belgium.
出版信息
Int J Med Sci. 2007 Oct 9;4(5):237-41. doi: 10.7150/ijms.4.237.
INTRODUCTION
Some forms of tinnitus are considered to be auditory phantom phenomena related to reorganization and hyperactivity of the auditory central nervous system. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool capable of modulating human brain activity, using single pulse or burst stimuli. Burst rTMS has only been performed in the theta range, and has not been used clinically. The authors analyze whether burst TMS at theta (5 Hz), alpha (10 Hz) and beta (20 Hz) frequencies can temporarily suppress narrow band noise/white noise tinnitus, which has been demonstrated to be intractable to tonic stimulation.
METHODS
rTMS is performed both in tonic and burst mode in 46 patients contralateral to the tinnitus side, at 5, 10 and 20 Hz. Fourteen placebo negative rTMS responders are further analyzed.
RESULTS
In 5 patients, maximal tinnitus suppression is obtained with theta, in 2 with alpha and in 7 with beta burst stimulation. Burst rTMS suppresses narrow band/white tinnitus much better than tonic rTMS t(13)=6.4, p<.000. Women experience greater suppression of their tinnitus with burst stimulation than men, t(12)=2.9, p<.05. Furthermore left sided tinnitus is perceived as more distressing on the TQ than right sided tinnitus, t(12)=3.2, p<.01. The lower the tinnitus pitch the more effectively rTMS suppresses tinnitus(r=-0.65, p<0.05).
DISCUSSION
Burst rTMS can be used clinically, not only theta burst, but also alpha and beta burst. Burst rTMS is capable of suppressing narrow band/white noise tinnitus very much better than tonic rTMS. This could be due the simple fact that burst neuromodulation is more powerful than tonic neuromodulation or to a differential effect of burst and tonic stimulation on the lemniscal and extralemniscal auditory system. In some patients only alpha or beta burst rTMS is capable of suppressing tinnitus, and theta burst not. Therefore in future rTMS studies it could be worthwhile not to limit burst stimulation to theta burst rTMS.
引言
某些形式的耳鸣被认为是与听觉中枢神经系统重组和活动亢进相关的听觉幻觉现象。重复经颅磁刺激（rTMS）是一种能够使用单脉冲或脉冲串刺激来调节人脑活动的非侵入性工具。脉冲串rTMS仅在θ波范围内进行过，尚未应用于临床。作者分析了θ（5赫兹）、α（10赫兹）和β（20赫兹）频率的脉冲串经颅磁刺激是否能暂时抑制窄带噪声/白噪声耳鸣，这种耳鸣已被证明对强直刺激难以治疗。
方法
对46例耳鸣侧对侧的患者分别以5、10和20赫兹的频率进行强直模式和脉冲串模式的rTMS治疗。对14例安慰剂阴性rTMS反应者进行进一步分析。
结果
5例患者通过θ波脉冲串刺激获得最大耳鸣抑制效果，2例通过α波，7例通过β波脉冲串刺激。脉冲串rTMS比强直rTMS能更好地抑制窄带/白噪声耳鸣，t（13）=6.4，p<0.000。女性在脉冲串刺激下耳鸣抑制程度比男性更大，t（12）=2.9，p<0.05。此外，在耳鸣问卷（TQ）上，左侧耳鸣比右侧耳鸣更令人苦恼，t（12）=3.2，p<0.01。耳鸣音调越低，rTMS抑制耳鸣的效果越有效（r=-0.65，p<0.05）。
讨论
脉冲串rTMS可用于临床，不仅是θ波脉冲串，α波和β波脉冲串也可。脉冲串rTMS抑制窄带/白噪声耳鸣的能力比强直rTMS强得多。这可能是因为脉冲串神经调节比强直神经调节更强大，或者是脉冲串和强直刺激对lemniscal和extralemniscal听觉系统的不同作用。在一些患者中，只有α波或β波脉冲串rTMS能够抑制耳鸣，而θ波脉冲串则不能。因此，在未来的rTMS研究中，不将脉冲串刺激局限于θ波脉冲串rTMS可能是值得的。
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