Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany.
Front Syst Neurosci. 2012 Feb 23;6:11. doi: 10.3389/fnsys.2012.00011. eCollection 2012.
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.
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.
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.
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.
重复经颅磁刺激（rTMS）作为慢性耳鸣的治疗选择已经研究了近 10 年。尽管这些研究中的大多数都证明了其有益的效果，但治疗结果显示出高度的个体间变异性，而且对于治疗反应的预测因素知之甚少。
分析了 538 例慢性耳鸣患者的数据。患者接受左侧颞叶皮层低频 rTMS 治疗（n = 345，1 Hz，110%运动阈值，2000 次刺激/天）或颞叶和额叶联合刺激（n = 193，110%运动阈值，20 Hz 左背外侧前额叶 2000 次刺激加 1 Hz 颞叶皮层 2000 次刺激）。分析了许多人口统计学、临床和听力变量以及不同的耳鸣特征，作为治疗结果的潜在预测因素，治疗结果定义为耳鸣问卷（TQ）评分的变化。
两种刺激方案均导致 TQ 评分显著降低。然而，效果大小较小。在接受联合治疗的组中，伴有颞下颌关节紊乱症的患者从 rTMS 中获益多于无这些抱怨的患者。此外，基线时 TQ 评分较高的患者比 TQ 基线评分较低的患者 TQ 降低更为明显。此外，与没有初始改善的患者相比，从筛查到基线已经改善的患者获益较少。
这项大样本研究的结果表明，rTMS 在慢性耳鸣的治疗中仅显示出较小但具有临床意义的效果。对于治疗结果，没有良好的人口统计学或临床预测因素。
