Park Sera, Park Hae-Jung, Kyeong Sung-Hyon, Moon In Seok, Kim Minbum, Kim Hee Nam, Choi Jae-Young
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
Acta Otolaryngol. 2013 Jun;133(6):600-6. doi: 10.3109/00016489.2012.763181. Epub 2013 Feb 28.
The study showed that combined repetitive transcranial magnetic stimulation (rTMS) on the auditory cortex and prefrontal cortex has more benefit than rTMS on the auditory cortex alone for tinnitus control in patients with depression. Further studies for the most optimal combination of stimulation on both areas are needed.
Recent studies suggest that the neuronal network changes of chronic tinnitus are beyond the auditory pathway. There is increasing evidences for the application of rTMS on multiple brain cortices in addition to the auditory cortex for the treatment of tinnitus. Sequential rTMS was performed on the auditory cortex alone as well as the auditory cortex combined with prefrontal cortex in patients with both chronic tinnitus and depression.
Patients who presented with chronic tinnitus of more than 1 year were enrolled in the present study (seven males, four females; mean age 54 years). To select the site for the rTMS, PET CT was performed. Patients received the first rTMS on the primary auditory cortex for 5 days and on the primary auditory cortex and prefrontal cortex in the second application after tinnitus relapse. The Tinnitus Handicap Inventory (THI), visual analog scale (VAS), and Beck Depression Inventory (BDI) were evaluated before and after rTMS.
The mean THI score of the eight patients with depression changed from 77.5 ± 15 to 61.8 ± 20.1 after the second rTMS. There was statistical significance only for the second rTMS. The VAS score changed from 8.6 ± 1.6 to 6.3 ± 1.8 after the first rTMS and from 7.6 ± 2.4 to 4.6 ± 2.7 after the second rTMS, showing statistically significant changes both times. The THI changes after the second rTMS were greater than after the first rTMS, and the changes in VAS score showed a similar pattern. The changes in BDI score, which indicates the severity of depression, showed a variable pattern after rTMS. Patients with mild depression (10≤ BDI score <16, n = 4) showed significant improvement of THI with the second combined rTMS (ΔTHI = 24.5) as compared with the first rTMS on the auditory area (ΔTHI = 6). In contrast, combined rTMS did not show any better improvement on THI (ΔTHI = 6.5) than the first rTMS on the auditory cortex (ΔTHI = 7) in patients without depression (BDI <10, n = 3) and patients with moderate to severe depression (BDI ≥16, n = 4).
研究表明，对于抑郁症患者的耳鸣控制，在听觉皮层和前额叶皮层联合进行重复经颅磁刺激（rTMS）比仅在听觉皮层进行rTMS更有益。需要进一步研究这两个区域刺激的最佳组合。
最近的研究表明，慢性耳鸣的神经网络变化超出了听觉通路。越来越多的证据表明，除了听觉皮层外，在多个脑皮层应用rTMS治疗耳鸣。对患有慢性耳鸣和抑郁症的患者，分别单独在听觉皮层以及在听觉皮层与前额叶皮层联合进行序贯rTMS。
本研究纳入了患有超过1年慢性耳鸣的患者（男性7例，女性4例；平均年龄54岁）。为选择rTMS的部位，进行了PET CT检查。患者在初次rTMS时在初级听觉皮层进行5天治疗，耳鸣复发后第二次治疗时在初级听觉皮层和前额叶皮层进行。在rTMS前后评估耳鸣障碍量表（THI）、视觉模拟量表（VAS）和贝克抑郁量表（BDI）。
8例抑郁症患者的平均THI评分在第二次rTMS后从77.5±15降至61.8±20.1。仅第二次rTMS有统计学意义。VAS评分在第一次rTMS后从8.6±1.6降至6.3±1.8，在第二次rTMS后从7.6±2.4降至4.6±2.7，两次均显示有统计学意义的变化。第二次rTMS后THI的变化大于第一次rTMS后，VAS评分的变化呈现类似模式。表明抑郁严重程度的BDI评分变化在rTMS后呈现可变模式。轻度抑郁症患者（10≤BDI评分<16，n = 4）在第二次联合rTMS后THI有显著改善（ΔTHI = 24.5），相比在听觉区域的第一次rTMS（ΔTHI = 6）。相比之下，在无抑郁症患者（BDI<10，n = 3）和中度至重度抑郁症患者（BDI≥16，n = 4）中，联合rTMS在THI改善方面（ΔTHI = 6.5）并不比在听觉皮层的第一次rTMS（ΔTHI = 7）更好。
