Ciminelli Patricia, Sender David, Palmeira Manoela, Mezzasalma Marco André, Cascardo Arnaldo, Machado Sergio, Nardi Antonio Egidio
Laboratory of Panic & Respiration (LABPR), Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
Juiz de Fora Federal University, Niterói, Brazil.
Eurasian J Med. 2019 Feb;51(1):98-100. doi: 10.5152/eurasianjmed.2018.18073. Epub 2018 Apr 8.
We present a successful tinnitus treatment case with intensity and distress reduction in a patient subjected to bilateral 10 Hz repetitive transcranial magnetic stimulation (rTMS) to the dorsomedial prefrontal cortex (DMPFC). Subjective tinnitus is the perception of sound in the ears or head when no corresponding external stimulus exists. Approximately 1%-2% of the population report severe tinnitus with daily life impairment. Sham-controlled studies have revealed benefits using rTMS in tinnitus, although the improvement is moderate or temporary, indicating the need for new strategies. Evidence that the DMPFC is important in tinnitus pathophysiology makes this area a promising target. A 51-year-old male patient with a 4-year history of treatment-resistant moderate bilateral tinnitus was treated with 20 sessions of bilateral 10 Hz DMPFC rTMS. The patient showed important reduction and sustained 4-month response in tinnitus loudness and annoyance, 24 point drop in tinnitus handicap inventory, visual analog scale reduction to zero, and tinnitus loudness of 1 dB compared to baseline 15 dB. Tinnitus treatment is challenging and new alternatives are needed. To our knowledge, this is the first report using rTMS to the DMPFC for tinnitus. In this protocol, important and sustained reduction of tinnitus annoyance and loudness was obtained. This outcome of the case suggests that this approach is promising for treating tinnitus and is worth further investigation.
我们报告了一例成功的耳鸣治疗案例，该患者接受了双侧10赫兹重复经颅磁刺激（rTMS）至背内侧前额叶皮质（DMPFC），耳鸣强度和痛苦程度均有所降低。主观性耳鸣是指在没有相应外部刺激时，耳朵或头部出现的声音感知。约1%-2%的人群报告有严重耳鸣并伴有日常生活障碍。伪对照研究显示，rTMS对耳鸣有一定益处，尽管改善程度为中度或暂时的，这表明需要新的治疗策略。有证据表明DMPFC在耳鸣病理生理学中起重要作用，这使得该区域成为一个有前景的治疗靶点。一名51岁男性患者，患有4年难治性中度双侧耳鸣，接受了20次双侧10赫兹DMPFC rTMS治疗。患者耳鸣响度和烦恼程度显著降低，并持续了4个月，耳鸣 handicap 量表下降了24分，视觉模拟量表降至零，耳鸣响度从基线的15分贝降至1分贝。耳鸣治疗具有挑战性，需要新的治疗方法。据我们所知，这是第一份使用rTMS刺激DMPFC治疗耳鸣的报告。在此方案中，耳鸣烦恼程度和响度得到了显著且持续的降低。该病例结果表明，这种方法对耳鸣治疗具有前景，值得进一步研究。
