Kan Ying, Wang Wei, Zhang Shu-Xin, Ma Huan, Wang Zhen-Chang, Yang Ji-Gang
Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
World J Clin Cases. 2019 Jul 6;7(13):1582-1590. doi: 10.12998/wjcc.v7.i13.1582.
The central mechanism of idiopathic tinnitus is related to hyperactivity of cortical and subcortical auditory and non-auditory areas. Repetitive transcranial magnetic stimulation (rTMS) is a well-tolerated, non-invasive potential treatment option for tinnitus.
To investigate the changes of neural metabolic activity after rTMS in chronic idiopathic tinnitus (IT) patients.
Eleven patients underwent rTMS (1 Hz, 90% motor threshold, 1000 stimuli/day for consecutive 10 d) on the left temporoparietal region cortex. Tinnitus handicap inventory (THI) and visual analogue score (VAS) were assessed at baseline and posttreatment. All patients underwent F-fluorodeoxyglucose (FDG) positron emission tomography to evaluate the neural metabolic activity. Data were preprocessed using statistical parametric mapping and Gretna software to extract the regions of interest (ROIs). The correlation between brain areas involved and THI scores was analyzed.
Baseline and posttreatment parameters showed no significant difference regarding THI score ( = 1.019, = 0.342 > 0.05) and VAS ( = 0.00, = 1.0 > 0.05). Regions with the highest FDG uptake were the right inferior temporal gyrus (ITG), right parahippocampa gyrus (PHG), right hippocampus, rectus gyrus, left middle frontal gyrus, and right inferior frontal gyrus in IT patients. After rTMS treatment, IT patients showed increased activities in the right PHG, right superior temporal gyrus, right superior frontal gyrus, anterior insula, left inferior parietal lobule, and left precentral gyrus, and decreased activities in the left postcentral gyrus and left ITG. The ROIs in the right parahippocampa gyrus and right superior frontal gyrus were positively correlated with THI scores ( = 0.737, = 0.037 < 0.05; = 0.735, = 0.038 < 0.05).
Our study showed that 1-Hz rTMS directed to the left temporo-parietal junction resulted no statistically significant symptom alleviation. After treatment, brain areas of the limbic and prefrontal system showed high neutral metabolic activity. The auditory and non-auditory systems together will be the target for rTMS treatment.
特发性耳鸣的核心机制与皮质及皮质下听觉和非听觉区域的活动亢进有关。重复经颅磁刺激（rTMS）是一种耐受性良好的耳鸣非侵入性潜在治疗选择。
探讨慢性特发性耳鸣（IT）患者经rTMS治疗后神经代谢活动的变化。
11例患者在左侧颞顶叶皮质区域接受rTMS治疗（1赫兹，90%运动阈值，连续10天，每天1000次刺激）。在基线和治疗后评估耳鸣 handicap 量表（THI）和视觉模拟评分（VAS）。所有患者均接受F-氟脱氧葡萄糖（FDG）正电子发射断层扫描以评估神经代谢活动。使用统计参数映射和Gretna软件对数据进行预处理以提取感兴趣区域（ROI）。分析受累脑区与THI评分之间的相关性。
基线和治疗后参数在THI评分（=1.019，=0.342>0.05）和VAS（=0.00，=1.0>0.05）方面无显著差异。IT患者中FDG摄取最高的区域是右侧颞下回（ITG）、右侧海马旁回（PHG）、右侧海马、直回、左侧额中回和右侧额下回。rTMS治疗后，IT患者右侧PHG、右侧颞上回、右侧额上回、前岛叶、左侧顶下小叶和左侧中央前回的活动增加，左侧中央后回和左侧ITG的活动减少。右侧海马旁回和右侧额上回的ROI与THI评分呈正相关（=0.737，=0.037<0.05；=0.735，=0.038<0.05）。
我们的研究表明，针对左侧颞顶交界区的1赫兹rTMS治疗在统计学上没有显著的症状缓解。治疗后，边缘系统和前额叶系统的脑区显示出高神经代谢活动。听觉和非听觉系统共同将成为rTMS治疗的靶点。
