Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
European School for Interdisciplinary Tinnitus Research (ESIT), Regensburg, Germany.
Sci Rep. 2019 Aug 21;9(1):12190. doi: 10.1038/s41598-019-48750-9.
Over the past few years extensive body of research was produced investigating the effects of repetitive transcranial magnetic stimulation (rTMS) for the treatment of chronic tinnitus with heterogeneous results. This heterogeneity is exemplified by two recently published large-scale clinical trials reporting different outcomes. Technical aspects of rTMS were suspected as a potential source for this incongruency. The aim of this systematic review is to examine the overall efficacy as well as to identify possible technical factors relevant for the effectiveness of rTMS tinnitus trials. Via a literature search appropriate original research papers were identified and rTMS parameters were extracted from each study arm for subsequent statistical analysis with respect to observed effects (significant vs. not significant pre-post rTMS effects). Our findings indicate that verum rTMS is superior to sham rTMS as demonstrated by the proportion of significant pre-post contrasts. Some relevant rTMS parameters (e.g., pulse waveform) are not reported. Lower rTMS stimulation intensity was associated with significant effects in verum rTMS arms. An additional stimulation of the DLPFC to the temporal cortex was not found to promote efficacy. Future research should consider differential effects of rTMS induced by technical parameters and strive for an exhaustive reporting of relevant rTMS parameters.
在过去的几年中，已经产生了大量的研究来调查重复经颅磁刺激（rTMS）治疗慢性耳鸣的效果，结果存在异质性。这种异质性体现在最近发表的两项大型临床试验报告了不同的结果中。rTMS 的技术方面被怀疑是这种不一致的潜在来源。本系统评价的目的是检查整体疗效，并确定 rTMS 耳鸣试验有效性的可能技术因素。通过文献检索，确定了合适的原始研究论文，并从每个研究臂中提取 rTMS 参数，以便随后进行统计学分析，以观察到的效果（rTMS 前后的显著与不显著效果）。我们的研究结果表明，正如显著 rTMS 前后对比的比例所证明的那样，真实 rTMS 优于假 rTMS。一些相关的 rTMS 参数（例如，脉冲波形）没有报告。真实 rTMS 臂中较低的 rTMS 刺激强度与显著效果相关。我们没有发现对颞叶皮层的 DLPFC 的额外刺激可以提高疗效。未来的研究应该考虑由技术参数引起的 rTMS 的差异效应，并努力详尽地报告相关的 rTMS 参数。
