Neurosurgery, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand.
Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
Curr Top Behav Neurosci. 2021;51:249-293. doi: 10.1007/7854_2021_219.
The pathophysiological mechanisms that underlie the generation and maintenance of tinnitus are being unraveled progressively. Based on this knowledge, a large variety of different neuromodulatory interventions have been developed and are still being designed, adapting to the progressive mechanistic insights in the pathophysiology of tinnitus. rTMS targeting the temporal, temporoparietal, and the frontal cortex has been the mainstay of non-invasive neuromodulation. Yet, the evidence is still unclear, and therefore systematic meta-analyses are needed for drawing conclusions on the effectiveness of rTMS in chronic tinnitus. Different forms of transcranial electrical stimulation (tDCS, tACS, tRNS), applied over the frontal and temporal cortex, have been investigated in tinnitus patients, also without robust evidence for universal efficacy. Cortex and deep brain stimulation with implanted electrodes have shown benefit, yet there is insufficient data to support their routine clinical use. Recently, bimodal stimulation approaches have revealed promising results and it appears that targeting different sensory modalities in temporally combined manners may be more promising than single target approaches.While most neuromodulatory approaches seem promising, further research is required to help translating the scientific outcomes into routine clinical practice.
耳鸣产生和维持的病理生理机制正在逐步被揭示。基于这一知识,已经开发出了大量不同的神经调节干预措施,并且还在不断设计中,以适应耳鸣病理生理学的不断深入的机制见解。针对颞叶、颞顶叶和额叶皮层的 rTMS 一直是非侵入性神经调节的主要手段。然而,证据仍然不明确,因此需要进行系统的荟萃分析,才能得出 rTMS 治疗慢性耳鸣有效性的结论。不同形式的经颅电刺激(tDCS、tACS、tRNS)应用于额叶和颞叶皮层,也已经在耳鸣患者中进行了研究,但普遍有效性的证据仍然不足。植入电极的皮层和深部脑刺激显示出了益处,但目前的数据还不足以支持其常规临床应用。最近,双模态刺激方法显示出了有希望的结果,似乎表明以时间组合的方式针对不同的感觉模态进行靶向治疗可能比单一目标方法更有前途。虽然大多数神经调节方法似乎很有前景,但需要进一步的研究来帮助将科学成果转化为常规临床实践。
Curr Top Behav Neurosci. 2021
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