Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany.
Department of Psychology, Universität der Bundeswehr München, Neubiberg, Germany.
BMC Neurol. 2023 Jan 12;23(1):14. doi: 10.1186/s12883-022-03036-y.
Low frequency repetitive transcranial magnetic stimulation (rTMS) is commonly used to inhibit pathological hyperactivity of the auditory cortex in tinnitus. Novel and supposedly superior and faster inhibitory protocols such as continuous theta burst stimulation (cTBS) were examined as well, but so far there is not sufficient evidence for a treatment application in chronic tinnitus. rTMS effects in general are dependent on the brain state immediate before stimulation. This feasibility study was designed based on the concept to shift the pathological intrinsic brain state of tinnitus patients via acoustic stimulation ("activate") and induce inhibitory effects via cTBS ("fire").
Seven tinnitus patients with response in residual inhibition received 10 consecutive daily sessions of a combinatory treatment comprised of 3-minute acoustic stimulation with white noise followed by 600 pulses of cTBS over the left temporo-parietal cortex (activate & fire). A control group of 5 patients was treated parallel to the activate & fire data collection with 10 sessions á 3000 pulses of 1 Hz rTMS over the left temporo-parietal cortex.
The activate & fire protocol was well tolerated except in one patient with tinnitus loudness increase. This patient was excluded from analyses. No statistical superiority of the activate & fire treatment approach in alleviating tinnitus-related symptoms was evident. Power calculations showed an effect size of 0.706 and a needed sample size of 66 for statistical significant group differences. On a descriptive level the activate & fire group demonstrated a stronger decrease in tinnitus-related symptoms.
The present feasibility study showed that combining acoustic stimulation with magnetic brain stimulation may be well-tolerable in the majority of patients and represents a promising treatment approach for tinnitus by hypothetically alter the intrinsic state prior to brain stimulation.
低频重复经颅磁刺激（rTMS）常用于抑制耳鸣患者听觉皮层的病理性过度兴奋。新型且据称更优越、更快的抑制方案，如连续 theta 爆发刺激（cTBS），也进行了研究，但迄今为止，慢性耳鸣的治疗应用还没有足够的证据。rTMS 的效果一般取决于刺激前的大脑状态。本可行性研究基于通过声刺激改变耳鸣患者病理性内在大脑状态（“激活”）并通过 cTBS 诱导抑制效应（“点火”）的概念设计。
7 名对残余抑制有反应的耳鸣患者接受了 10 次连续的联合治疗，每次治疗包括 3 分钟的白噪声声刺激，随后在左颞顶叶皮层进行 600 个脉冲的 cTBS（激活和点火）。对照组的 5 名患者在与激活和点火数据采集平行的情况下接受了 10 次治疗，每次治疗左颞顶叶皮层接受 1Hz rTMS 的 3000 个脉冲。
激活和点火方案除了在一名耳鸣响度增加的患者中耐受性较差外，其余患者均耐受良好。该患者被排除在分析之外。没有明显证据表明激活和点火治疗方法在缓解耳鸣相关症状方面具有统计学优势。功效计算显示，组间差异具有统计学意义的效应大小为 0.706，需要的样本量为 66。在描述性水平上，激活和点火组表现出更强的耳鸣相关症状减轻。
本可行性研究表明，在大多数患者中，将声刺激与磁脑刺激相结合可能具有良好的耐受性，通过假设在脑刺激前改变内在状态，代表了一种有前途的耳鸣治疗方法。
