Yang Shuangfeng, Yang Dan, Gou Chen, Tu Min, Tan Yuling, Yang Ling, Wang Xiaoming
Institute of Neurological Diseases, North Sichuan Medical College, Nanchong 637000, China; Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China; Department of Endocrinology and Geriatrics, The People's Hospital of Yuechi County, Yuechi 638300, China.
Institute of Neurological Diseases, North Sichuan Medical College, Nanchong 637000, China; Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
Clin Neurol Neurosurg. 2023 Apr;227:107664. doi: 10.1016/j.clineuro.2023.107664. Epub 2023 Feb 28.
To observe abnormal tinnitus activity by evaluating the amplitude of low-frequency fluctuation (ALFF) changes in the brain was which detected by resting-state functional magnetic resonance imaging (rs-fMRI) in patients with intractable tinnitus before and after repetitive transcranial magnetic stimulation (rTMS). We hypothesized that rTMS could progressively revert local brain function back to a relatively normal range.
This prospective observational research study recruited 25 patients with intractable tinnitus, with 28 healthy controls matched by age, sex, and education level. Participants' Tinnitus Handicap Inventory (THI) scores and the visual analog scale (VAS) were used to determine the severity of their tinnitus before and after treatment. We processed the brain spontaneous neural activity of intractable tinnitus patients by ALFF, then, we determined its association with clinically evaluated indicators of intractable tinnitus.
The total and the three sub-modules (functional [F], emotional [E], and catastrophic [C]) score of the THI and VAS in patients with intractable tinnitus decreased after treatment (P < 0.001). The effective rate of tinnitus patients was 66.9%. A few patients had a slight left facial muscle tremor or temporary mild scalp pain during treatment. Compared with healthy controls, participants with tinnitus significantly reduced ALFF within the left and right medial superior frontal gyrus (P < 0.005). After rTMS treatment, the left fusiform gyrus and right superior cerebellar lobe increased ALFF in those with tinnitus (P < 0.005). The changes in THI, VAS, and ALFF were positively correlated (P < 0.05).
RTMS is effective in the treatment of tinnitus. It significantly reduces the THI/VAS score and improves the symptoms of tinnitus. No serious adverse reaction during rTMS were reported. The changes in the left fusiform gyrus and right superior part of the cerebellum may explain the mechanism of rTMS treatment in intractable tinnitus.
通过评估静息态功能磁共振成像（rs-fMRI）检测的顽固性耳鸣患者重复经颅磁刺激（rTMS）前后大脑低频波动幅度（ALFF）的变化，观察异常耳鸣活动。我们假设rTMS可以逐渐将局部脑功能恢复到相对正常范围。
这项前瞻性观察性研究招募了25例顽固性耳鸣患者，以及28例年龄、性别和教育水平相匹配的健康对照者。使用参与者的耳鸣障碍量表（THI）评分和视觉模拟量表（VAS）来确定治疗前后耳鸣的严重程度。我们通过ALFF处理顽固性耳鸣患者的大脑自发神经活动，然后确定其与顽固性耳鸣临床评估指标的关联。
顽固性耳鸣患者治疗后THI总分及三个子模块（功能[F]、情感[E]和灾难性[C]）评分以及VAS评分均降低（P < 0.001）。耳鸣患者的有效率为66.9%。少数患者在治疗期间出现轻微左侧面部肌肉震颤或短暂轻度头皮疼痛。与健康对照者相比，耳鸣患者在左右内侧额上回的ALFF显著降低（P < 0.005）。rTMS治疗后，耳鸣患者左侧梭状回和右侧小脑上叶的ALFF增加（P < 0.005）。THI、VAS和ALFF的变化呈正相关（P < 0.05）。
rTMS治疗耳鸣有效。它显著降低THI/VAS评分并改善耳鸣症状。rTMS治疗期间未报告严重不良反应。左侧梭状回和小脑右侧上部的变化可能解释了rTMS治疗顽固性耳鸣的机制。
