Vaziri Zahra, Salmon Carlos E G, Ghodratitoostani Iman, Santos Antonio Carlos Dos, Hyppolito Miguel A, Delbem Alexandre C B, Leite João P
Department of Neuroscience and Behavior, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048-900, Brazil.
InBrain Lab, Department of Physics, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto 14040-901, Brazil.
Brain Sci. 2023 May 19;13(5):826. doi: 10.3390/brainsci13050826.
Around 30% of the general population experience subjective tinnitus, characterized by conscious attended awareness perception of sound without an external source. Clinical distress tinnitus is more than just experiencing a phantom sound, as it can be highly disruptive and debilitating, leading those affected to seek clinical help. Effective tinnitus treatments are crucial for psychological well-being, but our limited understanding of the underlying neural mechanisms and a lack of a universal cure necessitate further treatment development. In light of the neurofunctional tinnitus model predictions and transcranial electrical stimulation, we conducted an open-label, single-arm, pilot study that utilized high-definition transcranial direct current stimulation (HD-tDCS) concurrent with positive emotion induction (PEI) techniques for ten consecutive sessions to down-regulate tinnitus negative valence in patients with clinical distress tinnitus. We acquired resting-state functional magnetic resonance imaging scans of 12 tinnitus patients (7 females, mean age = 51.25 ± 12.90 years) before and after the intervention to examine resting-state functional connectivity (rsFC) alterations in specific seed regions. The results showed reduced rsFC at post-intervention between the attention and emotion processing regions as follows: (1) bilateral amygdala and left superior parietal lobule (SPL), (2) left amygdala and right SPL, (3) bilateral dorsolateral prefrontal cortex (dlPFC) and bilateral pregenual anterior cingulate cortex (pgACC), and (4) left dlPFC and bilateral pgACC (FWE corrected < 0.05). Furthermore, the post-intervention tinnitus handicap inventory scores were significantly lower than the pre-intervention scores ( < 0.05). We concluded that concurrent HD-tDCS and PEI might be effective in reducing tinnitus negative valence, thus alleviating tinnitus distress.
大约30%的普通人群经历过主观性耳鸣，其特征是在没有外部声源的情况下有意识地察觉到声音。临床困扰性耳鸣不仅仅是体验到一种幻听，因为它可能具有高度的干扰性和使人衰弱，导致受影响者寻求临床帮助。有效的耳鸣治疗对于心理健康至关重要，但我们对潜在神经机制的了解有限，且缺乏通用的治愈方法，因此需要进一步开发治疗方法。根据神经功能性耳鸣模型预测和经颅电刺激，我们进行了一项开放标签、单臂的试点研究，该研究连续十次使用高清经颅直流电刺激（HD-tDCS）并结合积极情绪诱导（PEI）技术，以降低临床困扰性耳鸣患者的耳鸣负性情绪。我们在干预前后对12名耳鸣患者（7名女性，平均年龄 = 51.25 ± 12.90岁）进行了静息态功能磁共振成像扫描，以检查特定种子区域的静息态功能连接（rsFC）变化。结果显示，干预后注意力和情绪处理区域之间的rsFC降低，如下所示：（1）双侧杏仁核与左侧顶上小叶（SPL），（2）左侧杏仁核与右侧SPL，（3）双侧背外侧前额叶皮质（dlPFC）与双侧膝前扣带回皮质（pgACC），以及（4）左侧dlPFC与双侧pgACC（FWE校正 < 0.05）。此外，干预后的耳鸣障碍量表得分显著低于干预前得分（< 0.05）。我们得出结论，HD-tDCS与PEI联合使用可能有效降低耳鸣负性情绪，从而减轻耳鸣困扰。
