Tang Si Jie, Holle Jonas, Dadario Nicholas B, Lim Sol, Valcarce-Aspegren Marcus, Lesslar Olivia, Teo Charles, Sughrue Michael E, Yeung Jacky
School of Medicine, University of California Davis Medical Center, Sacramento, CA, 21772, USA.
Cingulum Health, Sydney, Australia.
Brain Topogr. 2025 Jul 14;38(5):52. doi: 10.1007/s10548-025-01126-x.
Increasing evidence suggests that brain areas outside of the auditory pathway may be involved in the development and maintenance of tinnitus. We hypothesized that repetitive transcranial magnetic stimulation (rTMS) to those areas in patients with comorbid psychiatric and neurocognitive disorder may reduce tinnitus distress. This is a case series of patients treated with off-label accelerated continuous or intermittent theta burst rTMS for medically refractory tinnitus. Target selections for each patient were performed using a personalized brain atlas based on resting state functional MRI (rsMRI) that identified regions of anomalous connectivity by comparing resting state functional connectivity to a normal cohort. Nine patients were treated with personalized, parcel-guided rTMS (Sydney, Australia) from 2018 to 2023, inclusive. Four patients had Major Depressive Disorder (MDD) of which three had comorbid anxiety, three patients had traumatic brain injury, and one patient had migraines. All patients had targets identified outside of the auditory network, including central executive network (CEN), default mode network (DMN), and salience network (SN). Clinically significant improvements in tinnitus symptoms were reported in 75% and 100% of patients based on TRQ and THI, respectively. No major adverse safety events occurred. rTMS with target selection using a personalized, agile approach is safe and may provide durable symptomatic relief rTMS with target selection using a personalized, agile approach is safe and may provide durable symptomatic relief for patients with chronic tinnitus, including those with comorbid psychiatric and neurocognitive conditions.
越来越多的证据表明，听觉通路以外的脑区可能参与耳鸣的发生和维持。我们假设，对合并精神和神经认知障碍的患者的这些脑区进行重复经颅磁刺激（rTMS）可能会减轻耳鸣困扰。这是一个病例系列，患者接受了用于治疗药物难治性耳鸣的超说明书加速连续或间歇性theta爆发rTMS治疗。每位患者的靶点选择是使用基于静息态功能磁共振成像（rsMRI）的个性化脑图谱进行的，该图谱通过将静息态功能连接与正常队列进行比较来识别异常连接区域。2018年至2023年（含）期间，9名患者接受了个性化、基于脑区的rTMS治疗（澳大利亚悉尼）。4名患者患有重度抑郁症（MDD），其中3名合并焦虑症，3名患者有创伤性脑损伤，1名患者有偏头痛。所有患者的靶点均位于听觉网络之外，包括中央执行网络（CEN）、默认模式网络（DMN）和突显网络（SN）。分别基于耳鸣反应问卷（TRQ）和耳鸣残疾评定量表（THI），75%和100%的患者报告耳鸣症状有临床显著改善。未发生重大不良安全事件。使用个性化、灵活方法进行靶点选择的rTMS是安全的，可能为慢性耳鸣患者，包括那些合并精神和神经认知疾病的患者提供持久的症状缓解。
