Deep Brain Stimulation (DBS) for Tinnitus

No, unfortunately, I haven't received a mail from her yet. Still waiting for a mail from AMC too.

 

You guys realize a labotomy consists of taken part of your brain out. Supposedly they already do this treatment for people with Parkinson's.

 

At the stage I'm in I'd go for this treatment on my own dime if it was available here in Australia. Unfortunately it isn't and I'm having a hard time getting any treatment I find meaningful. At one stage I was very close to having myself committed as I lost my temper with an audiologist I was seeing. He phoned up the mental health people when I walked out of his office in disgust, saying he was worried about me when I said I was borderline suicidal at this point.

 

Hi everyone, it took a while but I finally came into contact with someone who was involved in the DBS study at the Academic Medical Center (AMC) in Amsterdam. Dr. Dijkstra is one of the leading specialists of this particular DBS trial (concerning Rianne Kok) and she was so kind as to provide me the case study paper that might give some insights for some of you here on Tinnitus Talk.

One thing worth noting in my correspondence with Dr. Dijkstra is that AMC is planning to conduct more DBS research in the future. That's at least some good news for those who are considering this kind of treatment.

Anyway, here's an evaluation + PDF document of the case study.

Effective deep brain stimulation of intractable tinnitus: A case study (Dijkstra et al., 2018)

''In this patient with severe intractable tinnitus, one year of vALIC-DBS resulted in major improvement of the tinnitus. Even though the tinnitus was still present, DBS enabled her to cope with the sound and fully direct her attention to normal daily life, which also greatly improved her mood. This suggests that vALIC-DBS primarily improved tinnitus-related distress and not merely depression, which is supported by the observation that temporarily DBS-discontinuation caused a primary relapse of tinnitus symptoms. Interestingly, improvement was first achieved with 4V-stimulation, which became more durable at 4.5V and was sustainable only at 5V, suggesting a dose-dependent stimulation effect.''

''As of yet, beneficial effects of DBS for tinnitus have only been reported as coincidental finding. For example, tinnitus was retrospectively assessed in 443 patients receiving subthalamic nucleus DBS for movement disorders, of which 61 patients reported having experienced tinnitus before DBS [9]. During DBS, their mean THI score significantly decreased compared to pre-surgically (....) Accordingly, a pilot study of area LC-DBS is currently performed in ten tinnitus patients (trial NCT01988688). It has been proposed that tinnitus is caused by altered sensory input, such as auditory deprivation,which induces functional changes in a network of auditory and non-auditory structures [2]. ''

''Nonauditory structures, such as the basal ganglia, have been proposed being involved in the gating and selecting of the tinnitus sound [5]. Accordingly, the NAc shows structural and functional abnormalities in tinnitus patients compared to healthy controls, such as significant grey-matter decrease [7] and tinnitus-evoked hyperactivity [5]. We have previously demonstrated that vALIC-DBS for OCD is able to normalize NAc activity and excessive connectivity from the NAc [11]. Based on these findings, we hypothesize that vALIC DBS improves tinnitus symptoms by restoring basal ganglia function, enabling healthy affective gating of the tinnitus percept. To the best of our knowledge, the current case study is the first to report effectiveness of vALIC-DBS for severe intractable tinnitus, casting hope for this intervention in other patients with intractable tinnitus.''

 

Interesting, but I don't think I have understood everything. Does it reduce distress, loudness or both?

 

Bonjour @ThomasC. The researchers of this particular case study have not tested specifically for tinnitus loudness (e.g., Loudness Match with corresponding Numeric Rating Scale), but they have only used measurements that implicitly encapsulate the distressful impact that tinnitus has on our daily lives and routines (e.g. sleep, work, relations, memory, hearing, ability to focus), such as Tinnitus Handicap Inventory, Tinnitus Functional Index and Hamilton Depression Rating Scale.

If we draw some insights from this paper, we cannot state without any doubt that the tinnitus of the patient has been altered, but we can read that her emotional reaction to tinnitus has changed. You can read this part in the following text:

''Three weeks after the surgical procedure, we activated the DBS according to standard settings: 3.5V, 130Hz, and 90ms at the middle two contact points located in the vALIC. Due to lack of effect after initial activation, we increased the voltage three times successively with 0.5V, after which a stable improvement of tinnitus was achieved at 5V. After one year of chronic DBS, symptoms had improved with 63.2% on the TFI (score change: 7.4/2.72) compared to pre-surgically, 73.7% on the THI (score change: 76/20), and 76.2% on the HDRS (score change: 21/5). The patient reported that the tinnitus sound itself had not disappeared, but that she had become able to ignore the sound. This also greatly improved her mood and gave her the energy to engage with her children and husband again. After a few months of stable improvement, she was able to take a job and fully engage herself in the sports she used to like. She reported only mild forgetfulness as side effect of DBS.''