Transcranial Stimulation Treatments (rTMS & tDCS & tACS)

I truly wish you well. tRNS is something newer to the treatment field. I first became aware of it by Dr. De Ridder at the Brai3n clinic in Belgium. From what I understand you need to have several sessions before you may respond.

Tinnitus and Brain Stimulation

 

I will keep my fingers crossed for you @ErikaS.

I hope you find success in just the first sessions and get relief by the end of the treatment. Thanks for updating the community about your progress.

 

Thank you, @Nick47, I really appreciate it. Fortunately, Chris is very knowledgeable of Dr. De Ridder's work and has sent me literature on thalamocortical dysrhythmia and how that appears to be relevant to my case. What I am looking forward to is a personalized approach and that he has the ability to do this with his equipment, unlike being part of a study with a set protocol. I will be keeping daily logs of symptoms, changes, etc. and treatment will shift and develop with that. Ultimately, if tinnitus is one thing, other than freaking awful, it is very personalized and individualized, and with that I feel a treatment that can be shaped to these specifics has the best chance for a positive outcome.

He said that because we are going for "the bear" first, aka my big gamma electric ball, I may experience changes sooner rather than later, but we will see. Just hoping to God for no permanent worsening. I am very well aware poking at the bear may cause some temporary agitation, but I'd be lying if I said a part of me isn't terrified with my reactivity. The "random noise" he will use initially is pink noise, to cover an array of frequencies but with more energy in the lower frequencies.

So cross fingers and hope! If this doesn't work, my psych has agreed to prescribe Oxcarbazepine and will call it in if I need to go that route.

Thank you, @eagerUser! Members like you that continually wish others well and push for hope and positivity are a light that is very much needed. I appreciate you and your kindness.

 

How is this noise delivered?

 

So I think when we say noise, we can’t help but think a sound that is heard, and although it is “noise,” it’s the frequencies that make up those noises, and they are delivered through electric currents to the scalp, just like tDCS. I included in my description post on the last page what NeuroField provided specifically how this is done, but basically it is giving current at randomized or chosen frequencies and milliamperes between the two sites. The region of the brain between the electrodes are stimulated, increasing neuroplasticity and reducing stuck patterns.

 

Thanks @ErikaS. When they said random pink noise, I assumed it was some bimodal type thing that was delivered through the ear canal. I didn't know they could actually deliver noise through the scalp.

 

Yes, it is very interesting. Ironic you bring that up though, because there is an ongoing study (according to ClinicalTrials.gov) that is researching the effects of tRNS plus acoustic stimulation for tinnitus. They state:

They state that the acoustic stimulation will be white noise through the ears while the tRNS will be lower frequency sound/electric waves.

Transcranial Electrical and Acoustic Stimulation for Tinnitus

 

Update: I was going to share an update post Sunday, but the plan has changed temporarily and I wanted to share what has been going on.

I had my first session on Monday where we did 40 minutes of transcranial random noise stimulation (tRNS) over the right temporal area as well as electro-magnetic frequency coil stimulation. The random noise electrical frequency used was pink noise. The idea behind this is that pink noise frequencies, in the form of electric current frequencies, are delivered to the area to break up the dysfunction of brain wave activity of the heightened gamma area that is seen with tinnitus and get it out of this stuck pattern. In addition, a series of magnets were placed over my head and ran specific low level frequencies that are a protocol for tinnitus. This is not TMS like we have discussed and heard about, however these are magnet squares that use coils and deliver electro-magnetic frequencies. It is not loud, just some random very low noise level beeps sometimes. He stated this is used at the same time because as the pink noise breaks up the gamma waves/electric activity, we want to give that activity a “new job to learn” and not let it just go haywire. So the magnets deliver low frequencies to calm and bring down the distressing frequency levels of the tinnitus.

Monday night, let’s just say it was evident that something went on in my brain earlier that day lol. My tinnitus responded, great! But man did it respond in a “what the heck just happened?!” way. I had increased volume and tinnitus was erratic. Although this was distressing for me, this is not a bad sign. This is actually expected with “poking the bear”, and I was told many times things could get agitated before improving. Easier said than experiencing I had trouble going to sleep Monday night due to this agitation. Tuesday was a little better, but I quickly learned how shot my nervous system is because I could not calm myself and regulate my emotions due to the change. Even though I wanted to push through and keep going with this protocol, I had to be honest with myself and stand up for my nervous system. So many of us, especially those in success stories, have come to realize how important a stable nervous system is on the path to healing. It was evident to me this needed some attention before proceeding if I wanted the best shot at effective results.

So, I went back Wednesday and told him what I experienced and was very honest with him. I basically said “four months ago, I would have the nervous system stamina to endure this. Now, I do not. I am sorry.” He completely understood, was actually happy to hear that the tinnitus responded in some way after one session which he thinks is a “great indicator”, because he’s had some patients have minimal responses after many sessions for various conditions. He also said he ALWAYS runs a nervous system regulation protocol first, but was going with what the remote team told him to do which was “go after the gamma”. So he had no problem with what I shared and actually agreed we may be more successful in the long run doing nervous system first, then moving on.

So, yesterday and today we used transcranial alternating current stimulation (tACS) for vagus nerve, brainstem, and parasympathetic intervention. This is to calm the brain down overall and calm down my fight/flight response. He said this is also very beneficial because all 12 cranial nerves run through the brainstem, so each nerve was getting some calming stimulation. The electrodes were placed on my mastoid bones. I told him I could tell when the electric stimulation was running through which electrode because I’d get a sensation in that ear and reactivity to the electric current. He found that fascinating, I found it annoying lol, I definitely felt calming effects pretty immediately though, even some euphoric feelings today. It’s crazy how effective these avenues can be, and apparently I’m very fortunate that I am so responsive. Lastly, we ran an electro-magnetic frequency protocol again over the head, but for this time it was a protocol for neuro-inflammation. They have a lot of success with this protocol for long haul covid and any condition that can create inflammation in the brain.

So moving forward, we will be doing the tACS nervous system + EMF neuro-inflammation protocol for about 6 sessions, see how I am doing, then move back to the tRNS + EMF tinnitus protocol and see how things go. I am VERY happy and fortunate to have a practitioner who is very invested in my case, is very knowledgeable and good within this neuromodulation space, has others to discuss my case with, and will personalize treatment as we go. May take some time, trial and error, etc., but we both feel with how responsive my brain is, we can take this somewhere where some neuro rerouting and relief is a reality.

With all this said, I am going to do my best to avoid signing on every day because I need to keep my nervous system as stable as I can. I have exercises and things to do at home that the brainstem specialist gave me to do on a daily basis, so going to really focus on healing and hope. I am determined to get better and to improve to a more functional state. I will absolutely give updates, just know I may not check in as often as I have been.

Thanks for reading!

 

Thank you so much for taking the time to give and update, @ErikaS!

Take care until next time. See you soon.

I root for you and I am confident you will have benefits

 

Nice update @ErikaS - I am rooting for you! There are a handful of people I come on here to catch up on and you are one of them. Keep on keeping on x

 

Thank you so much @hopefuldede , you are so sweet and caring. There are WAY too many amazing, kind, good people debilitated with these awful conditions. My biggest hope is that the next 2-5 years drastically brings relief and increased quality of life for all of us.

Things have been go, stop, and now go again with my treatment. I didn't update here but on Friday I experienced huge swings of panic and deep depression as well as exacerbated tinnitus and reactivity. Could have been a mix of things, but last week when I started the tECS therapy, I also started my cycle, and I exposed too much on Father's Day, so I was already sensitive going into the week before the therapy even began. Monday we targeted the tinnitus, which led to my Monday evening of increased, erratic tinnitus. My nervous system is just too fried to deal with that agitation before (hopeful) improvement type thing right now, so then we decided okay, let's target parasympathetic and get the brain to calm down first. That sounded great, but it just so happens that the electrodes for the parasympathetic protocol go on the mastoid bones. I could literally feel the alternating currents as they would make the ear feel weird and my reactivity react. Could not win lol. I did two days in a row of that. Then I just had like a panic breakdown followed by major depression on Friday. So my family and I initially decided okay, time to try a medication, which I got ordered. Well, after talking to my practitioner for the tECS therapy, he basically said the medication and the therapy would be working against each other.

So we regrouped, I cried some more and pulled up my big girl pants, and we have decided to hold off on the medication and start therapy again tomorrow, but with a tDCS protocol for depression in which the electrodes are placed on the L and R prefrontal cortex. If there is one thing that affects me the most, it is my deep depression, stubborn anger, mourning my lost life, and just not having a will to take on each day. My practitioner said that this protocol for depression has shown very good responses, so just taking one thing at a time and listening to my brain through this process.

I have to say, my practitioner has been so caring. He truly wants to help me. He asked me to type up my own patient summary and timeline and send him MRI, CT, and audiogram so he can further consult with his higher up. We both knew my brain was going to be sensitive, just didn't know how sensitive. So now that he sees this aspect, he just wants to follow up with his partner. We both believe if we can get through the beginning of trial and error, we can get somewhere that will be worth these rough patches. Pain before the gain, I guess! Praying daily that God intervenes in some way on my behalf.

 

Getting to the bottom of the phantom sounds of tinnitus

Research Lives: Prof Sven Vanneste, Trinity College Institute for Neuroscience and School of Psychology

You are looking at ways to help people ‘unlearn’ the phantom sounds of tinnitus, can you explain?

In tinnitus, a person hears phantom sounds such as ringing or hissing even though there is no outside source of that noise. People used to think that tinnitus was an ear problem, but recent evidence suggests the brain is very much involved, and my lab wants to better understand the mechanisms behind it.

We think that the person’s brain starts to expect the phantom noises, and we want to help them unlearn that, so the brain no longer sets the phantom noise as the expected status quo.

Why might someone’s brain make them ‘hear’ a phantom sound?

In tinnitus, people have often experienced some kind of hearing loss. The brain predicts that a sound will come in, but it doesn’t. This is what we call a prediction error, and in tinnitus we think the brain responds to the mismatch or uncertainty by filling in noise. Then this noise becomes the prediction, tinnitus becomes the new normal.

How can someone unlearn this new normal?

This is where neuromodulation comes in. We stimulate a specific nerve that runs from the back of the head, called the greater occipital nerve. We use a device like an electrode on your head and it doesn’t hurt. Some people say it feels a bit tingly.

We found out if you stimulate that particular nerve it activates a specific brain pathway that improves how we stabilise memories. So we combine this nerve stimulation with training where the person pays attention to sounds that we play. We train them to differentiate between tones that sound very similar.

The idea is that this combination will teach the brain that all noises are important, and to stop filling in blanks with phantom noises. We are currently testing this in the lab.

Can you use the technology to help people with memory or other issues too?

Yes, we have projects on how neuromodulation might be able to help people with mild cognitive impairment or other memory impairments, and also how the unlearning process might be applied to types of chronic pain.

You publish prolifically, do you enjoy the work?

I love research, and I have a large group of PhD students and post-docs working on projects. I encourage them to write papers and help them with that as part of their training. I enjoy the writing process.

What was your route to Ireland?

After my initial training in Belgium, I worked in Harvard for two years as a postdoc, then I moved to the University of Texas to lead a large trial. Through conversations with Prof Ian Robertson, I learned more about the Global Health Brain Institute and I moved to Trinity about four years ago. I still hold a position in Texas and I have many links with colleagues there.

And what do you like to do in your spare time?

I don’t really have any. When I’m not doing the research in Ireland, I work in a clinic that I set up in Belgium with some medical colleagues to apply brain stimulation techniques.

I’m also about to start a big project with partners in the US. We are looking for objective markers of tinnitus, to see are there specific signals in the brain that correlate with how loudly the person hears phantom noises. This could really help to push the field forward and build more interest in tinnitus research and solutions.

 

Small pilot study.

Focal transcranial direct current stimulation of auditory cortex in chronic tinnitus: A randomized controlled mechanistic trial

 

I sent Professor Sven an email asking if they had any participant/client take part in this protocol in their lab that presents with reactive tinnitus or hyperacusis. I asked this because I, unfortunately, was not responding well to the transcranial stimulation I was trialing with my erratic, oscillating tinnitus sounds that are very reactive/sound sensitive. It was making my tinnitus more erratic and sensitivity worse. He emailed me back saying “unfortunately, sound sensitivity or hyperacusis is one of the exclusion criteria in this study”.

This upsets me as I fear maybe those with reactivity and/our loudness hyperacusis may not be good candidates for transcranial stimulation? Who knows.

 

I'm aware of this. They are currently in Phase 2 clinical trials. There was a radio interview I heard a couple of days ago.

 

Really bums me out that those with any sound sensitivity tend to be left out on these clinical trials, especially ones that include a sound stimuli. I get it, but it would be great to know if there is a protocol that could not only potentially calm down the tinnitus, but calm down the reactivity as well. I couldn't find that with my go around.

 

Is this the interview you were talking about, @Nick47?

New research aims to help the brain ‘unlearn’ tinnitus

Between 10% and 15% of the Irish population is currently living with tinnitus but groundbreaking new research in Trinity College is discovering novel ways to help sufferers.

Jarlath Regan was joined by Professor Sven Vanneste, from the Trinity College Institute for Neuroscience and School of Psychology to discuss...

 

That's the one mate, it's in Phase 2. It has nothing to do with Prof. De Ridder's TU DELFT, does it? Should this have its own thread in the Research News section?

 

I think that it should have its own thread when we know more about the mechanism of this particular device. I contacted Brai3n via Facebook about a week ago but I haven't received any reaction.

 

BurstDR spinal cord stimulation rebalances pain input and pain suppression in the brain in chronic neuropathic pain (De Ridder & Vanneste, 2023)

Abstract

Objective:
Chronic pain is processed by at least three well-known pathways, two pain provoking pathways including a medial ‘suffering’ and lateral ‘painfulness’ pathway. A third descending pain pathway modulates pain but is predominantly inhibitory. Chronic pain can be seen as an imbalance between the two pain-provoking and the pain inhibitory pathways. If this assumption is correct, then the imbalance between pain input and pain suppression should reverse and normalize in response to successful, i.e., pain reducing burstDR spinal cord stimulation, one of the current treatment options for neuropathic pain.

Materials and Methods:
Fifteen patients, who received spinal cord stimulation for failed back surgery were included in this study, using source localized electrical brain activity and connectivity recording via EEG to identify the purported imbalance.

Results:
BurstDR spinal cord stimulation induces a significant change in EEG activity in both the left and right somatosensory cortex (SSC) for both θ and γ oscillations. In the dorsal anterior cingulate cortex (dACC), we observed a significant drop in both α and β oscillations. This reduction is accompanied by a change in pain intensity and suffering. BurstDR spinal cord stimulation is also associated with a reduction in θ at the pregenual anterior cingulate cortex (pgACC). Analyzing effective connectivity indicates that for the θ band, more information is sent from the pgACC to the left and right SSC. For α, increased information is sent from the pgACC to the dACC and both the left and right SSC. This is associated with a reduced θ-γ coupling in the SSC and reduced α-β coupling in dACC.

Conclusion:
This study suggests that chronic pain is indeed an imbalance between the ascending and descending pathways in the brain and that burst spinal cord stimulation can normalize this imbalance in the brain.

Interesting quote from this study:

 

Auditory cortex hyperconnectivity before rTMS is correlated with tinnitus improvement

 

I just got this sent to my email, it's for a condition that I have called "interstitial cystitis" but wondering if it could help with tinnitus. I am 8 hours from this study. Do you think it could be useful to try for tinnitus too?

 

Recent TED Talk with Dr. Kristin Barry who is a research fellow at the Ear Science Institute Australia and adjunct at the University of Western Australia, with her career keenly focused on investigating the changes that occur in the brain after traumatic sound exposure. Kristin was drawn to this area of research by her fascination with the phenomenon of phantom limb perception. She has also investigated drug treatments, biomedical implants, and the use of repetitive transcranial magnetic stimulation, in the treatment of hearing loss and tinnitus.

This tinnitus discovery could lead to a new...

 

We need more researchers like her.

 

I thought her presentation was bullshit and offered nothing new.

 

Good luck. But isn't rTMS is an old news? It instantly reminded me of this poor guy:

Suicidal Because Noise from rTMS (140 dB!) Massively Worsened My Tinnitus and Caused Hearing Loss

 

I'm not saying Dr. Kristin Barry brought much to the table here, but rTMS has worked for some, hence Brai3n still continue to offer it as a potential treatment in Belgium under Prof. De Ridder.

My point was we need more researchers Dr. Kristin Barry who are at least willing to try.

As @Hazel has been finding out, many researchers don't head in to the field of tinnitus. It's not 'sexy' or 'glamorous' enough.

It may not be Dr. Kristin Barry that cures tinnitus, but it will be someone like her, or Dr. Josef Rauschecker who also had a TED Talk, that could have the first breakthrough or inspire someone else to have the first breakthrough (Dr. Susan Shore aside).

 

Has it?

I am not really sure her talk will make a dent in research prospects, but I guess this is better than nothing.

Talking about tinnitus is certainly good for awareness. Too late for us, but not too late for many others. I made this promise to myself, I will reach out to anyone I know and warn them about tinnitus. Many, not all, people can be saved if they learn about it. I would have been.

 

It was offered to me by Prof. De Ridder after a qEEG I had done in Belgium. He felt it may reduce my tinnitus and reduce the reactivity. Could it or would it, for me I may never know as I decided against it - but not because of the fear of worsening but because of other symptoms.

There are many charlatans out there willing to grab money off tinnitus sufferers, to me this was not the Brai3n setup. To me they were offering the same 20%-30% reduction chances as say hearing aids would do for the right sufferer.

We are talking transcranial simulation which I am sure could be done in many ways. Perhaps the right way hasn't been found yet, or perhaps alongside medication (which is also something Prof. De Ridder is researching) it could yield more fruitful results.

Dr. Kristin Barry's talk won't do anything for tinnitus, it's a drop in the ocean, but I for one are glad that there are people that are still trying out there, and not giving up.

As I said in my first post, we need more people like that.

 

I am glad that you shared this, because there is a trial going on for rTMS that I could be a part of here in California, but it is being used to treat Interstitial Cystitis (IC) specifically, which I have. I thought maybe I could sign up for the trial since I have IC and that it would also in return help my tinnitus. Now that I’m reading all this, I might not sign up after all.