Transcranial Stimulation Treatments (rTMS & tDCS & tACS)

[Dr. Jay Hobbs]

@Paulmanlike , I do think there is a possibility that refining the placement COULD improve the results.
Regarding it being a"standard tx for tinnitus," I think the limited results + the price of the required machinery is what prevents it from being more common.
...and maybe some folks are hesitant to have their neurons instantaneously reset.
I think it is neat that this has worked as well as it has. I am pleasantly surprised that there haven't been significant unwanted effects. I suspect that we are far enough into it that there will not be any, but as the this technology gets more powerful, I too would proceed with caution.

 

[Bill Bauer]

The following paper provides some information that might be useful for you as you decide whether to pursue this treatment. This paper also provides technical information that you can give to the clinic (they use this technique mostly to treat mentally ill patients; in the US they are open to treating tinnitus patients) about where to locate the coil, etc.
http://link.springer.com/article/10.1007/s00415-011-6037-6

 

[Frédéric]

In June 2013, I followed an fMRI (in order to focus on the right area to treat) then I followed 10 sessions of rTMS (2000 pulses per session). No effect on tinnitus, no side effect.

 

[GregCA]

In June 2013, I followed an fMRI (in order to focus on the right area to treat) then I followed 10 sessions of rTMS (2000 pulses per session). No effect on tinnitus, no side effect.

Did you use any intravenous contrast to perform the fMRI?

Do you know how many Teslas your MRI was at?

 

[Frédéric]

No intravenous constrast.
I have no idea about how many teslas, I didn't find any information on the report sheet.

 

[Bill Bauer]

http://www.sciencedirect.com/science/article/pii/S1935861X10001671
Transcranial magnetic stimulation for the treatment of tinnitus: 4-year follow-up in treatment responders—a retrospective analysis

"Conclusions
These data underscore the clinical relevance of rTMS in the treatment of tinnitus. A potential explanation for the observed long-lasting clinical effects is that rTMS interferes with tinnitus related neuronal activity and thus facilitates the intrinsic ability of the brain to restore normal function."

 

[Frédéric]

Effect of Transcranial Direct Current Stimulation in Patients With Tinnitus: A Meta-Analysis and Systematic Review
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Tang-Chuan Wang, MDRichard S. Tyler, PhD, Ta-Yuan Chang, MS, PhD, ...
First Published December 1, 2017 Research Article

Objectives:
Subjective tinnitus is a phantom sensation experienced without any external source of sound that profoundly impacts the quality of life. Some investigations have claimed that transcranial direct current stimulation (tDCS) reduces tinnitus, but studies on tDCS have demonstrated variable results. This meta-analysis aimed to examine the effect of tDCS on patients with tinnitus.

Methods:
We searched for articles published through January 5, 2016, in Medline, Cochrane, EMBASE, and Google Scholar using the following keywords: tinnitus, transcranial direct current stimulation, and tDCS. The study outcomes were change in magnitude estimates of loudness (loudness), tinnitus-related distress (distress), and Tinnitus Handicap Inventory (THI).

Results:
Pooled results demonstrated that tDCS did not have a beneficial effect on loudness (pooled standardized difference in means = 0.674, 95% CI, –0.089 to 1.437, P = .083). Further, the pooled results demonstrated a greater reduction in distress for the tDCS group (pooled standardized difference in means = 0.634, 95% CI, 0.021-1.247, P = .043).

Conclusions:
We conclude that the pooled results demonstrated a greater reduction in distress for groups treated with tDCS as compared with those administered a sham treatment.

tinnitus, transcranial direct current stimulation, tDCS, meta-analysis, systematic review

Source: http://journals.sagepub.com/doi/abs/10.1177/0003489417744317

 

[Frédéric]

Another article found today:

Effect of transcranial direct current stimulation on short-term and long-term treatment of chronic tinnitus
Abstract
Objective
This study was conducted to investigate the effectiveness of anodal and cathodal methods in reducing the intensity of tinnitus and to compare them with the control.

Methodology
This randomized double-blind clinical trial with case and control groups was conducted in Al-Zahra Hospital in Isfahan between 2015 and 2016. In this trial, 51 patients with tinnitus, for at least one year, were selected among those outpatients visiting the throat, nose and ear clinic within this period. Inclusion criteria were patients on electrical stimulation prohibition, with Ménière's disease, otosclerosis, chronic headache, and pulsatile tinnitus. Patients were randomly divided in three equal-sized groups: anodal stimulation group, cathodal stimulation group, and control group. The subjects received 20-min current stimulation (2 mA). Five subjects were selected from those with a significant difference between the stimulated states (anodal or cathodal) and/or control. They received weekly transcranial electrical stimulation for two months, and their long-term recovery from tinnitus was investigated. Data analysis was done with SPSS20.

Results
Findings showed no significant between-groups difference in mean scores of tinnitus before the intervention (p = .68); whereas, this difference was significant immediately after the intervention (p = .02) and 1 h after it (p = .03). The mean score of tinnitus in the anodal stimulation group was significantly lower than the control; whereas, no significant difference was observed between the anodal and cathodal stimulation groups, and between the cathodal and control groups (p < .05). Findings also showed that the mean scores of tinnitus in two cathodal stimulation groups (p = .24) and control group (p = .62) were not significantly different at three different points of time; whereas, this score was significantly different in the anodal group at these time points (p = .01).

Conclusion
In conclusion, anodal stimulation was more effective than the cathodal and control stimulation in reducing the intensity of tinnitus in the short term.


Keywords:
Tinnitus, Cathodal stimulation, Anodal stimulation, Transcranial direct current stimulation

Source: http://www.amjoto.com/article/S0196-0709(17)30500-8/abstract

 

[Frédéric]

I found this article yesterday. Unfortunately bad results:

Combined transcranial magnetic stimulation in the treatment of chronic tinnitus
Martin Formánek
Petra Migaľová
Petra Krulová
Michal Bar
Debora Jančatová
Hana Zakopčanová‐Srovnalová
Hana Tomášková
Karol Zeleník
Pavel Komínek
First published: 08 June 2018

Abstract
Objective
Repetitive transcranial magnetic stimulation (rTMS) is currently being tested for suppressing the symptoms of subjective chronic primary tinnitus, although its effect is controversial. The aim of this randomized double‐blinded controlled trial was to determine the effect of rTMS with unique settings for tinnitus treatment.

Methods
Fifty‐three adult patients suffering from chronic subjective unilateral or bilateral nonpulsatile primary tinnitus for at least 6 months were randomly assigned to rTMS (group 1, n = 20), sham stimulation (group 2, n = 12), or medicament therapy only (group 3, n = 21). The dorsolateral prefrontal cortex (frequency 25 Hz, 300 pulses, and 80% resting motor threshold [RMT]) on the left side and primary auditory cortex (1 Hz, 1000 pulses, 110% RMT) were stimulated on both sides in patients in group 1 for 5 consecutive days. The Tinnitus Reaction Questionnaire (TRQ), Tinnitus Handicap Questionnaire (THQ), Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), pure‐tone audiometry with Fowler scoring of hearing loss, and tinnitus analysis were used to evaluate tinnitus in all patients. Data were recorded the day the patient was included in the study and at 1‐ and 6‐month follow‐up.

Results
The study groups were homogenous. No significant effect of rTMS was found at 1 or 6 months based on the BDI, THQ, and TRQ scores or tinnitus masking. There was a significant but clinically irrelevant effect on the THI score after 1 and 6 months.

Interpretation
No significant effect of bilateral low‐frequency rTMS of the primary auditory cortex and high‐frequency stimulation of the left dorsolateral prefrontal cortex was demonstrated.

full article: https://onlinelibrary.wiley.com/doi/full/10.1002/acn3.587
also in pdf file.

 

[Frédéric]

Effects of Electrical Stimulation in Tinnitus Patients: Conventional Versus High-Definition tDCS
Abstract
Background. Contradictory results have been reported for transcranial direct current stimulation (tDCS) as treatment for tinnitus. The recently developed high-definition tDCS (HD tDCS) uses smaller electrodes to limit the excitation to the desired brain areas. Objective. The current study consisted of a retrospective part and a prospective part, aiming to compare 2 tDCS electrode placements and to explore effects of HD tDCS by matched pairs analyses. Methods. Two groups of 39 patients received tDCS of the dorsolateral prefrontal cortex (DLPFC) or tDCS of the right supraorbital–left temporal area (RSO-LTA). Therapeutic effects were assessed with the tinnitus functional index (TFI), a visual analogue scale (VAS) for tinnitus loudness, and the hyperacusis questionnaire (HQ) filled out at 3 visits: pretherapy, posttherapy, and follow-up. With a new group of patients and in a similar way, the effects of HD tDCS of the right DLPFC were assessed, with the tinnitus questionnaire (TQ) and the hospital anxiety and depression scale (HADS) added. Results. TFI total scores improved significantly after both tDCS and HD tDCS (DLPFC: P< .01; RSO-LTA: P < .01; HD tDCS: P = .05). In 32% of the patients, we observed a clinically significant improvement in TFI. The 2 tDCS groups and the HD tDCS group showed no differences on the evolution of outcomes over time (TFI: P = .16; HQ: P = .85; VAS: P = .20). Conclusions. TDCS and HD tDCS resulted in a clinically significant improvement in TFI in 32% of the patients, with the 3 stimulation positions having similar results. Future research should focus on long-term effects of electrical stimulation.

Keywords:
tinnitus, neuromodulation, noninvasive brain stimulation, transcranial direct current stimulation (tDCS), high-definition transcranial direct current stimulation (HD tDCS), treatment

Source: http://journals.sagepub.com/doi/abs/10.1177/1545968318787916

 

[Frédéric]

Just one more article on rTMS
Source: https://cdn.intechopen.com/pdfs/59181.pdf
or see attached file

 

[Frédéric]

Bilateral Dorsomedial Prefrontal Cortex rTMS for Tinnitus Treatment: A Successful Case
Source: http://www.eajm.org/sayilar/196/buyuk/EAJM-2018-0073.R2 UNC.pdf
or see attached file

 

[Frédéric]

Transcranial direct current stimulation for the treatment of tinnitus: a review of clinical trials and mechanisms of action

Background
Tinnitus is the perception of sound in the absence of any external acoustic stimulation. Transcranial direct current stimulation (tDCS) has shown promising though heterogeneous therapeutic outcomes for tinnitus. The present study aims to review the recent advances in applications of tDCS for tinnitus treatment. In addition, the clinical efficacy and main mechanisms of action of tDCS on suppressing tinnitus are discussed.

Methods
The study was performed in accordance with the PRISMA guidelines. The databases of the PubMed (1980–2018), Embase (1980–2018), PsycINFO (1850–2018), CINAHL, Web of Science, BIOSIS Previews (1990–2018), Cambridge Scientific Abstracts (1990–2018), and google scholar (1980–2018) using the set search terms. The date of the most recent search was 20 May, 2018. The randomized controlled trials that have assessed at least one therapeutic outcome measured before and after tDCS intervention were included in the final analysis.

Results
Different tDCS protocols were used for tinnitus ranging single to repeated sessions (up to 10) consisting of daily single session of 15 to 20-min and current intensities ranging 1–2 mA. Dorsolateral prefrontal cortex (DLPFC) and auditory cortex are the main targets of stimulation. Both single and repeated sessions showed moderate to significant treatment effects on tinnitus symptoms. In addition to improvements in tinnitus symptoms, the tDCS interventions particularly bifrontal DLPFC showed beneficial outcomes on depression and anxiety comorbid with tinnitus. Heterogeneities in the type of tinnitus, tDCS devices, protocols, and site of stimulation made the systematic reviews of the literature difficult. However, the current evidence shows that tDCS can be developed as an adjunct or complementary treatment for intractable tinnitus. TDCS may be a safe and cost-effective treatment for tinnitus in the short-term application.

Conclusions
The current literature shows moderate to significant therapeutic efficacy of tDCS on tinnitus symptoms. Further randomized placebo-controlled double-blind trials with large sample sizes are needed to reach a definitive conclusion on the efficacy of tDCS for tinnitus. Future studies should further focus on developing efficient disease- and patient-specific protocols.

Source: https://bmcneurosci.biomedcentral.com/articles/10.1186/s12868-018-0467-3

 

[Frédéric]

Transcranial Magnetic Stimulation as a Therapeutic Option for Neurologic and Psychiatric Illnesses

 

[Frédéric]

Neuronavigated Versus Non-navigated Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus: A Randomized Study

Abstract Repetitive transcranial magnetic stimulation (rTMS) has shown variable effect on tinnitus. A prospective, randomized 6- month follow-up study on parallel groups was conducted to compare the effects of neuronavigated rTMS to non-navigated rTMS in chronic tinnitus. Forty patients (20 men, 20 women), mean age of 52.9 years (standard deviation [SD] ¼ 11.7), with a mean tinnitus duration of 5.8 years (SD ¼ 3.2) and a mean tinnitus intensity of 62.2/100 (SD ¼ 12.8) on Visual Analog Scale (VAS 0–100) participated. Patients received 10 sessions of 1-Hz rTMS to the left temporal area overlying auditory cortex with or without neuronavigation. The main outcome measures were VAS scores for tinnitus intensity, annoyance, and distress, and Tinnitus Handicap Inventory (THI) immediately and at 1, 3, and 6 months after treatment. The mean tinnitus intensity (hierarchical linear mixed model: F3 ¼ 7.34, p ¼.0006), annoyance (F3 ¼ 4.45, p ¼.0093), distress (F3 ¼ 5.04, p ¼.0051), and THI scores (F4 ¼ 17.30, p <.0001) decreased in both groups with non-significant differences between the groups, except for tinnitus intensity (F3 ¼ 2.96, p ¼.0451) favoring the non-navigated rTMS. Reduction in THI scores persisted for up to 6 months in both groups. Cohen's d for tinnitus intensity ranged between 0.33 and 0.47 in navigated rTMS and between 0.55 and 1.07 in non-navigated rTMS. The responder rates for VAS or THI ranged between 35% and 85% with no differences between groups (p ¼.054–1.0). In conclusion, rTMS was effective for chronic tinnitus, but the method of coil localization was not a critical factor for the treatment outcome. Keywords tinnitus, transcranial magnetic stimulation, TMS, rTMS, neuronavigated Date received: 17 August 2018; revised: 26 November 2018; accepted: 5 December 2018

Full article: see attached file.

 

[Frédéric]

Adjunctive Role of Bifrontal Transcranial Direct Current Stimulation in Distressed Patients with Severe Tinnitus

I didn't manage to post the abstract.

Full article: https://www.jkms.org/search.php?where=aview&id=10.3346/jkms.2019.34.e19&code=0063JKMS&vmode=FULL

 

[Frédéric]

Tinnitus Treatment Using Noninvasive and Minimally Invasive Electric Stimulation: Experimental Design and Feasibility

 

[Emrethal]

I tried the R-TMS in Istanbul around 2018. 10 sessions in total, did not help me, but I met a lady there while waiting who told me that hers got much better.

 

[Abby]

I tried the R-TMS in Istanbul around 2018. 10 sessions in total, did not help me, but I met a lady there while waiting who told me that hers got much better.

Hi, what was the cause of your tinnitus? How long have you had it? Could you give me the name and contact of the clinic in Istanbul. Thanks.

 

[Emrethal]

Hi, what was the cause of your tinnitus? How long have you had it? Could you give me the name and contact of the clinic in Istanbul. Thanks.

Of course, contact: Op. Ahmet Sirin (he is Turkish, must sure know English, he goes to meetings etc. worldwide.

My cause of tinnitus was brain nerves not related with my ear. And rTMS did not help me.
First he examined me (hearing test etc.) , then he gave me some supplement and let me try them for 6 months (Ginkgo biloba, antidepressants)

Then neither my hearing nor my tinnitus changed and he sent me to a close by (20min taxi) hospital where they have 3 Tesla MR capability and they took some fMRI images (basically they give sound to your ears and see the signals from your ear to your auditory cortex).

This is how I learned that I have hearing loss related with my brain (ear is healthy surprisingly) and "most probably" tinnitus is caused by these damaged nerves. And he suggested rTMS (3 floors down in the same apartment) and told me that, it may help or may not. Anyways 10 days in a row, I received rTMS, each takes around 20 mins. Did not help me.

Let me know if you need further info. I think I went under rTMS between Feb-March 2018.

His website in English:
http://www.ahmetsirin.com/en

 

[chuto]

I tried rTMS in Istanbul with the same doctor as well and since my tinnitus is noise induced, and as rTMS makes some noise (a metal ball hits the metal coverage on top of your head), it made my tinnitus worse so I stopped the treatment without taking the required 10 sessions.

 

[Melike]

I received the same r-TMS treatment with @Ozlem Senturk and @Emrethal in İstanbul from Dr. Ahmet Şirin. No effect on tinnitus either. I have contacted with him last week for some other issue but also mentioned that my tinnitus is still the same (more or less) and he said; just stop by and we should re-evaluate your situation, lol. Nah.

 

[derpytia]

My psychiatrist's office says that they offer TMS and when I asked about it they said that technically, it's not approved for patient use in the United States, but they have it and are only allowed to use it for patients who have exhausted all other available options in the world for their depression. I've asked other doctors about it and they've all told me the same thing. It's technically not FDA approved for patient use. Gotta love the state of medical science in the United States.

 

[Emrethal]

I received the same r-TMS treatment with @Ozlem Senturk and @Emrethal in İstanbul from Dr. Ahmet Şirin. No effect on tinnitus either. I have contacted with him last week for some other issue but also mentioned that my tinnitus is still the same (more or less) and he said; just stop by and we should re-evaluate your situation, lol. Nah.

I am sorry to hear that. I hope we all find a solution in close future...

 

[Frédéric]

Treatment of Tinnitus Using Theta Burst Based Repetitive Transcranial Magnetic Stimulation—A Single Blinded Randomized Control Trial
Joanna Godbehere;Jaswinder Sandhu;Alexander Evans;Victoria Twigg;Ian Scivill;Jaydip Ray;Anthony Barker;

Abstract
Objective:To determine whether theta burst repetitive transcranial magnetic stimulation is an effective treatment for chronic tinnitus compared with a control stimulus.Study Design:A two-arm, single-blind, randomized controlled trial comparing an active treatment group to a placebo control group.Setting:Neurotology department of a tertiary referral center.Patients:Forty new and existing patients with chronic unilateral or bilateral tinnitus were recruited from specialist hearing and balance clinics.Interventions:The subjects were randomized into two groups representing the treatment and sham subcategories. Two 40 second trains, 15 minutes apart of transcranial stimulation was provided using a super rapid stimulator (2.2. Tesla, Magstim Inc., Wales, UK) using a circular delivery coil. Treatment was provided over 5 consecutive days.Main Outcome Measure:Tinnitus functional index (TFI) scores were recorded before treatment, immediately after treatment, 2 weeks, and at 4 weeks following treatment and compared.Results:TFI scores were analyzed using the Shapiro–Wilk test and found to be normally distributed. A paired Student t test was then performed. Both the active treatment group and control group had a significant improvement in their TFI scores following treatment; however, there was no significant difference between active treatment and sham treatment groups.Conclusion:This study demonstrated a significant placebo effect following treatment with sham therapy and may suggest that repetitive transcranial magnetic stimulation does not have a therapeutic use in treating chronic tinnitus.

Source: https://insights.ovid.com/otology-n...t-tinnitus-using-theta-burst-based/7/00129492

 

[acute]

I was wondering if "Transcutaneous Electrical Nerve Stimulation" (TENS) and rTMS "repetitive Transcranial Magnetic Stimulation" are seen as a possibility for tinnitus treatment.

Has someone tried this? Can it make tinnitus worse?

My clinic offers me these treatments and says that there are patients who have improved and even eliminated the noise. I do not know if it's a scam.

Maybe it's placebo...

 

[GregCA]

I was wondering if "Transcutaneous Electrical Nerve Stimulation" (TENS) and rTMS "repetitive Transcranial Magnetic Stimulation" are seen as a possibility for tinnitus treatment.

Has someone tried this? Can it make tinnitus worse?

My clinic offers me these treatments and says that there are patients who have improved and even eliminated the noise. I do not know if it's a scam.

Maybe it's placebo...

Check out pubmed. There is data about rTMS.

 

[acute]

Check out PubMed. There is data about rTMS.

I was reading on clinicaltrials.gov and it's not very promising... But I wanted to read some experiences and opinions around here... English is not my native language and for me it's a little bit difficult to read science articles and trials, but I'm trying.

Seems like these treatments are not valid?

I will also check PubMed. Thank you.

[ Currently reading: https://clinicaltrials.gov/ct2/results?cond=tinnitus+rtms&term=&cntry1=&state1=&recrs= ]

 

[Frédéric]

O-15 Repetitive transcranial magnetic stimulation for the treatment of chronic subjective non-pulsatile primary tinnitus case report

https://doi.org/10.1016/j.clinph.2019.04.331

Background
Therapy of subjective chronic primary tinnitus could be challenging. Repetitive transcranial magnetic stimulation (rTMS) is currently being tested for suppressing the symptom. However, effect of stimulation remains controversial.

Objective
The aim was to uncover real effect of rTMS stimulation for tinnitus treatment.

Methods
Fifty-three adult patients suffering from chronic subjective non-pulsatile primary tinnitus for at least 6 months were included in the study. Patients were randomly assigned into rTMS stimulation group (group 1), sham stimulation group (group 2) and group with medicament therapy only (group 3). Dorsolateral prefrontal cortex(frequency 25 Hz; 300 pulses; 80% resting motor threshold = RMT) and primary auditory cortex on both sides (1 Hz; 1000 pulses; 110% RMT) were stimulated in patients in rTMS stimulation group for 5 consecutive days. Tinnitus reaction questionnaire (TRQ), tinnitus handicap questionnaire (THQ), tinnitus handicap inventory (THI), Beck Depression Inventory (BDI), pure-tone audiometry with Fowler scoring of hearing loss and tinnitus analysis were used for evaluation of tinnitus in all patients. Data was recorded in the day patient was included in the study, during follow-up after 1 month and 6 months.

Results
No significant effect of rTMS stimulation after 1 month and 6 months was found in our study in BDI, THQ and TRQ score or in tinnitus masking. There was significant effect in THI score ater 1 ano 6 months. We would like to present case reports of 2 patients with the effect of stimulation, in which the deterioration of the socioeconomic state leaded to a marked deterioration of tinnitus.

 

[Frédéric]

Steady-State Auditory Evoked Fields Reflect Long-Term Effects of Repetitive Transcranial Magnetic Stimulation in Tinnitus
https://doi.org/10.1016/j.clinph.2019.05.022

Highlights
Long-term effects of rTMS on steady-state auditory evoked fields (SSAEFs) in tinnitus are unknown.
We report that SSAEFs remained decreased for one month after rTMS.
SSAEFs may serve as a biomarker for long-term effects of rTMS on tinnitus.

Abstract
Objectives
Evidence of plastic changes in tinnitus has been demonstrated in functional brain imaging. Although repetitive transcranial magnetic stimulation (rTMS) has been shown to decrease steady-state auditory evoked fields (SSAEFs) in tinnitus, the long-term consequence remained unknown. In addition, association between plastic changes as reflected by hemispheric asymmetry and tinnitus handicap inventory (THI) before and after rTMS have not been addressed.

Methods
Twelve tinnitus patients received rTMS and 12 received sham stimulation. Another 12 healthy participants served as the normal hearing controls. Patients responded to the THI before the 1st session and at one month after the final session of rTMS/sham stimulation. Changes in brain activity were assessed by measuring SSAEFs.

Results
SSAEFs remained decreased one month after rTMS compared to before treatment, along with a significant reduction in THI score. There was no significant effect between the index of hemispheric asymmetry and THI score.

Conclusions
The current study objectively demonstrated the long-term effects of rTMS on tinnitus using SSAEFs. A longitudinal study to develop an index using SSAEFs to assess the subjective severity of tinnitus is warranted.

Significance
This study suggests the possible use of SSAEFs to assess the long-term effects of rTMS on tinnitus.