Transcranial Stimulation Treatments (rTMS & tDCS & tACS)

Thanks for your reply!

 

Have we made any progress on this?

Back in 2009 I saw an ENT who was convinced that rtms was just on the verge of being approved for tinnitus as soon as they got done getting the protocell right and he anticipated being able to offer it to me in his office.

 

I called UCLA TMS. The treatment consists of 36 sessions which you need to do every day, M-F, for 6 weeks. They start to taper at the end. Each session will last 30-60 minutes. If you have insurance, it should be covered. I didn't ask for the out of pocket cost as I knew it would be high and I wouldn't be able to pay for it without my insurance. This old link has an average cost of $9k.

https://abc7.com/archive/6999817/

 

I'm frankly very surprised insurance would cover this. Maybe for depression, but for tinnitus?

 

I'm sure they are skilled at getting the treatment covered by insurance, otherwise few could afford it. I think being on anti-depressants first is a requirement. I would imagine there isn't much difference between TMS for depression and tinnitus.

 

Actually the treatment has to be configured for tinnitus specifically. If you do TMS for depression it may worsen your tinnitus because it is configured to be excitatory. The protocol is different.

They do it at Brai3n in Ghent but they do a qEEG first. There is a private psychiatric centre that does TMS in London for depression. It's super expensive. I called them and they claim they can reconfigure the treatment for tinnitus but they weren't able to tell me how many patients they treated for tinnitus and the success rate.

My neurologist told me TMS treatments are not very effective for tinnitus. Given the cost and the lack of data from this London practice ran by psychiatrists, and the possibility of a worsening, I let that go.

EDIT: this is the link to the treatment in London. They do mention tinnitus explicitly now. Has anyone tried this in London?

https://www.psychiatrycentre.co.uk/...ion-rtms-clinic/tinnitus-treatment-with-rtms/

 

Trying to fix something and making it worse is the story of my life. Lol!

Talk about timing. I saw an interesting post on Reddit from someone who bought a home rTMS device and had a huge improvement in their tinnitus. It may have been an anecdotal result, but it was done in a scientific manner. Here is the device.

https://omnipemf.com/

I think I'm going to make a purchase given the discount.

 

Interesting device. Is it TMS? They talk about electromagnetic stimulation but it's not entirely clear. Which of the following modes did they use?

Theta Meditation
Dominant frequency: 4 Hz.
Magnetic flux density: 2.5 mT.
Accompanying frequency: 10 Hz.
Magnetic flux density: 0.25 mT.

Improve Sleep
Dominant frequency: 4 Hz.
Magnetic flux density: 2.5 mT.
Accompanying frequency: 2.67 Hz.
Magnetic flux density: 0.25 mT.

Pain control
Dominant frequency: 303 Hz.
Magnetic flux density: 2.0 mT.
Accompanying frequency: 12 Hz.
Magnetic flux density: 0.25 mT.

Improve Focus
Dominant frequency: 33 Hz.
Magnetic flux density: 2.5 mT.
Accompanying frequency: 50 Hz.
Magnetic flux density: 0.25 mT.

Meditation for Calming
Dominant frequency: 9 Hz.
Magnetic flux density: 2.5 mT.
Accompanying frequency: 6 Hz.
Magnetic flux density: 0.25 mT.

Deep Relaxation
Dominant frequency: 10 Hz.
Magnetic flux density: 2.5 mT.
Accompanying frequency: 3 Hz.
Magnetic flux density: 0.25 mT.

Energy & Vitality
Dominant frequency: 40 Hz.
Magnetic flux density: 2.5 mT.
Accompanying frequency: 55 Hz.
Magnetic flux density: 0.5 mT.

 

@vttbx, concerning OmniPEMF, I searched the web and I think I found the posts you are referring to. Interestingly, from what I read based on the anecdotal experience, the setting that seems to help is "deep relaxation" but one also needs to position the head device in a somewhat atypical position that is different from the position used for depression/sleep etc. The user that had success said that the headset has to be positioned in front of the ears and that one has to choose two particular frequencies (that I think coincide with deep relaxation).

This is the link provided by the manufacturer for tinnitus, but as you see it is relatively vague. It claims that Pulsed Electromagnetic Field Therapy (PEMF) can benefit tinnitus patients based on this study:

Engel S, Markewitz R, Langguth B, Schecklmann M. Paired Associative Stimulation of the Temporal Cortex: Effects on the Auditory Steady-State Response. Front Psychiatry. 2017;8:227. DOI:10.3389/fpsyt.2017.00227

That is a study for general PEMF and not for the specific device. The manufacturer does not claim to cure tinnitus but says they can help with tinnitus symptoms (I guess anxiety, insomnia etc). However the user I mentioned above experienced periods of remission of tinnitus itself. But this is a sample of one.

There is also a report of one user getting tinnitus from using the device after three weeks for other conditions, but this might be due to the particular setting used, in that it is known that stimulating-type therapies (like TMS for depression) can trigger tinnitus. We know that already. One could then try the relaxing setting with this device, with an ad hoc positioning of the device, and hopefully this could be similar to a TMS clinic treatment? That is another question I have, is PEMF therapy the same as TMS? They call PEMF also low level magnetic therapy but it's not clear to me if this is the same as proper TMS. Here in London proper TMS for tinnitus would cost about £10,000-£20,000 depending on the number of sessions. It's highly standardized as they don't base it on brain scans or anything, so I suspect its effectiveness is not that clear. I can barely afford that with all that's coming up in my life right now and if the effect is temporary and therapy needs to be repeated this would be totally unsustainable, and if it does nothing or worsens me God knows how I would feel, it's already desperation now. A home device would be a much better option for me, given also the COVID-19 issues.

@vttbx, I think the main challenge would be to make sure that the device setting and positioning matches as well as possible the setting of the successful academic papers using TMS specifically for tinnitus. This is a summary paper for TMS that also develops personalized protocols:

Individualized Repetitive Transcranial Magnetic Stimulation Treatment in Chronic Tinnitus?

However this is not the same paper I linked above. This second paper is a real TMS paper and as I said above I'm not clear how much home PEMF devices are comparable to proper TMS therapy. I'm not sure how I would use a home device in a way that matches this second paper as much as possible. Again the user I mentioned came up with some suggestions but they are really very anecdotal and I'm not sure what to do. May I ask you how you plan to proceed? If you feel like answering these questions it would be helpful, but no worries otherwise:

1. Do you think PEMF is really a form of TMS, and is it comparable to proper TMS?

2. What program would you use? Would you agree the relaxation one is the most appropriate in trying to match the frequencies of the above TMS paper?

3. Where would you position the headset?

4. Is there anything else we can do to understand how to best customize the treatment?

 

@vttbx -- I just tried to do a quick look and see what price was. All I could see was 53% off. But they don't say off of what. Do you know what the price is? -- I really hate it when businesses won't even show the price of their products. It's a big turnoff for me.

 

If you click through it gives you the price. Looks like $299 USD with the sale price factored in. You can divide by .53 to figure out the original price if you want.

 

It's $299 US. If you do a Google search, you can find a coupon for 10% off. I paid $269. It took a few coupon searches to find one that works.

 

I ordered my device yesterday and plan to follow the protocol set by the user on Reddit. I believe the setting was "deep relax," with a variation on the headset placement being over the forehead and above the ears. You have researched this device far more than I have, so I can't offer any additional insight.

Great work, by the way. They do offer a 60-day money-back guarantee.

https://omnipemf.com/returns-and-refunds-policy/

 

There is a negative experience with the OmniPEMF NeoRhythm on Tinnitus Talk:

Severe Tinnitus Seemingly from Using NeoRhythm PEMF Device

 

Indeed, this is what he did. The frequencies of the "Deep Relaxation" mode are not an exact match for the ones used in the successful TMS paper but they are the closest you can find in the different settings. I'm still trying to assess how precise the "mapping" from traditional TMS to therapy with this device is. What complicates matters further is that even traditional TMS is not guaranteed to help. We need some luck. I'm thinking about ordering this. I'm a little concerned with a possible worsening as we have two anecdotal reports of worsening, beside the one from Tinnitus Talk I posted above there is one also from Reddit. What is particularly concerning is that the report from Tinnitus Talk concerns a worsening under the "Deep Relaxation" mode. I had hoped the worsening was happening under a stimulating setting, but even the relaxation one used by the successful user caused severe worsening in another instance. On the other hand I think permanent damage is very unlikely and the money back guarantee is solid.

I just wanted to suggest a prudent approach, given the above anecdotal cases. Please let us know how it goes, I would be very grateful if you could update us here. I have not been helped by devices like hearing aids, Parasym or Lenire, so I hope this one may work. Fingers crossed.

 

Humbled again by the mighty Tinnitus Talk community. Just when you think you have found something new, someone has tried it. Thanks for posting!

 

Here's a new vid about Dr. Laure Jacquemin's research (HD-tDCS). It's in Dutch, but you could easily find the translate button. One thing worth mentioning is that she talked about patients who noticed a reduction in their tinnitus (maybe for considerable amount of peeps, but not all of them). We could certainly use some good news given that we have survived this particularly shitty year.

Laure doet onderzoek naar oorsuizen | LabKlap #7

 

I haven't found any translation in English but, in another interview with English subtitles, she says that 30 % improve.

 

Yes, that's right @ThomasC. I remember that she mentioned in an earlier video that she noticed an 30% improvement. Interestingly, she is currently doing another study with HD-tDCS with a few adjustments to the intervention in hopes of increasing the success rate.

 

Just got back from meeting with Jacquemin.

I copy pasted your question into my Messenger so I could ask her literally what you asked. I told her it was a question from a forum member.

Her answer:

"Yes, absolutely I know Susan Shore, I consider her to be a pioneer in the field. But again (she had told me something similar already when talking about Lenire) we are all just trying something at this point. Even my solution is not working for everyone (she still repeats the 1 in 3 statistic). We are looking at tongue tip stimulation and audio stimulation but... (loose quote) I have the feeling that audio stimulation is mostly a temporary patch."​

She pretty much recognizes that there may as well be a lot of different roads, but more research is needed.
But this is literally the first doctor that I have seen that actually knows about Susan Shore and Lenire.

Next steps:

I am now on the waiting list (3 month long list so far) for brain stimulation.

Tomorrow I will go to Brai3n (which funnily enough Jacquemin also referred to when I asked her if she was the only one with this device) but it will obviously be more expensive at Brai3n, even though my insurance is not covering the stimulation at UZA (Jacquemin) either.

It will be interesting tomorrow to get my first qEEG (at Brai3n) to see what my troubled exhausted brain is up to.

 

I got back from the Brai3n institute.

If anything, I have to commend them on being so thorough.
Not expecting any miracles from them (or anyone) but at least it gives some peace of mind that finally 'all' angles have been covered.

They did:
1) qEEG
2) took blood samples (to look for infections etc)
3) normal audiogram
4) extended audiogram
5) extended ear pressure testing

Results:
Normal audiogram still only shows that 20 dB dip at 4000 Hz which so far not a single doctor has considered as being an issue (directly related to tinnitus).
Extended audiogram shows damage in the lower frequencies but after meeting with the doctor to talk over those results he said "but also this is normal damage, 'everyone' has this - my damage is even worse than yours and I don't have tinnitus"

The doctor also said "I never link damage directly with tinnitus as it is more complex than that and not (always) 1:1 linked"

He put me on Clonazepam and Deanxit (it's a Belgian protocol for tinnitus, that's why you won't find much online, mostly links to Belgium) combo to calm down in preparation for a possible tympanic patch on my eardrum (for TTTS > I have low drone noise tinnitus). I'm still not sure if I need it / or if I want it. It seems scary.
The doctor also noticed the left chin area being tense and in fact a bit painful when he put pressure on it (I had not noticed this before).

Next time at Brai3n:
- talk about results of qEEG and blood samples (I still don't know the results of those)
- meet up with their physiotherapist because I have a lot of shoulder and chin issues (important note: I do not believe for a second that my tinnitus is being caused by neck / muscle issues ... I clearly had an acoustic trauma and 3 weeks later my tinnitus started.)
- I've been put on Clonazepam and Deanxit to be ready for that tympanic patch. But as I said above, not sure if I want it yet.

Side note:
I'm not taking the Clonazepam, only the Deanxit and it kind of works 'wonders'. It feels like I'm on top of the world. I guess that's what antidepressants do. The tinnitus also seems lower in volume.

 

I'm on the same boat: 20 dB dip at 4 kHz from using earphones. I didn't have any acoustic trauma and had stopped using earphones a few months prior to the sudden offset (happened during the lockdown and didn't go out much in that period.). My ENT however attributed my tinnitus onset to that dip and said that it's pretty common.

 

Go figure...

I have now seen a total of 5 specialists, in 2 countries, including the very specialized doctor at Brai3n.
Not a single one of them (!) regarded that 20 dB dip at 4000 Hz as a 1:1 reason for the tinnitus.
Based on the overwhelming amount of doctors on "my side", I'm inclined to dismiss what your ENT said, kind of feels that he/she just said that to be done with it quickly.

That said, I'm quite certain I already had that dip a long time ago, without the tinnitus component.

Also - Google "normal audiograms"... You will find none with a 20 dB dip that are catalogued as "problematic". Even more, a lot of "normal audiogram" images actually include a 20 dB dip at 4000 Hz.

 

Hi. I used my OmniPEMF in Deep Relaxation mode maybe 10 times over the last 5 weeks. Unfortunately, my tinnitus did not improve at all. I returned it today as I can't risk the $300 to have something that is ineffective. FYI, If you are in the United States, the shipping is to Slovenia. The basic rate is $25 with standard tracking and $68 with complete tracking from CA. I went with the basic, so I hope there are no issues with the tracking.

 

I kept investigating and all I found is one case of success vs two worsening cases. One of the worsening cases is dramatic and had the same setting of the success case. This is not good enough for me to risk it so I didn't go for it. Thank you for your update and sorry it didn't work in the end.

 

I know a 3rd case of rTMS severely worsening someone to suicidal levels too.

 

High Definition transcranial Direct Current Stimulation (HD-tDCS) for chronic tinnitus: Outcomes from a prospective longitudinal large cohort study (Jacquemin et al., 2021)

Abstract
Background: Transcranial Direct Current Stimulation (tDCS) aims to induce cortical plasticity by modulating the activity of brain structures. The broad stimulation pattern, which is one of the main limitations of tDCS, can be overcome with the recently developed technique called High-Definition tDCS (HD-tDCS).

Objective: Investigation of the effect of HD-tDCS on tinnitus in a large patient cohort.

Methods: This prospective study included 117 patients with chronic, subjective, non-pulsatile tinnitus who received six sessions of anodal HD-tDCS of the right Dorsolateral Prefrontal Cortex (DLPFC). Therapy effects were assessed by use of a set of standardized tinnitus questionnaires filled out at the pre-therapy (Tpre), post-therapy (T3w) and follow-up visit (T10w). Besides collecting the questionnaire data, the perceived effect (i.e., self-report) was also documented at T10w.

Results: The Tinnitus Functional Index (TFI) and Tinnitus Questionnaire (TQ) total scores improved significantly over time (pTFI < 0.01; pTQ < 0.01), with the following significant post hoc comparisons: Tpre vs. T10w (pTFI < 0.05; pTQ < 0.05) and T3w vs. T10w (pTFI < 0.01; pTQ < 0.01). The percentage of patients reporting an improvement of their tinnitus at T10w was 47%. Further analysis revealed a significant effect of gender with female patients showing a larger improvement on the TFI and TQ (pTFI < 0.01; pTQ < 0.05).

Conclusions: The current study reported the effects of HD-tDCS in a large tinnitus population. HD-tDCS of the right DLPFC resulted in a significant improvement of the tinnitus perception, with a larger improvement for the female tinnitus patients.

Link:
https://www.sciencedirect.com/science/article/pii/S0079612320301606

 

Small update:

I went to Brai3n again last week to talk through my qEEG results.

- Only thing they could see is that my "Active" brain network and my "Subconscious" brain network are not balanced out.
Meaning: they should really never be "ON" at the same time because then weird stuff will happen.
They are advising tDCS to bring back that balance (to make sure only "Active" is ON or "Subconscious" is ON, not both at the same time).

- The dude interpreting my qEEG literally said (remember I have a 20 dB tip at 4000 Hz in both ears): "Where can I sign to get your hearing? It's amazing to see how your hearing aging process has not even started at your age (I'm 43). That dip is a dip, sure, but not hearing loss and I would not attribute your tinnitus to that dip 1:1".

- I saw another specialist doctor there (never seen him before) and he said something slightly different: while that dip is not hearing loss, it is clear that there is damage there. (Since all my other frequencies are not dipping at all, I would have a smooth curve if it wasn't for that 4000 Hz dip). The brain might be not happy about that dip, but it's not dramatic.

I must say - I'm kinda done getting opinions from doctors This is my 8th one or something. They really are just guessing at this point. Even the doctors at Brai3n (world leaders on tinnitus imho) are contradicting a bit and just guessing.

That said: My first visit with them they put me on Clonazepam and Deanxit. I decided on my own to not take the Clonazepam but I am taking the Deanxit and, for me, it has been nothing short of a miracle drug. It's an anti-anxiety drug.

I have taken Clonazepam in the beginning, it never did much but suck the soul out of me.

Deanxit doesn't really change my personality, but it MOST DEFINITELY has an effect on the weight I attribute to my tinnitus.

The volume has gone down and my reaction to it has gone down. Maybe the first thing follows because of the second, who knows... I'm afraid to stop taking Deanxit because I know I can't take it forever, but it's good to know I have this way out if I'm struggling.

I have my first tDCS session today at Brai3n > not expecting too much to be honest. I'm not the best mindset. Just being realistic.

I will keep updating this thread.

 

Very quick update:

I had 3rd tDCS session today.

The "operator" said I'm improving...

Basically you are hearing beeps / buzzes if your brain is doing something good (the beeps are "cookie" treats for your brain).

In the first session I didn't get so many beeps. Third session I got a lot more and my 2 graph lines were closer together > which is what you want.

As I understand, all this is to make sure my active brain network and my subconscious brain network get decoupled "again".

I'm still taking Deanxit, and I still think it's a miracle drug... I will sadly not be able to take it forever of course, and I'm scared of the comedown.

I have my next tDCS session on Friday - then evaluation if it's actually helping my tinnitus - if it's not, they might try one of the other treatments they offer (including Lenire). Not there yet.

 

Interesting. Did the rewarding beeps result in a perceived improvement of your symptoms?

Deanxit is one of the drugs promoted by De Ridder. It's a combo of an antipsychotic and a tricyclic antidepressant. I wonder why it is not approved in many countries, including the UK.

I'm desperate but I could invest a month in Ghent to visit Brai3n if I find the strength. It's one of the very few centres specialized in tinnitus that is not doing only trivial things (as opposed to the so called "tinnitus clinic" in London).