Transcranial Stimulation Treatments (rTMS & tDCS & tACS)

Discussion in 'Treatments' started by exodus, Apr 18, 2012.

    1. papu
      Chatty

      papu Member Benefactor

      Tinnitus Since:
      03/2015
      Cause of Tinnitus:
      Acoustic Trauma
      @Dr. Jay Hobbs
      A little bit out off topic what are your thoughts regarding trns or transcranial random noise stimulation. I have read several studies which seem promising but now one comments on them.

      It seems although electric instead of magnetic about the same principle of breaking sinchronicity in the audio cortex areas.
       
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    2. Dr. Jay Hobbs
      Studious

      Dr. Jay Hobbs Member Benefactor

      Location:
      central valley California
      Tinnitus Since:
      Blessed to not have...often
      Cause of Tinnitus:
      NA
      I was not familiar with this technique, but I did a little reading, and I'll share my initial analysis.

      One 2013 study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866637/)compared THREE transcranial electrical stimulation (tES) techniques:
      • transcranial direct current stimulation (tDCS),
      • transcranial alternating current stimulation (tACS) and
      • transcranial random noise stimulation (tRNS)
      The only one that had any statistically significant effect was tRNS.
      The average VAS for LOUDNESS went from 7.0 to 6.25
      The average VAS for DISTRESS went from 6.75 to 6.15​
      It was only one session, so it wasn't a study to see the full potential effect.

      A 2014 study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283418/) at the SAME Belgium clinic using (tACS) and (tRNS) for 8 sessions delivered over 4 weeks demonstrated:
      No statistical benefit from single or multiple sessions of tACS.
      A statistical benefit from single and multiple sessions of tRNS was demonstrated:
      Multiple sessions of tRNS -->
      • tinnitus loudness went from 7.20 to 5.70 a 21% improvement, and
      • tinnitus annoyance went from from 6.20 to 5.40, a 13% improvement.
      There was no long-term follow-up to see how well it stuck, but it does show a little promise.

      A different group did a study in 2017 (https://www.ncbi.nlm.nih.gov/pubmed/27761741) comparing tDCS and tDCS + tRNS, with multi-site treatment.
      Not surprisingly, after reading the studies above, they found that the group that included tRNS saw an added benefit over tDCS alone. I only read the abstract, so I don't know the results. I expect they were similar to the ones above.​
       
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    3. linearb
      Psychedelic

      linearb Member Hall of Fame

      Location:
      1
      Tinnitus Since:
      1900
      Cause of Tinnitus:
      karma
      @Dr. Jay Hobbs thanks for the insight, it's great to have an MD venturing into the broader forum here.

      I'm curious if you personally have tinnitus, or if your interest in it is just compassion/professional? No reason for asking other than simple curiosity.
       
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    4. Dr. Jay Hobbs
      Studious

      Dr. Jay Hobbs Member Benefactor

      Location:
      central valley California
      Tinnitus Since:
      Blessed to not have...often
      Cause of Tinnitus:
      NA
      I am blessed to NOT have tinnitus.

      Oh, just to be clear, I am a DC, DACNB, not a MD.

      Since 8th grade, I have felt compelled to help others restore their health and performance in a natural, holistic way. Of course, I didn't know the word "holistic" back then, but I knew that just doing ONE thing to address a problem that had THREE causes was not going to get the best results.

      I came to tinnitus SPECIFICALLY by way of chronic pain studies. As a chiropractic neurologist and nutritionist, pain was a more likely target for my efforts. I continued running across mentions of tinnitus in the chronic pain, especially phantom limb and Complex Regional pain, literature. I brushed it off for a couple years while I developed protocols for those conditions.

      After reaching a level of completion with those topics, I turned to investigate tinnitus. I found that there was some good work going on with auditory discrimination, but that the researchers eventually moved on to other topics, presumably because they had to follow the grant money. I thought, "This is doable, as a functional neurologist, I am uniquely equipped to add insight to this approach, and no one is really pursuing this aggressively." I ended up testing some theories in an online research project. I got some promising results, but I am convinced that we can do considerably better.

      ...That's my interest.
       
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    5. Paulmanlike

      Paulmanlike Member Hall of Fame

      Tinnitus Since:
      2008
      Cause of Tinnitus:
      Noise
      Dr Hobbs,

      I read that rTMS is still very much in a testing stage with mixed results, however, the researchers think that it's only a matter of time before they work out where to place it, how long, the dose for it to have its full effect? Is this true and do you think it soon Ben clinical practice for rTMS to be a standard treatment for tinnitus?
       
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    6. Dr. Jay Hobbs
      Studious

      Dr. Jay Hobbs Member Benefactor

      Location:
      central valley California
      Tinnitus Since:
      Blessed to not have...often
      Cause of Tinnitus:
      NA
      @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.
       
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    7. Champ
      Woot

      Champ Member Benefactor

      Location:
      Boston, MA
      Tinnitus Since:
      01/2013
      Cause of Tinnitus:
      Acoustic trauma from headphones
      Thank you so much for your dedication and work doctor.
       
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    8. Fairy
      Cool

      Fairy Member

      Tinnitus Since:
      2016
      Tinnitus is like a train sound going thru your head. I did go to chiropractor and I still got the tinnitus. So it is hell. I have pay good money to acupuncture, dental, physical therapist, and audiologist. I did the supplements, and there is no way to get rid of it. Unless laser LLLT works. I saw that today.
       
    9. Bill Bauer
      No Mood

      Bill Bauer Member Hall of Fame

      Tinnitus Since:
      February, 2017
      Cause of Tinnitus:
      Acoustic Trauma
      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
       
    10. Frédéric

      Frédéric Member Benefactor

      Location:
      Marseille, France
      Tinnitus Since:
      11/19/2012
      Cause of Tinnitus:
      acoustic trauma
      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.
       
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    11. GregCA
      Jaded

      GregCA Member Benefactor Hall of Fame

      Tinnitus Since:
      03/2016
      Cause of Tinnitus:
      Otosclerosis
      Did you use any intravenous contrast to perform the fMRI?

      Do you know how many Teslas your MRI was at?
       
    12. Frédéric

      Frédéric Member Benefactor

      Location:
      Marseille, France
      Tinnitus Since:
      11/19/2012
      Cause of Tinnitus:
      acoustic trauma
      No intravenous constrast.
      I have no idea about how many teslas, I didn't find any information on the report sheet.
       
    13. G61

      G61 Member

      Tinnitus Since:
      2016
      Cause of Tinnitus:
      Head and neck trauma
      I won't recommend any tinnitus suffers including myself to do rTMS. rTMS is a new way to treat depression and the ECT is the traditional method when medication doesn't work. The scientists don't even understand how ECT works. Basically, what they hope for is to fry your brain and by miracle in this random process, it will cure your brain chemistry. I understand some people might be offended by what I say here. But I just want us consider how dangerous it can be.

      Watch
      Simple Truth 10: Electroshock is Brain Trauma
       
    14. Bill Bauer
      No Mood

      Bill Bauer Member Hall of Fame

      Tinnitus Since:
      February, 2017
      Cause of Tinnitus:
      Acoustic Trauma
      This is a good point. However, in cases like that (no theory, have to rely on a random process) we can look at statistics collected on previous patients. It is my understanding that statistics seem to indicate that a considerable fraction of T patients get some relief (while a much smaller fraction have their T get worse). I also believe the data shows that serious side effects are rare.
       
    15. GregCA
      Jaded

      GregCA Member Benefactor Hall of Fame

      Tinnitus Since:
      03/2016
      Cause of Tinnitus:
      Otosclerosis
      You should know that this is true of many drugs as well. Have you ever taken Tylenol? Penicillin? Are you reluctant to take them? Because their principles of action are still a mystery apparently.
       
    16. Christian78
      Alone

      Christian78 Member

      Location:
      Gothenburg
      Tinnitus Since:
      (Sep 2013)
      Cause of Tinnitus:
      progressive tinnitus, time of expiring in next 3-6 months
      To be honest not true. rTMS, or now called only TMS as there is none other than repetitive is used at Bra2n clinick in Belgium, I tried it. No avail, but friend in Germany went to longer sessions that spiked his tinnitus very much.

      Sensation is like you jaw is jumping and teeth too, anyway there are different protocols for depression as for tinnitus, depression protocol is targeted at back side of head and purpose is to excite neurons and therefore lower depression. It works, I been here in Sweden in Eksjö and they are doing it and when severely depressed patient comes they do it for him and there is significant improvement but problem is after stimulations stop so does neurological transmission and release of serotonin so...

      With tinnitus, point is that they place it on a head, front side and try to destimulate or slower neurological excitement, but only after they have done Loreta qEEG to detect overactive centers. You may think what you want but well I explained it in theory as they do.
      tms1_0.jpg

      http://www.brai2n.com/nl/patient/behandelingen/tms

      @G61
       
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    17. Dive Master
      Tired

      Dive Master Member Benefactor

      Location:
      France
      Tinnitus Since:
      06/2014
      Cause of Tinnitus:
      Airbag blast
      For the French guys in South of France, I had 8 rTMS sessions (25 min each) with Pr Alchaar, neurologist in Nice.
      https://www.docvadis.fr/alchaar/mon...ulation-magnetique-transcranienne-repetitive/
      I had a relief (less bad days and no more migraines) but the effects are not lasting... Next appointment in September. His successful rate is around 70% (He is relieving colleagues and half of the philarmonic orchestra of Nice).
       
    18. Fabrikat

      Fabrikat Member

      Tinnitus Since:
      1973
      Cause of Tinnitus:
      Otosclerosis then volume then viral infection
      I keep seeing this sort of statistic about rTMS @Dive Master, but I never see anyone on TT come back and say, well I've had rTMS and I'm cured of tinnitus. Where are this 70% we always hear of? I'm very skeptical about this therapy, not completely dismissive, just sceptical.
       
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    19. Paulmanlike

      Paulmanlike Member Hall of Fame

      Tinnitus Since:
      2008
      Cause of Tinnitus:
      Noise
      Some guy on Facebook on one of the pages stated his tinnitus was 90% reduced with it.

      Don't know if it lasted tho...
       
    20. Melike
      Studious

      Melike Member

      Location:
      Istanbul, Turkey
      Tinnitus Since:
      17 / 03 /2017
      Cause of Tinnitus:
      Most probably TMJD and neck issues that came with it.
      I personally know a person whose T reduced by %90. Also that person knows 2 Tinnitus patients who got rid of their T completely with rTMS sessions but since I don't know them, I can't speak for them.

      But I don't think it made any significant change for me. My T is nearly silent nowadays but thats probably not due to the efficacy of rTMS sessions.
       
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    21. Fabrikat

      Fabrikat Member

      Tinnitus Since:
      1973
      Cause of Tinnitus:
      Otosclerosis then volume then viral infection
      Well that's fabulous news @Melike! Are you sure it wasn't the rTMS? They did tell you, that after your sessions, your condition should improve in time, didn't they?
       
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    22. Fabrikat

      Fabrikat Member

      Tinnitus Since:
      1973
      Cause of Tinnitus:
      Otosclerosis then volume then viral infection
      @Paulmanlike and @Melike, what was different about their tinnitus, there favoured their success, compared to those whose treatment fails? That's the part I don't understand.
       
    23. Melike
      Studious

      Melike Member

      Location:
      Istanbul, Turkey
      Tinnitus Since:
      17 / 03 /2017
      Cause of Tinnitus:
      Most probably TMJD and neck issues that came with it.
      I am not sure, becuse only 3-4 days ago my T was screaming like crazy again and I couldn't mask it most of the time. Then I discovered a new audio (it is probably one of those ACRNM audios ) out of desperation. Surprisingly it immediately calms down my T to a level of 0.5/10 and it stays like that even after I stop playing. I think I can have %98 silence with that. It is so weird and I really wish it stays like that.

      So yeah, I'm not sure if it is because of rTMS or not. The awkward silence I can experience now is very similar to the one I had right after the sessions. So there is that.
       
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    24. Dive Master
      Tired

      Dive Master Member Benefactor

      Location:
      France
      Tinnitus Since:
      06/2014
      Cause of Tinnitus:
      Airbag blast
      To be clear: nobody reacts the same way, and it was just a relief for me not a cure... Less bad days, bad days less intrusive, but T still here and coming back to the pre-TMS sessions level. Efficiency did not last. Ready for a second round...
       
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    25. Melike
      Studious

      Melike Member

      Location:
      Istanbul, Turkey
      Tinnitus Since:
      17 / 03 /2017
      Cause of Tinnitus:
      Most probably TMJD and neck issues that came with it.
      Believe me, nobody understands that. That guy I know had very slight hearing loss and nothing else. But he started to receive that the treatment shortly after his onset. He told me that he woke up in silence in the middle of the 10 day that is required for sessions, then it slowly came back but at a very very low volume and stabilized then.
       
    26. Melike
      Studious

      Melike Member

      Location:
      Istanbul, Turkey
      Tinnitus Since:
      17 / 03 /2017
      Cause of Tinnitus:
      Most probably TMJD and neck issues that came with it.
      One thing that caught my attention is his fMRI scans shows only the involvement of auditory areas (hyperactivity in that region).

      I've met another girl with T who hasn't seen any significant improvement either, both of our fMRI scans show evidence for involvement of non-auditory areas in the brain too. I don't know if there is any correlation but it seems interesting.
       
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    27. Bill Bauer
      No Mood

      Bill Bauer Member Hall of Fame

      Tinnitus Since:
      February, 2017
      Cause of Tinnitus:
      Acoustic Trauma
      Is it on YouTube?
       
    28. Melike
      Studious

      Melike Member

      Location:
      Istanbul, Turkey
      Tinnitus Since:
      17 / 03 /2017
      Cause of Tinnitus:
      Most probably TMJD and neck issues that came with it.
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    29. Bill Bauer
      No Mood

      Bill Bauer Member Hall of Fame

      Tinnitus Since:
      February, 2017
      Cause of Tinnitus:
      Acoustic Trauma
      Thank you!
       
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    30. Paulmanlike

      Paulmanlike Member Hall of Fame

      Tinnitus Since:
      2008
      Cause of Tinnitus:
      Noise
      How long after playing this do you get relief for? How long do you play it
       

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