Thursday, 20 July 2017

Tinnitus experimental treatment with repetitive TMS in Iceland

20 of July 2017, Reykjavik

by Neurophysiology Plus

Experimental treatment with repetitive TMS (rTMS) for subjective tinnitus is a challenging option. Preliminary research data on rTMS has yielded mixed results, especially when rTMS patients are compared to patients in a placebo test group (American Tinnitus Association). 
Low frequency ( LF 1 Hz) rTMS unilaterally applied to temporal or temporoparietal cortical areas can interact with an abnormal hyperactivity of auditory cortices that may constitute the neural correlate of tinnitus perception. Literature data showed that this type of rTMS protocol has a possible therapeutic efficacy (Level C recommendation) in this clinical condition (J.-P. Lefaucheur et al.2014 / Clinical Neurophysiology 125, page 2177).
In Iceland, our first patient started the 10 sessions treatment with 1200 daily pulses 100%RMT applied in 60 series of 20 pulses (1Hz frequency) on 17th of July 2017. Location of coil was set to stimulate between T3 and C3/T5 using 10-20 international EEG system (Lee H.Y. et al 2013). 
We use the same protocol used in Department of Otorhinolaryngology - Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul (Lee H.Y. et al 2013Clinical and Experimental Otorhinolaryngology Vol. 6, No. 2: 63-67, June 2013). To assess the progression of a possible rTMS effect on tinnitus perception we used Tinnitus Handicap Inventory THI questionnaire and Visual Analogue Scale for both tinnitus annoyance and loudness (here). 

Primary Auditory Cortex: In humans, the primary auditory cortex is located in the transverse temporal gyri (of Heschl) of the medial aspect of the superior temporal gyrus. Brodmann’s area 42 is the auditory association area. Together, Brodmann’s areas 41 and 42 are called the A-1 region and receive projections from the medial geniculate nucleus (geniculotemporal fibers or auditory radiations). The tonotopic organization in the auditory relay nuclei is maintained in the auditory cortex as well. One of the secondary auditory areas includes Wernicke’s area, which is important for the interpretation of the spoken word.


20.07.2017 Clinical Neurophysiology Unit, Reykjavik
Photo: Aron Dalin Jónasson

3 comments:

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