A comparison study of repetitive transcranial magnetic stimulation for tinnitus treatment in an Asian population.

BACKGROUND: Tinnitus, a subjective auditory perception of sounds or noise not triggered by external auditory stimuli, carries considerable morbidity. To date, pharmacological, physical or behavioral therapy is the mainstay of management. METHODS: We compared repetitive transcranial magnetic stimulation (rTMS) of 1000 or 2000 stimulations/day at 1 Hz and 110% of the motor threshold for 5 consecutive days over the left auditory cortex. Ratings based on the Tinnitus Handicap Inventory (THI) rating scale were completed weekly for 4 weeks. None of the patients had significant hearing impairment. RESULTS: All 28 patients (age range 21-72; 18 men) tolerated rTMS well and no adverse effects were observed. Analysis of variance (ANOVA) showed significant decrease in THI scores over the entire time period (F (1,26)=11.33, p=0.002). At every weekly time point of evaluation, ANOVA with repeated measures demonstrated significantly lower THI score compared to baseline (p<0.02 for all). RTMS treatment had resulted in tinnitus reduction in the range of 15-25% over the 4 week period. Separately, ANOVA also demonstrated significantly reducing THI for both the 1000 pulse (F (1,14)=4.8, p=0.04) and 2000 pulse (F (1,14)=6.56, p=0.02) rTMS treatment arms. Comparison of THI ratings between the 2 treatment arms did not result in significant difference (F (1,26)=1.48, p=0.24). CONCLUSIONS: The present study has revalidated the efficacy and safety of rTMS for improving tinnitus up to 4 weeks post-treatment in Asians. However, there was no significant difference with THI evaluation between the 1000 pulse and 2000 pulse treatment arms.

A prospective pilot study of repetitive transcranial magnetic stimulation for gait dysfunction in vascular parkinsonism.

OBJECTIVE: Vascular Parkinsonism (VP) causes significant gait dysfunction in patients who otherwise have good lower limb strength. Its pathophysiology is not clearly understood, and current treatment with physical therapy remains unsatisfactory. The study explores repetitive transcranial magnetic stimulation (rTMS) as a potential new and safe therapy for VP. MATERIALS AND METHODS: We prospectively applied 5 Hz rTMS treatment to 5 patients who satisfied all the criteria for VP. Repetitive TMS was performed on 5 consecutive days and patients were assessed on (1) timed 10 m walk (T10MW), (2) Unified Parkinson's Disease Rating Scale (UPDRS) motor subsection, (3) Clinician's Global Impression of Change (CGIC), and (4) Patient's Global Impression of Change (PGIC), for up to 6 weeks post-rTMS. RESULTS: All the outcome measures were found to have improved ratings post-rTMS when compared with baseline, and were statistically significant. The T10MW showed significant improvement at 4 weeks post-rTMS with a trend towards improvement at 2 weeks post-rTMS. The UPDRS motor subscores was significantly reduced at 2 weeks, 4 weeks and 6 weeks post-rTMS. The PGIC and CGIC scores were significantly better post-rTMS. The treatment was well-tolerated and all patients completed the study. CONCLUSION: This study demonstrated for the first time that 5 sessions of rTMS could improve gait in a measurable way for up to 6 weeks without any significant side-effects. Repetitive TMS could be a potentially useful adjunct in rehabilitation of VP patients and further research is warranted.

Short duration repetitive transcranial magnetic stimulation for tinnitus treatment: a prospective Asian study.

BACKGROUND: Tinnitus is a subjective auditory perception of sounds or noise not triggered by external auditory stimuli. To date, treatment in severe cases is generally unsatisfactory. Characteristic functional brain imaging changes associated with tinnitus include hyperactivity encompassing both the primary auditory cortex (AC) and the secondary or associative cortex. Brief repetitive transcranial magnetic stimulation (rTMS) trains applied to the scalp overlying the hyperactive left AC is known to produce moderate tinnitus attenuation. OBJECTIVE: Although Western studies have documented the value of rTMS in tinnitus treatment, we evaluate the efficacy of a short duration rTMS protocol for the first time in the Asian setting. METHOD: Consecutive patients were recruited at our tinnitus clinic. Detailed history, examination, audiogram and baseline tinnitus scales were recorded. RTMS consisted of 1000 pulses/day at 1 Hz and 110% of the motor threshold, for five consecutive days over the left temporoparietal cortex. Tinnitus ratings were determined weekly for 4 weeks after rTMS. RESULT: Fifteen patients completed the trial; none experienced significant side effects. Repeated measures ANOVA showed significant linear decrease in Tinnitus Handicap Inventory (THI) scores over the time period (F((1,14))=4.7, p=0.04). However, none of the other parameters (severity, annoyance, effect on lifestyle and overall impression: visual analogue scale) showed beneficial outcomes. CONCLUSIONS: Our findings point to a positive effect of short duration rTMS in tinnitus treatment using the THI. However, no significant benefits were demonstrated for other subjective patient ratings. Although well tolerated and convenient, short duration rTMS may prove inadequate for modulating maladaptive plastic changes at the cortical level, and our results suggest the need for delivery of more stimuli. Future studies will utilize at least 2000 pulses/day, in line with previous experience in Western settings.