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.
ABSTRACT
BACKGROUND: We studied whether 1 session of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied sequentially over both the left and right inferior frontal gyri (IFG) would enhance performance in tests evaluating the ability to inhibit habitual responses (Stroop test, ST; Frontal Assessment Battery, FAB) in patients with Parkinson's disease (PD). METHODS: Ten nondemented PD patients (6 men, 4 women; age, 66 ± 6 years; disease duration, 5.4 ± 2.45 years) entered the randomized, sham stimulation-controlled study with a crossover design. The ST and the FAB were performed prior to and immediately after an appropriate rTMS session. RESULTS: The active but not sham rTMS induced significant improvement in all ST subtests (word, color, color-word). Conversely, the calculated Stroop interference and the FAB scores remained unchanged. CONCLUSIONS: In PD patients, rTMS of the IFG increased the speed of cognitive processing in both the congruent and incongruent conditions of the ST.
Subject(s)
Cognition Disorders/therapy , Frontal Lobe/physiology , Transcranial Magnetic Stimulation , Aged , Cognition Disorders/etiology , Color Perception , Cross-Over Studies , Double-Blind Method , Female , Humans , Inhibition, Psychological , Male , Mental Status Schedule , Middle Aged , Neuropsychological Tests , Parkinson Disease/complications , Pilot Projects , VocabularyABSTRACT
The aim of the present study was to investigate the effects of one session of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied over the left dorsal premotor cortex (PMd) and left dorsolateral prefrontal cortex (DLPFC) on choice reaction time in a noise-compatibility task, and cognitive functions in patients with Parkinson's disease (PD). Clinical motor symptoms of PD were assessed as well. Ten patients with PD entered a randomized, placebo-controlled study with a crossover design. Each patient received 10 Hz stimulation over the left PMd and DLPFC (active stimulation sites) and the occipital cortex (OCC; a control stimulation site) in the OFF motor state, i.e. at least after 12 h of dopaminergic drugs withdrawal. Frameless stereotaxy was used to target the optimal position of the coil. For the evaluation of reaction time, we used a noise-compatibility paradigm. A short battery of neuropsychological tests was performed to evaluate executive functions, working memory, and psychomotor speed. Clinical assessment included a clinical motor evaluation using part III of the Unified Parkinson's Disease Rating Scale. Statistical analysis revealed no significant effect of rTMS applied over the left PMd and/or DLPFC in patients with PD in any of the measured parameters. In this study, we did not observe any effect of one session of high frequency rTMS applied over the left PMd and/or DLPFC on choice reaction time in a noise-compatibility task, cognitive functions, or motor features in patients with PD. rTMS applied over all three stimulated areas was well tolerated and safe in terms of the cognitive and motor effects.
Subject(s)
Cerebral Cortex/physiopathology , Cognition Disorders/etiology , Parkinson Disease/complications , Reaction Time/physiology , Transcranial Magnetic Stimulation/methods , Aged , Analysis of Variance , Attention/physiology , Biophysics/methods , Cerebral Cortex/pathology , Choice Behavior/physiology , Cognition Disorders/pathology , Electric Stimulation , Female , Humans , Male , Memory, Short-Term/physiology , Middle Aged , Neuropsychological Tests , Psychomotor Performance/physiologyABSTRACT
We studied whether the (123)I-FP-CIT uptake in the striatum correlates with depressive symptoms and cognitive performance in patients with Parkinson's disease (PD). Twenty patients with PD without major depression and/or dementia (mean age 61.7 +/- 12.7 years) underwent the (123)I-FP-CIT SPECT. Depressive symptoms and cognitive performance were assessed in the ON state. The ratios of striatal to occipital binding for the entire striatum, putamina, and putamen to the caudate (put/caud) index were calculated in the basal ganglia. The association between neuropsychiatric measures and dopamine transporter (DAT) availability was calculated; multiple regression analysis was used to assess association with age and disease duration. We found significant correlations between Montgomery and Asberg Depression Rating Scale (MARDS) and Tower of London (TOL) task scores and (123)I-FP-CIT uptake in various striatal ROIs. Multiple regression analysis confirmed the significant relationship between TOL performance and put/caud ratio (P = 0.001) and to age (P = 0.001), and between MADRS and left striatal (P = 0.005) and putaminal DAT availability (P = 0.003). Our pilot study results demonstrate that imaging with (123)I-FP-CIT SPECT appears to be sensitive for detecting dopaminergic deficit associated with mild depressive symptoms and specific cognitive dysfunction in patients with PD, yet without a current depressive episode and/or dementia.
