Chronischer Tinnitus

B. Langguth; M. Landgrebe; M. Schecklmann; C. Schönfeldt-Lecuona; J. Höppner; F. Padberg; A. J. Fallgatter; T. Kammer; S. Kayser; A. Lehner; J.-P. Lefaucheur; P. M. Kreuzer

doi:10.1055/s-0038-1627657

Nervenheilkunde, Table of Contents

Nervenheilkunde 2015; 34(12): 987-993
DOI: 10.1055/s-0038-1627657

Hirnstimulation

Schattauer GmbH

Chronischer Tinnitus

Therapeutischer Einsatz von rTMS^[*] Chronic tinnitus

Authors

B. Langguth

¹Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
M. Landgrebe

²kbo-Lech-Mangfall-Klinik Agatharied, Psychiatrie – Psychotherapie – Psychosomatik
M. Schecklmann

¹Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
C. Schönfeldt-Lecuona

³Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
J. Höppner

⁴Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Nervenheilkunde Universität Rostock
F. Padberg

⁵Klinik und Poliklinik für Psychiatrie und Psychotherapie der Ludwig-Maximilians-Universität München
A. J. Fallgatter

⁶Universitätsklinik für Psychiatrie und Psychotherapie, Universität Tübingen
T. Kammer

³Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
S. Kayser

⁷Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Mainz
A. Lehner

¹Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
J.-P. Lefaucheur

⁸Department of Physiology, Henri Mondor Hospital, Assistance Publique – Hôpitaux de Paris, Créteil, France

⁹EA 4391, Nerve Excitability and Therapeutic team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
P. M. Kreuzer

¹Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg

Abstract

Zusammenfassung

Zum Einsatz der repetitiven transkraniellen Magnetstimulation (rTMS) in der Behandlung des chronischen Tinnitus liegen 20 randomisierte placebokontrollierte Studien vor. In der Mehrzahl der Studien erfolgte die Behandlung mit niederfrequenter (1 Hz) rTMS über dem temporalen oder temporoparietalen Kortex. Die Spulenlokalisation erfolgte in den meisten Studien entweder linksseitig oder kontralateral zur Tinnituslateralität. Bei der Betrachtung ergibt sich kein eindeutiges Bild. Die Unterschiede in den Ergebnissen der einzelnen Studien könnten bedingt sein durch die Heterogenität der Stimulationsprotokollen und der Studiendesigns. Die Mehrzahl der Studien zeigte einen Nutzen der aktiven Stimulation im Vergleich zur Sham-Stimulation. Die Effektstärke war jedoch klein, der Effekt war in einzelnen (auch methodisch hochwertigen) Studien nicht nachweisbar und die Dauer des Behandlungseffektes bleibt ungewiss. Mehrere Studien legen nahe, dass die Behandlungseffekte durch die zusätzliche hochfrequente rTMS des linken frontalen Kortex verstärkt werden können. Aufgrund der nicht ganz eindeutigen Studienlage kann für den Einsatz der rTMS in der Behandlung des chronischen Tinnitus lediglich die Empfehlung mit Level C (mögliche Effekte wiederholter niederfrequenter rTMS-Sitzungen des temporalen/temporoparietalen Kortex) ausgesprochen werden.

Summary

Twenty randomized and placebo-controlled clinical trials have been performed for investigating the treatment of chronic tinnitus with repetitive transcranial magnetic stimulation (rTMS). In most cases rTMS was delivered following a low-frequency paradigm (1 Hz) targeting the left or contralateral (regarding the tinnitus percept) temporal or temporoparietal cortex. No consistent conclusion can be drawn based on these data so far. Differences in the outcome of the single studies might be attributed to heterogeneity in stimulation protocols and study designs. The majority of the presented studies demonstrated advantages of active rTMS stimulation compared to sham-stimulation. However, treatment effects were only moderate, not detectable in some (even methodologically sophisticated) studies, and the duration of treatment effects is uncertain. Some studies suggest that treatment effects might be enhanced by additional high-frequency rTMS of left frontal cortical areas. Due to the inconsistent character of current study results, only a level-C-recommendation (possible effects) can be obtained regarding serial application of low-frequency rTMS targeting the temporal/temporoparietal cortex.

Schlüsselwörter

Chronischer Tinnitus - rTMS - repetitive transkranielle Magnetstimulation

Keywords

Chronic tinnitus - repetitive transcranial magnetic stimulation - rTMS

Full Text

References

Literatur
1 Gallus S, Lugo A, Garavello W, Bosetti C, Santoro E, Colombo P. et al. Prevalence and determinants of tinnitus in the Italian adult population. Neuroepidemiology 2015; 45 (01) 12-9.
2 Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol 2013; 12 (09) 920-30.
3 Schecklmann M, Vielsmeier V, Steffens T, Landgrebe M, Langguth B, Kleinjung T. Relationship between Audiometric slope and tinnitus pitch in tinnitus patients: insights into the mechanisms of tinnitus generation. PLoS One 2012; 07 (04) e34878.
4 Eggermont JJ. Pathophysiology of tinnitus. Prog Brain Res 2007; 166: 19-35.
5 De Ridder D, Elgoyhen AB, Romo R, Langguth B. Phantom percepts: tinnitus and pain as persisting aversive memory networks. Proc Natl Acad Sci U S A 2011; 108 (20) 8075-80.
6 Norena AJ, Eggermont JJ. Enriched acoustic environment after noise trauma reduces hearing loss and prevents cortical map reorganization. J Neuro sci 2005; 25 (03) 699-705.
7 Lanting CP, De Kleine E, Bartels H, Van Dijk P. Functional imaging of unilateral tinnitus using fMRI. Acta Otolaryngol 2008; 128 (04) 415-21.
8 Langguth B, Eichhammer P, Wiegand R, Marienhegen J, Maenner P, Jacob P. et al. Neuronavigated rTMS in a patient with chronic tinnitus. Effects of 4 weeks treatment. Neuroreport 2003; 14 (07) 977-80.
9 Plewnia C, Bartels M, Gerloff C. Transient suppression of tinnitus by transcranial magnetic stimulation. Ann Neurol 2003; 53 (02) 263-6.
10 Lefaucheur JP, Andre-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH. et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. 2014. Jun 5; E-pub.
11 Kleinjung T, Eichhammer P, Landgrebe M, Sand P, Hajak G, Steffens T. et al. Combined temporal and prefrontal transcranial magnetic stimulation for tinnitus treatment: a pilot study. Otolaryngol Head Neck Surg 2008; 138 (04) 497-501.
12 Hiller W, Goebel G. A psychometric study of complaints in chronic tinnitus. J Psychosom Res 1992; 36 (04) 337-48.
13 Adamchic I, Tass PA, Langguth B, Hauptmann C, Koller M, Schecklmann M. et al. Linking the tinnitus questionnaire and the subjective clinical global impression: Which differences are clinically important?. Health Qual Life Outcomes 2012; 10 (01) 79.
14 Langguth B, Eichhammer P, Wiegand R, Marienhegen J, Maenner P, Jacob P. et al. Neuronavigated rTMS in a patient with chronic tinnitus. Effects of 4 weeks treatment. Neuroreport 2003; 14: 977-80.
15 Langguth B, Kleinjung T, Frank E, Landgrebe M, Sand P, Dvorakova J. et al. High-frequency priming stimulation does not enhance the effect of low-frequency rTMS in the treatment of tinnitus. Exp-Brain Res 2008; 184 (04) 587-91.
16 Lorenz I, Muller N, Schlee W, Langguth B, Weisz N. Short-term effects of single repetitive TMS sessions on auditory evoked activity in patients with chronic tinnitus. J Neurophysiol 2010; 104 (03) 1497-505.
17 Muller N, Lorenz I, Langguth B, Weisz N. rTMS induced tinnitus relief is related to an increase in auditory cortical alpha activity. PLoS One 2013; 08 (02) e55557.
18 Londero A, Langguth B, De Ridder D, Bonfils P, Lefaucheur JP. Repetitive transcranial magnetic stimulation (rTMS): a new therapeutic approach in subjective tinnitus?. Neurophysiol Clin 2006; 36 (03) 145-55.
19 Kleinjung T, Steffens T, Londero A, Langguth B. Transcranial magnetic stimulation (TMS) for treatment of chronic tinnitus: clinical effects. Prog Brain Res 2007; 166: 359-67.
20 Meeus OM, De Ridder D, Van de Heyning PH. Transcranial magnetic stimulation (TMS) in tinnitus patients. B-ENT 2009; 05 (02) 89-100.
21 Plewnia C. Brain stimulation: new vistas for the exploration and treatment of tinnitus. CNS Neuro sci Ther 2011; 17 (05) 449-61.
22 Hoekstra CE, Versnel H, Neggers SF, Niesten ME, van Zanten GA. Bilateral low-frequency repetitive transcranial magnetic stimulation of the auditory cortex in tinnitus patients is not effective: A randomised controlled trial. Audiol Neurootol 2013; 18 (06) 362-73.
23 Langguth B, Landgrebe M, Frank E, Schecklmann M, Sand PG, Vielsmeier V. et al. Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies. World J Biol Psychiatry 2014; 15 (04) 276-85.
24 Landgrebe M, Binder H, Koller M, Eberl Y, Kleinjung T, Eichhammer P. et al. Design of a placebocontrolled, randomized study of the efficacy of repetitive transcranial magnetic stimulation for the treatment of chronic tinntius. BMC Psychiatry 2008; 08 (01) 23.
25 Kleinjung T, Eichhammer P, Langguth B, Jacob P, Marienhagen J, Hajak G. et al. Long-term effects of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic tinnitus. Otolaryngol Head Neck Surg 2005; 132 (04) 566-9.
26 Khedr EM, Rothwell JC, Ahmed MA, El-Atar A. Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus: comparison of different stimulus frequencies. J Neurol Neurosurg Psychiatry 2008; 79 (02) 212-5.
27 Khedr EM, Rothwell JC, El-Atar A. One-year follow up of patients with chronic tinnitus treated with left temporoparietal rTMS. Eur J Neurol 2009; 16 (03) 404-8.
28 Marcondes RA, Sanchez TG, Kii MA, Ono CR, Buchpiguel CA, Langguth B. et al. Repetitive transcranial magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled, clinical and neuroimaging outcome study. Eur J Neurol 2010; 17 (01) 38-44.
29 Soleimani R, Jalali MM, Hasandokht T. Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2015 May 13; E-pub.
30 Burger J, Frank E, Kreuzer P, Kleinjung T, Vielsmeier V, Landgrebe M. et al. Transcranial magnetic stimulation for the treatment of tinnitus: 4-year follow-up in treatment responders – a retrospective analysis. Brain Stimul 201; 04 (04) 222-7.
31 Plewnia C, Reimold M, Najib A, Brehm B, Reischl G, Plontke SK. et al. Dose-dependent attenuation of auditory phantom perception (tinnitus) by PETguided repetitive transcranial magnetic stimulation. Hum Brain Mapp 2007; 28 (03) 238-46.
32 Rossi S, De Capua A, Ulivelli M, Bartalini S, Falzarano V, Filippone G. et al. Effects of repetitive transcranial magnetic stimulation on chronic tinnitus: a randomised, crossover, double blind, placebo controlled study. J Neurol Neurosurg Psychiatry 2007; 78 (08) 857-63.
33 Kleinjung T, Steffens T, Sand P, Murthum T, Hajak G, Strutz J. et al. Which tinnitus patients benefit from transcranial magnetic stimulation?. Otolaryngol Head Neck Surg 2007; 137 (04) 589-95.
34 Frank G, Kleinjung T, Landgrebe M, Vielsmeier V, Steffenhagen C, Burger J. et al. Left temporal lowfrequency rTMS for the treatment of tinnitus: clinical predictors of treatment outcome – a retrospective study. Eur J Neurol 2010; 17 (07) 951-6.
35 Langguth B, Kleinjung T, Frank E, Landgrebe M, Sand P, Dvorakova J. et al. High-frequency priming stimulation does not enhance the effect of low-frequency rTMS in the treatment of tinnitus. Exp Brain Res 2008; 184 (04) 587-91.
36 Forogh B, Yazdi-Bahri SM, Ahadi T, Fereshtehnejad SM, Raissi GR. Comparison of two protocols of transcranial magnetic stimulation for treatment of chronic tinnitus: a randomized controlled clinical trial of burst repetitive versus high-frequency repetitive Transcranial Magnetic Stimulation. Neurol Sci 2014; 35 (02) 227-32.
37 Plewnia C, Vonthein R, Wasserka B, Arfeller C, Naumann A, Schraven SP. et al. Treatment of chronic tinnitus with theta burst stimulation: a randomized controlled trial. Neurology 2012; 78 (21) 1628-34.
38 Chung HK, Tsai CH, Lin YC, Chen JM, Tsou YA, Wang CY. et al. Effectiveness of theta-burst repetitive transcranial magnetic stimulation for treating chronic tinnitus. Audiol Neurootol 2012; 17 (02) 112-20.
39 Kreuzer PM, Landgrebe M, Schecklmann M, Poeppl TB, Vielsmeier V, Hajak G. et al. Can temporal repetitive transcranial magnetic stimulation be enhanced by targeting affective components of tinnitus with frontal rTMS? A randomized controlled pilot trial. Front Syst Neurosci 2011; 05: 88.
40 De Ridder D, Song JJ, Vanneste S. Frontal cortex TMS for tinnitus. Brain Stimul 2013; 06 (03) 355-62.
41 Lehner A, Schecklmann M, Kreuzer PM, Poeppl TB, Rupprecht R, Langguth B. Comparing singlesite with multisite rTMS for the treatment of chronic tinnitus – clinical effects and neuroscientific insights: study protocol for a randomized controlled trial. Trials 2013; 14: 269.
42 Lehner A, Schecklmann M, Poeppl TB, Kreuzer PM, Vielsmeier V, Rupprecht R. et al. Multisite rTMS for the treatment of chronic tinnitus: stimulation of the cortical tinnitus network – a pilot study. Brain Topogr 2013; 26 (03) 501-10.
43 Marcondes R, Fregni F, Pascual-Leone A. Tinnitus and brain activation: insights from transcranial magnetic stimulation. Ear Nose Throat J 2006; 85 (04) 233-4.
44 Park S, Park HJ, Kyeong SH, Moon IS, Kim M, Kim HN. et al. Combined rTMS to the auditory cortex and prefrontal cortex for tinnitus control in patients with depression: a pilot study. Acta Otolaryngol 2013; 133 (06) 600-6.
45 Langguth B, Kleinjung T, Landgrebe M, de Ridder D, Hajak G. rTMS for the treatment of tinnitus: the role of neuronavigation for coil positioning. Neuro physiol Clin 2010; 40 (01) 45-58.
46 De Ridder D, van der Loo E, Van der Kelen K, Menovsky T, van de Heyning P, Moller A. Theta, alpha and beta burst transcranial magnetic stimulation: brain modulation in tinnitus. Int J Med Sci 2007; 04 (05) 237-41.
47 Lorenz I, Muller N, Schlee W, Langguth B, Weisz N. Short-term effects of single repetitive TMS sessions on auditory evoked activity in patients with chronic tinnitus. J Neurophysiol 2010; 104 (03) 1497-505.
48 De Ridder D. Should rTMS for tinnitus be performed left-sided, ipsilaterally or contralaterally, and is it a treatment or merely investigational?. Eur J Neurol 2010; 17 (07) 891-2.
49 Geven LI, de Kleine E, Willemsen AT, van Dijk P. Asymmetry in primary auditory cortex activity in tinnitus patients and controls. Neuroscience 2014; 256: 117-25.
50 Khedr EM, Abo-Elfetoh N, Rothwell JC, El-Atar A, Sayed E, Khalifa H. Contralateral versus ipsilateral rTMS of temporoparietal cortex for the treatment of chronic unilateral tinnitus: comparative study. Eur J Neurol 2010; 17 (07) 976-83.
51 Kim BG, Kim DY, Kim SK, Kim JM, Baek SH, Moon IS. Comparison of the outcomes of repetitive transcranial magnetic stimulation to the ipsilateral and contralateral auditory cortex in unilateral tinnitus. Electromagn Biol Med 2014; 33 (03) 211-5.
52 Kim HJ, Kim DY, Kim HI, Oh HS, Sim NS, Moon IS. Long-term effects of repetitive transcranial magnetic stimulation in unilateral tinnitus. Laryngoscope 2014; 124 (09) 2155-60.
53 Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation 1996. Electroencephalogr Clin Neurophysiol 1998; 108 (01) 1-16.
54 Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009; 120 (12) 2008-39.
55 Tringali S, Perrot X, Collet L, Moulin A. Repetitive transcranial magnetic stimulation: hearing safety considerations. Brain Stimul 2012; 05 (03) 354-63.
56 Schonfeldt-Lecuona C, Cardenas-Morales L, Moreno-Aguirre A, Dorn K, Langguth B, Bruhl AB. et al. Effect of 1 Hz repetitive transcranial magnetic stimulation over the auditory cortex on audiometry and otoacustic emissions. Brain Topogr 2012; 25 (03) 241-7.
57 Lefaucheur JP, Brugieres P, Guimont F, Iglesias S, Franco-Rodrigues A, Liegeois-Chauvel C. et al. Navigated rTMS for the treatment of tinnitus: a pilot study with assessment by fMRI and AEPs. Neurophysiol Clin 2012; 42 (03) 95-109.