jueves, 30 de diciembre de 2010

ACUFENOS-Seccíon Tecnicas de tratamiento

Transcranial magnetic stimulation for the treatment of tinnitus:next term 4-year follow-up in treatment responders—a retrospective analysis
Julia Burger1, Elmar Frank1, Peter Kreuzer1, Tobias Kleinjung2, Veronika Vielsmeier2, Michael Landgrebe1, Goeran Hajak1 and Berthold Langguth1, Corresponding Author Contact Information, E-mail The Corresponding Author

1 Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
2 Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
Received 29 September previous term2010;next term 
revised 8 November previous term2010;next term 
accepted 26 November previous term2010.next term 
Available online 28 December previous term2010.next term


Repetitive transcranial magnetic stimulation (rTMS) over the temporal cortex has been proposed as a new approach for the treatment of previous termtinnitus.next term Even if most studies have shown beneficial effects, there is only limited knowledge about clinical predictors for treatment response and about the duration of treatment effects.


In this study, we compared clinical characteristics of rTMS responders and nonresponders and assessed long-term outcome in the responder group.


Results from 235 patients, who were treated with rTMS because of chronic previous termtinnitusnext term were analysed.
Patients received either a standard protocol of low-frequency rTMS (n = 188; 110% motor threshold, 1 Hz, 2000 stimuli/day) over the left temporal cortex or combined frontal and temporal rTMS (n = 47; 110% motor threshold, 1000 stimuli at 20 Hz, left dorsolateral prefrontal cortex plus 1000 stimuli at 1 Hz left temporal cortex).

Response criterion was defined as an improvement of at least 10 points in the previous termtinnitusnext term questionnaire (TQ) score between baseline and the follow-up assessment 90 days after treatment.


For the entire study group there was a highly significant effect of treatment on the TQ score.

Fifty patients (21.3%) were responders according to the above mentioned definition.
The response criterion was fulfilled by 19.7% of the patients receiving left temporal rTMS and by 26% of the patients receiving combined rTMS.

The only significant difference between responders and nonresponders was a higher baseline score of the TQ in the responder group. 

There were no significant differences in all other assessed patient parameters (gender, age, previous termtinnitusnext term duration, previous termtinnitusnext term laterality, motor threshold, handedness).

Ninety days after treatment the average TQ reduction in the responder group was 18.2 points as compared with baseline. At the two long-term follow-up assessments (2.12 ± 1.17 years and 3.9 ± 1.17 years after treatment) the improvement in the responder group was still 14.2, respective 14.4 points.


These data underscore the clinical relevance of rTMS in the treatment of previous termtinnitus.next term 
A potential explanation for the observed long-lasting clinical effects is that rTMS interferes with previous termtinnitusnext term related neuronal activity and thus facilitates the intrinsic ability of the brain to restore normal function.

Keywords: chronic previous termtinnitusnext term; predictor; repetitive transcranial magnetic stimulation; treatment outcome; long-term effects

Correspondence to: Berthold Langguth, MD, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany.

fuente: Science Direct


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