Nervenheilkunde, Inhaltsverzeichnis

Nervenheilkunde 2006; 25(08): 649-652
DOI: 10.1055/s-0038-1626763

Originaler Artikel

Schattauer GmbH

Niedrigfrequente repetitive transkranielle Magnetstimulation

Ein neues Therapieverfahren zur Behandlung des chronischen Tinnitus?Treatment of chronic tinnitus with low frequency repetitive transcranial magnetic stimulation

B. Langguth

¹Klinik für Psychiatrie und Psychotherapie, Universität Regensburg (Leiter: Prof. Dr. H. E. Klein)

,

M. Landgrebe

¹Klinik für Psychiatrie und Psychotherapie, Universität Regensburg (Leiter: Prof. Dr. H. E. Klein)

,

P. G. Sand

¹Klinik für Psychiatrie und Psychotherapie, Universität Regensburg (Leiter: Prof. Dr. H. E. Klein)

,

T. Kleinjung

²Klinik für HNO-Heilkunde, Universität Regensburg (Leiter: Prof. Dr. J. Strutz)

,

G. Hajak

¹Klinik für Psychiatrie und Psychotherapie, Universität Regensburg (Leiter: Prof. Dr. H. E. Klein)

,

P. Eichhammer

¹Klinik für Psychiatrie und Psychotherapie, Universität Regensburg (Leiter: Prof. Dr. H. E. Klein)

³Molecular and Behavioral Neuroscience Institute, University of Michigan, USA (Leiter: Prof. Dr. J. K. Zubieta)

› Institutsangaben

Zusammenfassung

Der chronische Tinnitus ist eine häufige Erkrankung, deren Pathophysiologie nicht im Detail geklärt ist. Funktionell bildgebende Untersuchungen verweisen auf neuroplastische Veränderungen mit gesteigerter neuronaler Aktivität im Bereich des auditorischen Kortex. Pilotstudien haben gezeigt, dass neuronavigierte PET und NMR-gestützte niedrigfrequente repetitive transkranielle Magnetstimulation (rTMS) zu einer signifikanten Tinnitusreduktion führt. Im Rahmen der vorliegenden Studie soll untersucht werden, ob rTMS auch unter Verwendung einer einfacher durchführbaren Spulenlokalisationsmethode in der Lage ist, Tinnitus zu reduzieren. Elf Patienten fmit chronischem Tinnitus wurden mit rTMS behandelt (110% Motorschwelle, 1Hz, 2 000 Stimuli/Tag, 10 Tage). Die Positionierung der Spule zur Stimulation des linken auditorischen Kortex erfolgte mithilfe anatomischer Landmarken. Therapieeffekte wurden mit dem Tinnitusfragebogen nach Goebel und Hiller erfasst. Nach rTMS Behandlung kam es zu einer signifikanten Verminderung des Tinnitusschweregrades. Niedrigfrequente rTMS über dem linken auditorischen Kortex stellt ein vielversprechendes innovatives Instrument zur Behandlung des chronischen Tinnitus dar.

Summary

Idiopathic tinnitus isa frequent and debilitating disorder of largely unknown pathophysiological conditions. Recent studies demonstrated neuroplastic changes with increased activation in the central auditory system of patients suffering from chronic tinnitus. Pilot studies have demonstrated that tinnitus can be reduced by MRI and PET guided low frequency repetitive transcranial magnetic stimulation (rTMS). Eleven patients with chronic tinnitus were treated with low frequency rTMS (110% motor threshold, 1 Hz, 2 000 Stimuli/day, 10 days). The TMS coil was positioned over the left auditory cortex by using anatomical landmarks. Treatment effects were assessed with the Tinnitus Severity Questionnaire. After rTMS treatmenta significant reduction of tinnitus severity was observed, outlasting the stimulation period by at least two weeks. Low frequency rTMS of the left auditory cortex seems to be a promising new method for the treatment of chronic tinnitus.

Schlüsselwörter

Schlüsselwörter

Tinnitus - transkranielle Magnetstimulation - Neuroplastizität

Keywords

Keywords

Tinnitus - transcranial magnetic stimulation - neuroplasticity

Literatur
1 Coles RR. Epidemiology of tinnitus: (1) prevalence. J Laryngol Otol Suppl 1984; 09: 7-15.
2 Folmer RL, Griest SE, Martin WH. Chronic tinnitus as phantom auditory pain. Otolaryngol Head Neck Surg 2001; 124: 394-400.
3 Wallhausser-Franke E. et al. Expression of c-fos in auditory and non-auditory brain regions of the gerbil after manipulations that induce tinnitus. Exp Brain Res 2003; 153: 649-54.
4 Moller AR. Pathophysiology of tinnitus. Otolaryngol Clin North Am 2003; 36: 249-66.
5 Arnold W. et al. Focal metabolic activation in the predominant left auditory cortex in patients suffering from tinnitus:a PET study with [18F]deoxyglucose. ORL J Otorhinolaryngol Relat Spec 1996; 58: 195-9.
6 Eichhammer P. et al. Neuronavigated repetitive transcranial magnetic stimulation in patients with tinnitus: a short case series. Biol Psychiatry 2003; 54: 862-5.
7 Jastreboff PJ. Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neurosci Res 1990; 08: 221-54.
8 Moller AR. Similarities between severe tinnitus and chronic pain. J Am Acad Audiol 2000; 11: 115-24.
9 Langguth B. et al. Altered motor cortex excitability in tinnitus patients: a hint at crossmodal plasticity. Neurosci Lett 2005; 380: 326-9.
10 Muhlnickel W, Elbert T, Taub E, Flor H. Reorganization of auditory cortex in tinnitus. Proc Natl Acad Sci USA 1998; 95: 10340-3.
11 Weisz N, Wienbruch C, Dohrmann K, Elbert T. Neuromagnetic indicators of auditory cortical reorganization of tinnitus. Brain. 2005
12 Weisz N, Moratti S, Meinzer M, Dohrmann K, Elbert T. Tinnitus perception and distress is related to abnormal spontaneous brain activity as measured by magnetoencephalography. PLoS Med 2005; 02: e153.
13 Hoffman RE, Cavus I. Slow transcranial magnetic stimulation, long-term depotentiation, and brain hyperexcitability disorders. Am J Psychiatry 2002; 159: 1093-102.
14 Wang H, Wang X, Scheich H. LTD and LTP induced by transcranial magnetic stimulation in auditory cortex. Neuroreport 1996; 07: 521-5.
15 Hoffman RE. et al. Transcranial magnetic stimulation of left temporoparietal cortex and medication-resistant auditory hallucinations. Arch Gen Psychiatry 2003; 60: 49-56.
16 Langguth B. et al. Neuronavigated rTMS in a patient with chronic tinnitus. Effects of 4 weeks treatment. Neuroreport 2003; 14: 977-80.
17 Kleinjung T. et al. Treatment of chronic tinnitus with neuronavigated repetitive Transcranial Magnetic Stimulation (rTMS). Hno. 2005
18 Kleinjung T. et al. Long-term effects of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic tinnitus. Otolaryngol Head Neck Surg 2005; 132: 566-9.
19 Langguth B. et al. The impact of auditory cortex activity on characterizing and treating patients with chronic tinnitus -first results from a PET study. Acta Otolaryngologica. (in press).
20 Langguth B. et al. Transcranial Magnetic Stimulation for the treatment of tinnitus: A new coil positioning method and first results. Brain Topography. (in press).
21 Goebel G, Hiller W. The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results ofa multicenter study with the tinnitus questionnaire. Hno 1994; 42: 166-72.
22 Rossini PM. et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol 1994; 91: 79-92.
23 Goebel G, Hiller W. Qualitätsmanagement in der Therapie des chronischen Tinnitus. Otorhinolaryngol Nova 2000; 10: 260-8.
24 Langguth B. et al. [Low frequency repetitive transcranial magnetic stimulation (rTMS) for the treatment of chronic tinnitus--are there long-term effects?]. Psychiatr Prax 2004; 31 (Suppl. 01) S52-S54.
25 Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry 2003; 160: 835-45.