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The use of transcranial magnetic stimulation in modulation of pure tone and narrow band noise tinnitus
Abstracts Objective: Psychomotor symptoms are frequent in patients with major depression (MD). Results of Neuroimaging studies suggest disturbances of the mesolimbic and nigrostriatal dopaminergic system in MD associated with motor symptoms [1-3]. Repetitive transcranial magnetic stimulation (rTMS) has been discussed as a new treatment option for MD, and has been shown to influence dopaminergic neurotransmission [4, 5]. For this background, we investigated the effect of left prefrontal rTMS in comparison to sham stimulation on psychomotor retardation and agitation in patients with MD as a subanalysis of a recently published multi-centre trial [6]. Method: 30 patients (18 females, mean age: 52.3 years) were randomly assigned to 3 weeks of real 10 Hz rTMS on the left dorsolateral prefrontal cortex (DLPFC) or to sham stimulation. The rTMS was applied parallel to a standardized antidepressant medication (venlafaxine or mirtazapine). Psychomotor impairments were assessed with the Motor Agitation and Retardation Scale (MARS) [7], depressive symptoms with the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HDRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Response to the stimulation was assumed in case of an at least 50% reduction of the initial scores in two of the three depressive rating scales. Result: Both patients groups did not differ in age, clinical baseline characteristics and concomitant antidepressant medication. With regard to psychomotor functioning we found an enhanced reduction of the agitation after real compared to sham stimulation (p 5 0.045), whereas no group differences for the total and the retardation subscores were detected. Real rTMS, however, did not augment the antidepressant effect of pharmacological treatment compared to sham stimulation. Conclusion: Daily rTMS over three weeks significantly improved a certain domain of psychomotor functioning compared to the sham stimulation. Interestingly, this effect appeared to be specific for agitation. As reasons, we postulate an influence of rTMS on dopaminergic and serotonergic neurotransmission and hypothalamic-pituitary-adrenocortical (HPA) activity. References: [1] Meyer JH, et al. Am J Psychiatr. 2006 [2] Tremblay LK, et al. Arch Gen Psych. 2005 [3] Walter U, et al. Brain. 2007 [4] Keck ME, et al. Neuropharmacology. 2002 [5] Pogarell O, et al. J Psychiatr Res. 2006 [6] Herwig U, et al. Br J Psych. 2007 [7] Sobin C, et al. J Neuropsych Clin Neurosci. 1998
TMS Poster Only 10
The use of transcranial magnetic stimulation in modulation of pure tone and narrow band noise tinnitus
Meeus OMJ, De Ridder D, Van de Heyning PH, Antwerp University Hospital (Edegem, BE) Introduction: Tinnitus can be defined as the perception of noise without the presence of external sound. Up to 30% of individuals in developed countries report tinnitus at some point in their lives, and 10 to 15% of them experience tinnitus significant enough to require medical evaluation. Despite the impact of this pathology, no therapy could be proven to have an additional permanent tinnitus reducing effect compared to placebo. To date, several studies have already demonstrated transient pure tone tinnitus reduction following tonic TMS and rTMS. Repetitive TMS was even proposed as a possible treatment for chronic tinnitus. In a study with 12 auditory cortex implantation patients, the absence of white noise suppression with tonic TMS was pointed out, while other studies could
241 demonstrate the suppression of this white noise tinnitus using burst TMS in 14 patients. Aim: The aim of this study is to investigate the different effects of tonic and burst TMS on tinnitus and to compare the results obtained in both pure tone and white noise tinnitus patients. Material and Methods: 31 patients with pure tone tinnitus and 19 patients with white noise tinnitus were included in the study. Successive stimulation of the auditory cortex with tonic and burst TMS was administered in 200 pulses at 50% intensity to included patients. A possible tinnitus masking resulting from the sound of the TMS could be excluded as a result of an additional sham stimulation. Tinnitus intensity was assessed using a visual analogue scale. Results: Mean tinnitus reduction in unilateral pure tone tinnitus patients was significantly higher after burst TMS compared to tonic TMS (p 5 0,041). No statistic significant difference in tinnitus reduction between pure tone or white noise tinnitus could be seen after either tonic or burst TMS. For unilateral pure tone tinnitus, higher tinnitus reduction could be achieved following high frequency stimulation (5, 10 and 20Hz) compared to low frequency stimulation (1Hz) (p 5 0,008). Higher tinnitus reduction was seen when stimulation intensity in function to the muscle threshold was higher (p 5 0,022). Conclusion: This study was performed in order to investigate the effect of tonic and burst TMS in pure tone and narrow band noise tinnitus patients. Data suggest different reactions between both patient cathegories. Increased tinnitus reduction was seen with higher stimulation intensity.
tDCS Poster Only 11
Transcranial direct current stimulation in therapy-resistant depression: Preliminary results from a double-blind, placebo-controlled study
Palm U, Keeser D, Schiller C, Fintescu Z, Reisinger E, Mulert C, Pogarell O, Mo¨ller H-J, Padberg F, Klinik fu¨r Psychiatrie (Mu¨nchen, DE) Background: The method of direct current stimulation for modulating membrane potentials is known since the 1960s. More recently, transcranial direct current stimulation (tDCS) has been investigated as therapeutic intervention in various neuropsychiatric disorders. Based on the role of the dorsolateral prefrontal cortex (DLPFC) in the pathophysiology of depression and previous studies with repetitive transcranial magnetic stimulation in depression Fregni and co-workers investigated anodal tDCS of the left DLPFC in three consecutive trials yielding promising results. However, no data are available so far in therapy-resistant depression where new effective interventions are urgently needed. We report preliminary findings from a double-blind, placebo-controlled trial in therapy-resistant depression. Methods: Ten patients with moderate to severe major depression (DSM-IV criteria) were included in a four weeks cross-over trial. All patients had undergone at least two ineffective antidepressant trials prior to tDCS. Patients received tDCS after not responding to a stable antidepressant treatment over 3 weeks and were randomized to active or sham tDCS treatment. Real and placebo tDCS were applied in random order at 1 mA for 20 min per day and for two weeks per condition. The anode was positioned over F3 and the cathode over the contralateral supraorbital region. For placebo tDCS a novel sham device which is indistinguishable for the applying person. Severity of depression was assessed by HAMD, BDI, CGI and CORE scales and raters were blind to treatment conditions. Results: Overall there was no significant difference between real and sham tDCS in terms of clinical improvement. However, group 1 receiving real tDCS first showed a decrease in mean HAMD scores from 34.8 at baseline to 30.2 after two weeks real treatment and to 25.0 after further two weeks sham treatment and group 2 receiving sham tDCS first showed a decrease in mean HAMD from 37.0 at baseline to 34.0 after two weeks sham
TMS Poster Only 10
The use of transcranial magnetic stimulation in modulation of pure tone and narrow band noise tinnitus
Meeus OMJ, De Ridder D, Van de Heyning PH, Antwerp University Hospital (Edegem, BE) Introduction: Tinnitus can be defined as the perception of noise without the presence of external sound. Up to 30% of individuals in developed countries report tinnitus at some point in their lives, and 10 to 15% of them experience tinnitus significant enough to require medical evaluation. Despite the impact of this pathology, no therapy could be proven to have an additional permanent tinnitus reducing effect compared to placebo. To date, several studies have already demonstrated transient pure tone tinnitus reduction following tonic TMS and rTMS. Repetitive TMS was even proposed as a possible treatment for chronic tinnitus. In a study with 12 auditory cortex implantation patients, the absence of white noise suppression with tonic TMS was pointed out, while other studies could
241 demonstrate the suppression of this white noise tinnitus using burst TMS in 14 patients. Aim: The aim of this study is to investigate the different effects of tonic and burst TMS on tinnitus and to compare the results obtained in both pure tone and white noise tinnitus patients. Material and Methods: 31 patients with pure tone tinnitus and 19 patients with white noise tinnitus were included in the study. Successive stimulation of the auditory cortex with tonic and burst TMS was administered in 200 pulses at 50% intensity to included patients. A possible tinnitus masking resulting from the sound of the TMS could be excluded as a result of an additional sham stimulation. Tinnitus intensity was assessed using a visual analogue scale. Results: Mean tinnitus reduction in unilateral pure tone tinnitus patients was significantly higher after burst TMS compared to tonic TMS (p 5 0,041). No statistic significant difference in tinnitus reduction between pure tone or white noise tinnitus could be seen after either tonic or burst TMS. For unilateral pure tone tinnitus, higher tinnitus reduction could be achieved following high frequency stimulation (5, 10 and 20Hz) compared to low frequency stimulation (1Hz) (p 5 0,008). Higher tinnitus reduction was seen when stimulation intensity in function to the muscle threshold was higher (p 5 0,022). Conclusion: This study was performed in order to investigate the effect of tonic and burst TMS in pure tone and narrow band noise tinnitus patients. Data suggest different reactions between both patient cathegories. Increased tinnitus reduction was seen with higher stimulation intensity.
tDCS Poster Only 11
Transcranial direct current stimulation in therapy-resistant depression: Preliminary results from a double-blind, placebo-controlled study
Palm U, Keeser D, Schiller C, Fintescu Z, Reisinger E, Mulert C, Pogarell O, Mo¨ller H-J, Padberg F, Klinik fu¨r Psychiatrie (Mu¨nchen, DE) Background: The method of direct current stimulation for modulating membrane potentials is known since the 1960s. More recently, transcranial direct current stimulation (tDCS) has been investigated as therapeutic intervention in various neuropsychiatric disorders. Based on the role of the dorsolateral prefrontal cortex (DLPFC) in the pathophysiology of depression and previous studies with repetitive transcranial magnetic stimulation in depression Fregni and co-workers investigated anodal tDCS of the left DLPFC in three consecutive trials yielding promising results. However, no data are available so far in therapy-resistant depression where new effective interventions are urgently needed. We report preliminary findings from a double-blind, placebo-controlled trial in therapy-resistant depression. Methods: Ten patients with moderate to severe major depression (DSM-IV criteria) were included in a four weeks cross-over trial. All patients had undergone at least two ineffective antidepressant trials prior to tDCS. Patients received tDCS after not responding to a stable antidepressant treatment over 3 weeks and were randomized to active or sham tDCS treatment. Real and placebo tDCS were applied in random order at 1 mA for 20 min per day and for two weeks per condition. The anode was positioned over F3 and the cathode over the contralateral supraorbital region. For placebo tDCS a novel sham device which is indistinguishable for the applying person. Severity of depression was assessed by HAMD, BDI, CGI and CORE scales and raters were blind to treatment conditions. Results: Overall there was no significant difference between real and sham tDCS in terms of clinical improvement. However, group 1 receiving real tDCS first showed a decrease in mean HAMD scores from 34.8 at baseline to 30.2 after two weeks real treatment and to 25.0 after further two weeks sham treatment and group 2 receiving sham tDCS first showed a decrease in mean HAMD from 37.0 at baseline to 34.0 after two weeks sham