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Efficacy and Safety of Repeated Courses of rTMS Treatment in Patients with Chronic Subjective Tinnitus.

Lehner A, Schecklmann M, Poeppl TB, Kreuzer PM, Peytard J, Frank E, Langguth B - Biomed Res Int (2015)

Bottom Line: Both treatments were well tolerated and caused significant improvement of tinnitus severity.The main predictor for the outcome of the second treatment was the development of tinnitus distress in the phase between both treatment courses: the more patients worsened in this interval, the more they improved during the second treatment course.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany ; Interdisciplinary Tinnitus Center, University of Regensburg, 93053 Regensburg, Germany.

ABSTRACT
Background. Repetitive transcranial magnetic stimulation (rTMS) has shown promising effects in the treatment of chronic subjective tinnitus. However, little is known about maintenance treatment in order to achieve long-lasting improvements. Objective. This study addresses the questions whether the repeated application of rTMS treatment can contribute to the maintenance or enhancement of treatment effects and if so in which cases repetitive treatment courses are beneficial. Methods. 55 patients with chronic tinnitus were treated with two rTMS treatment courses with ten treatment sessions each. The mean intertreatment interval was 20.65 ± 18.56 months. Tinnitus severity was assessed before and after each treatment course. Results. Both treatments were well tolerated and caused significant improvement of tinnitus severity. The main predictor for the outcome of the second treatment was the development of tinnitus distress in the phase between both treatment courses: the more patients worsened in this interval, the more they improved during the second treatment course. Conclusion. Repeated application of rTMS seems to be useful in tinnitus management and should preferentially be offered to patients who experience a worsening of their tinnitus during the intertreatment interval, irrespective of their response to the first treatment course.

No MeSH data available.


Related in: MedlinePlus

Point diagram showing the relation between the outcome of the second treatment course and the TQ difference of the intertreatment interval.
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fig2: Point diagram showing the relation between the outcome of the second treatment course and the TQ difference of the intertreatment interval.

Mentions: All patients tolerated both treatment courses without any severe adverse effects. All treatments were completed as planned. Paired t-tests revealed that both the first and the second treatment course significantly reduced tinnitus severity as measured by the TQ (first treatment course t(54) = 3.26, p = 0.002; second treatment course t(54) = 4.033, p < 0.001). Please see Table 1 for mean and standard deviation of the TQ differences. Figure 1 shows the development of the TQ score over time. The t-test which was done to find out whether a change of treatment protocol from treatment one to treatment two had an influence on the outcome of the second treatment revealed no significant effect (t(53) = −0.89, p = 0.376). The product-moment correlations with TQ difference 2 were not significant for the duration of the intertreatment interval (r = −0.167, p = 0.223) and the baseline score of the second treatment course (r = −0.128, p = 0.351). In contrast, the correlations were significant for TQ difference 1 (r = 0.282, p = 0.037) and TQ difference ITI (r = −0.475, p < 0.001). Therefore, the latter two variables were entered as regressors in the linear regression analysis. Additionally, an interaction term between both variables was created by multiplying the centred variables. This term was also entered into the regression analysis. The TQ difference of the intertreatment interval significantly predicted the outcome of the second treatment course (β = −0.452, t = −3.12, and p = 0.003) while both TQ difference 1 (β = 0.041, t = 0.28, and p = 0.780) and the interaction term (β = −0.013, t = −0.11, and p = 0.915) were no significant predictors. Thus, TQ difference 1 loses its significant influence on TQ difference 2 if TQ difference ITI is controlled for. The overall model fit was R2 = 0.227, F(3,51) = 5.00, and p = 0.004. The scatter plot in Figure 2 shows the relation between TQ difference 2 and TQ difference ITI. The ANOVAs comparing the TQ differences obtained by the different treatment protocols turned out nonsignificant (F(5,49) = 0.37; p = 0.869 for the first treatment course; F(3,51) = 1.48, p = 0.231 for the second treatment course) indicating that none of the protocols was significantly superior (see Figure 3).


Efficacy and Safety of Repeated Courses of rTMS Treatment in Patients with Chronic Subjective Tinnitus.

Lehner A, Schecklmann M, Poeppl TB, Kreuzer PM, Peytard J, Frank E, Langguth B - Biomed Res Int (2015)

Point diagram showing the relation between the outcome of the second treatment course and the TQ difference of the intertreatment interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4637057&req=5

fig2: Point diagram showing the relation between the outcome of the second treatment course and the TQ difference of the intertreatment interval.
Mentions: All patients tolerated both treatment courses without any severe adverse effects. All treatments were completed as planned. Paired t-tests revealed that both the first and the second treatment course significantly reduced tinnitus severity as measured by the TQ (first treatment course t(54) = 3.26, p = 0.002; second treatment course t(54) = 4.033, p < 0.001). Please see Table 1 for mean and standard deviation of the TQ differences. Figure 1 shows the development of the TQ score over time. The t-test which was done to find out whether a change of treatment protocol from treatment one to treatment two had an influence on the outcome of the second treatment revealed no significant effect (t(53) = −0.89, p = 0.376). The product-moment correlations with TQ difference 2 were not significant for the duration of the intertreatment interval (r = −0.167, p = 0.223) and the baseline score of the second treatment course (r = −0.128, p = 0.351). In contrast, the correlations were significant for TQ difference 1 (r = 0.282, p = 0.037) and TQ difference ITI (r = −0.475, p < 0.001). Therefore, the latter two variables were entered as regressors in the linear regression analysis. Additionally, an interaction term between both variables was created by multiplying the centred variables. This term was also entered into the regression analysis. The TQ difference of the intertreatment interval significantly predicted the outcome of the second treatment course (β = −0.452, t = −3.12, and p = 0.003) while both TQ difference 1 (β = 0.041, t = 0.28, and p = 0.780) and the interaction term (β = −0.013, t = −0.11, and p = 0.915) were no significant predictors. Thus, TQ difference 1 loses its significant influence on TQ difference 2 if TQ difference ITI is controlled for. The overall model fit was R2 = 0.227, F(3,51) = 5.00, and p = 0.004. The scatter plot in Figure 2 shows the relation between TQ difference 2 and TQ difference ITI. The ANOVAs comparing the TQ differences obtained by the different treatment protocols turned out nonsignificant (F(5,49) = 0.37; p = 0.869 for the first treatment course; F(3,51) = 1.48, p = 0.231 for the second treatment course) indicating that none of the protocols was significantly superior (see Figure 3).

Bottom Line: Both treatments were well tolerated and caused significant improvement of tinnitus severity.The main predictor for the outcome of the second treatment was the development of tinnitus distress in the phase between both treatment courses: the more patients worsened in this interval, the more they improved during the second treatment course.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany ; Interdisciplinary Tinnitus Center, University of Regensburg, 93053 Regensburg, Germany.

ABSTRACT
Background. Repetitive transcranial magnetic stimulation (rTMS) has shown promising effects in the treatment of chronic subjective tinnitus. However, little is known about maintenance treatment in order to achieve long-lasting improvements. Objective. This study addresses the questions whether the repeated application of rTMS treatment can contribute to the maintenance or enhancement of treatment effects and if so in which cases repetitive treatment courses are beneficial. Methods. 55 patients with chronic tinnitus were treated with two rTMS treatment courses with ten treatment sessions each. The mean intertreatment interval was 20.65 ± 18.56 months. Tinnitus severity was assessed before and after each treatment course. Results. Both treatments were well tolerated and caused significant improvement of tinnitus severity. The main predictor for the outcome of the second treatment was the development of tinnitus distress in the phase between both treatment courses: the more patients worsened in this interval, the more they improved during the second treatment course. Conclusion. Repeated application of rTMS seems to be useful in tinnitus management and should preferentially be offered to patients who experience a worsening of their tinnitus during the intertreatment interval, irrespective of their response to the first treatment course.

No MeSH data available.


Related in: MedlinePlus