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Contralateral versus ipsilateral rTMS of temporoparietal cortex for the treatment of chronic unilateral tinnitus: comparative study
Author(s) -
Khedr E. M.,
AboElfetoh N.,
Rothwell J. C.,
ElAtar A.,
Sayed E.,
Khalifa H.
Publication year - 2010
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2010.02965.x
Subject(s) - tinnitus , medicine , transcranial magnetic stimulation , loudness , audiology , stimulation , depression (economics) , anxiety , neuromodulation , anesthesia , psychiatry , economics , macroeconomics
Background: Repetitive transcranial magnetic stimulation (rTMS) applied over left temporoparietal cortex has been reported to have a long‐term therapeutic effect on tinnitus. We compare the impact of 1 and 25 Hz rTMS delivered either contralateral or ipsilateral to symptoms in 62 patients with unilateral chronic tinnitus. Material and methods: Patients were randomly assigned to one of four treatment groups: with stimulation at 1 or 25 Hz applied either ipsilateral or contralateral to symptoms. Two thousand pulses per session were given daily for 2 weeks. Changes in tinnitus handicap inventory (THI), self‐rating scores of loudness, awareness, and annoyance were measured monthly for 10 months. Duration of residual inhibition (RI) and psychiatric morbidity were evaluated monthly for 3 months. Results: There was a significant main effect of time ( P < 0.0001) and a significant time × side interaction ( P = 0.032) between groups. This was because of the fact that contralateral stimulation had a greater effect on THI than ipsilateral stimulation; it was also superior to left side stimulation ( P = 0.027). Ratings of loudness improved more after contralateral rTMS ( P = 0.037). Twenty patients had no remaining tinnitus after 3 months; the remainder had a significant increase in RI. Patients with the shortest history of tinnitus tended to respond better to rTMS. There was a significant correlation between changes in THI score and changes in Hamilton anxiety and depression scores. Conclusion: Ten daily treatments of 1 and 25 Hz rTMS contralateral to the side of tinnitus have a greater beneficial effect on symptoms than either ipsilateral or left side stimulation.