Combined rTMS to the auditory cortex and prefrontal cortex for tinnitus control in patients with depression
우울감을 동반한 이명 환자에서 청각 피질과 전전두 피질에 대한 combined rTMS 의 효과
Dept. of Medicine/석사
Objectives:Recent studies suggest that the neuronal changes of the chronic tinnitus are beyond the auditory pathway. There is increasing evidence for repetitive transcranial magnetic stimulation (rTMS) on multiple brain cortex in addition to the auditory cortex for the treatment of tinnitus by various institution.We tried sequential treatment of rTMS on auditory cortex only and auditory area combined with prefrontal area in patient with both chronic tinnitus and depression.Methods:We recruited and enrolled patients who present chronic tinnitus more than one year with depressive symptom(4 male, 4 female, mean age 57). To select the site for the rTMS PET CT was performed. Patients received 1st rTMS on the primary auditory cortex for 5 days and on the primary auditory cortex and prefrontal cortex in the second treatment after relapse of tinnitus . THI(Tinnitus handicap inventory), VAS(Visual analog scale) and BDI were checked before and after rTMS.Results:The mean THI score of 8 patient changed 77.5 to 61.8 after 2nd TMS. There was statistical significance only in 2nd rTMS. The VAS score changed 8.6 to 6.2 after1st rTMS and 7.6 to 4.6 after 2nd rTMS which means statistically significant changes on both time on VAS score. The changes of THI after 2nd TMS was bigger than 1st and the changes of VAS score shows similar pattern. The changes of BDI score, which indicates the severity of depression shows variable pattern after rTMS. Patients with mild depression(BDI score < 10, n=4) showed much improvement of THI with 2nd combined rTMS (delta THI 24.5) than with the 1st rTMS on auditory area (delta THI 5.5). In contrast, combined rTMS showed no better effect on THI improvement(delta THI 6.5) than 1st rTMS on auditory cortex (delta THI 9) in patients with moderate to severe depression(BDI > 10, n=4)Conclusions:Our study showed that combined rTMS on auditory cortex and prefrontal area has more benefit than rTMS on auditory area only on tinnitus control in patients with depression. Further studies for the most optimal combination of the stimulation on both area in needed.