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Nervenheilkunde 2015; 34(12): 987-993
DOI: 10.1055/s-0038-1627657
Hirnstimulation
Schattauer GmbH

Chronischer Tinnitus

Therapeutischer Einsatz von rTMS[*] Chronic tinnitus
B. Langguth
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
,
M. Landgrebe
2   kbo-Lech-Mangfall-Klinik Agatharied, Psychiatrie – Psychotherapie – Psychosomatik
,
M. Schecklmann
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
,
C. Schönfeldt-Lecuona
3   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
J. Höppner
4   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Nervenheilkunde Universität Rostock
,
F. Padberg
5   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Ludwig-Maximilians-Universität München
,
A. J. Fallgatter
6   Universitätsklinik für Psychiatrie und Psychotherapie, Universität Tübingen
,
T. Kammer
3   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
S. Kayser
7   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Mainz
,
A. Lehner
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
,
J.-P. Lefaucheur
8   Department of Physiology, Henri Mondor Hospital, Assistance Publique – Hôpitaux de Paris, Créteil, France
9   EA 4391, Nerve Excitability and Therapeutic team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
,
P. M. Kreuzer
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
› Author Affiliations
Further Information

Publication History

eingegangen am: 30 September 2015

angenommen am: 30 September 2015

Publication Date:
22 January 2018 (online)

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Zusammenfassung

Zum Einsatz der repetitiven transkraniellen Magnetstimulation (rTMS) in der Behandlung des chronischen Tinnitus liegen 20 randomisierte placebokontrollierte Studien vor. In der Mehrzahl der Studien erfolgte die Behandlung mit niederfrequenter (1 Hz) rTMS über dem temporalen oder temporoparietalen Kortex. Die Spulenlokalisation erfolgte in den meisten Studien entweder linksseitig oder kontralateral zur Tinnituslateralität. Bei der Betrachtung ergibt sich kein eindeutiges Bild. Die Unterschiede in den Ergebnissen der einzelnen Studien könnten bedingt sein durch die Heterogenität der Stimulationsprotokollen und der Studiendesigns. Die Mehrzahl der Studien zeigte einen Nutzen der aktiven Stimulation im Vergleich zur Sham-Stimulation. Die Effektstärke war jedoch klein, der Effekt war in einzelnen (auch methodisch hochwertigen) Studien nicht nachweisbar und die Dauer des Behandlungseffektes bleibt ungewiss. Mehrere Studien legen nahe, dass die Behandlungseffekte durch die zusätzliche hochfrequente rTMS des linken frontalen Kortex verstärkt werden können. Aufgrund der nicht ganz eindeutigen Studienlage kann für den Einsatz der rTMS in der Behandlung des chronischen Tinnitus lediglich die Empfehlung mit Level C (mögliche Effekte wiederholter niederfrequenter rTMS-Sitzungen des temporalen/temporoparietalen Kortex) ausgesprochen werden.

Summary

Twenty randomized and placebo-controlled clinical trials have been performed for investigating the treatment of chronic tinnitus with repetitive transcranial magnetic stimulation (rTMS). In most cases rTMS was delivered following a low-frequency paradigm (1 Hz) targeting the left or contralateral (regarding the tinnitus percept) temporal or temporoparietal cortex. No consistent conclusion can be drawn based on these data so far. Differences in the outcome of the single studies might be attributed to heterogeneity in stimulation protocols and study designs. The majority of the presented studies demonstrated advantages of active rTMS stimulation compared to sham-stimulation. However, treatment effects were only moderate, not detectable in some (even methodologically sophisticated) studies, and the duration of treatment effects is uncertain. Some studies suggest that treatment effects might be enhanced by additional high-frequency rTMS of left frontal cortical areas. Due to the inconsistent character of current study results, only a level-C-recommendation (possible effects) can be obtained regarding serial application of low-frequency rTMS targeting the temporal/temporoparietal cortex.

Schlüsselwörter

Chronischer Tinnitus - rTMS - repetitive transkranielle Magnetstimulation

Keywords

Chronic tinnitus - repetitive transcranial magnetic stimulation - rTMS

* Dieses Manuskript wurde als Positionspapier der Deutschen Gesellschaft für Hirnstimulation in der Psychiatrie (DGHP) erarbeitet


 

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