Single-Session of Combined tDCS-TMS May Increase Therapeutic Effects in Subjects With Tinnitus

Eun Bit Bae, Jun Ho Lee, Jae-Jin Song, Eun Bit Bae, Jun Ho Lee, Jae-Jin Song

Abstract

To treat motor and psychiatric disorders, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) are used in clinics worldwide. We combined these two types of neuromodulation technique to increase the effective response of a single session of neuromodulation in subjective tinnitus. Eighty tinnitus subjects were split into four different treatment groups: tDCS, tDCS with sham TMS, tDCS-TMS, and TMS group. Subjects were given 1.5 mA tDCS on the bi-frontal area and TMS stimulated the contralateral single side of the temporo-parietal cortex with 200 pulses at 1 Hz stimulation. Comparing pre-treatment questionnaire scores to post-treatment questionnaire scores, all four groups showed statistically significant improvements. Although there was no significant difference among group comparison, the largest mean difference was shown in the combined group, especially for tinnitus intensity and tinnitus-related distress. Responders in the combined group were the highest for VAS intensity, with a maximum of 80% of twenty subjects. To summarize, dual-neuromodulation responders could consist of responders of frontal tDCS and temporal TMS. In addition, abnormal activity in the frontal or temporal area of the responders is presumed to be modulated by treatment and will be suggested as the target areas in future studies.

Keywords: neuromodulation; tinnitus; tinnitus distress; tinnitus handicap inventory; tinnitus intensity; tinnitus perception; transcranial direct current stimulation; transcranial magnetic stimulation.

Copyright © 2020 Bae, Lee and Song.

Figures

Figure 1
Figure 1
Schematic summary of the study protocol.
Figure 2
Figure 2
Pre- and post-treatment questionnaire scores of the four study groups. Single asterisk (*) designates P < 0.05 while double asterisks (**) designate P < 0.01. THI, tinnitus handicap inventory; VAS, visual analog scale; Tx, treatment; tDCS, transcranial direct current stimulation; TMS, transcranial magnetic stimulation; sh, sham.
Figure 3
Figure 3
The percentage neuromodulation responders and non-responders with regard to respondents in intensity or distress (A), VAS intensity (B), and VAS distress (C) in the 4 study groups. VAS, visual analog scale; Tx, treatment; tDCS, transcranial direct current stimulation; TMS, transcranial magnetic stimulation; sh, sham.

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