search
Back to results

rTMS Bimodal Treatment For Tinnitus: A Pilot Study

Primary Purpose

Tinnitus

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Bimodal rTMS
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tinnitus focused on measuring tinnitus, bimodal stimulation, rTMS, Repetitive Transcranial Magnetic Stimulation

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Must be between the ages of 18 and 60 years.
  • Subjective, idiopathic, troublesome, unilateral or bilateral, non-pulsatile tinnitus of ≥ 2 month's duration but no greater than 5 year's duration.
  • Bothersome Tinnitus according to Tinnitus Handicap Inventory score.
  • Must be able to understand, speak, read and write English proficiently
  • Able to provide informed consent
  • Women who are of childbearing potential must agree to use a medically acceptable form of birth control and must have a negative urine pregnancy test at screening

Exclusion Criteria:

  • •• Patients with tinnitus related to cochlear implantation, retrocochlear lesion, or other known anatomic/structural lesions of the ear and temporal bone. Patients with a history of stapedectomy and insertion of implant will be excluded.

    • Hypersensitive to noises (hyperacusis)
    • Patients with history of head injury with 15 minutes or more loss of consciousness or required medical treatment.
    • Patients with cardiac pacemakers; intracardiac lines; implanted medication pumps; implanted electrodes in the brain; other implanted electrical or magnetic medical devices; or other intracranial metal objects or shrapnel, with the exception of dental fillings.
    • Patients with additional significant neurological disorders including increased intracranial pressure, brain mass, epileptic seizures (or family history of epileptic seizures), history of stroke, transient ischemic attack within 2 years, cerebral aneurysm, Huntington's chorea or multiple sclerosis.
    • Patients with an acute or unstable medical condition including all patients with any significant heart disease, pneumonia, uncontrolled hypertension, or other disorders which would require stabilization prior to initiation of transcranial magnetic stimulation.
    • Active alcohol and/or drug dependence or history of alcohol and/or drug dependence within the last year.
    • Patients with moderate to severe clinical depression as evidenced by a score of 15 or greater on the PHQ-9.
    • Patients who, in the opinion of the psychiatric sub-investigator, demonstrate moderate to severe depressive symptoms according to DSM-IV-TR criteria for Major Depressive Disorder.
    • Patients with psychiatric illness or trauma which would prohibit participation in the study.
    • Patients with active psychotic symptoms or a history of psychotic disorder
    • Female patients of child-bearing potential, unless sterilized or using an appropriate form of birth control acceptable to the research team.
    • Currently breastfeeding
    • Currently pregnant
    • Patients will be excluded if a motor threshold cannot be elicited,
    • Patients whose ability to give informed consent is in question
    • Undiagnosed symptomatic hypertension: .
    • Undiagnosed asymptomatic hypertension:
    • Any patient who has scheduled an elective surgery or change in medication during the 5 weeks of the study.
    • Use of Neuromonics Device during duration of study or currently in Tinnitus Retraining Program during course of study.
    • Any medical condition that, in the opinion of the investigators, confounds study results or places the subject at greater risk.
    • Patients currently taking psychotropic medications including antidepressants, benzodiazepines, anticonvulsants, stimulants, antipsychotics, or anxiolytics.
    • Tinnitus related to a Workman's Compensation claim or litigation-related event that is still pending.

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Bimodal rTMS

Arm Description

Open-label and single-arm rTMS bimodal treatment with placement of magnet over Dorsolateral Prefrontal Cortex (DLPFC) and Temporoparietal Junction (TPJ) for 2 weeks of treatment (10 days) Stimulation Settings: DLPFC Stimulation Frequency 10 Hz Intensity 110% of motor threshold On 5 seconds Off 15 seconds Total Trains 80 per session Total pulses session 4000/session Duration session 26.6 minutes Total pulses (study) 40000 TPJ Stimulation Frequency 1 Hz Intensity 110% of motor threshold On 900 seconds Off 60 seconds Total Trains 2 per session Total Pulses session 1800 Duration session 31 minutes Total Pulses study 18000

Outcomes

Primary Outcome Measures

Adverse Events
Subject will be queried for Adverse Events daily for 2 weeks of treatment. This is foremost a feasibility study, so measure of Adverse Events and relation to treatment is primary outcome.

Secondary Outcome Measures

Change in Tinnitus Handicap Inventory
Participant will complete the Tinnitus Handicap Inventory (THI)at the end of 2 weeks of treatment. Difference of the THI post treatmement minus baseline THI was calculated. Scale ranges in scores from 0 to 100 with 0 = no bother and 100 being the most bothered.

Full Information

First Posted
April 30, 2012
Last Updated
February 25, 2013
Sponsor
Washington University School of Medicine
search

1. Study Identification

Unique Protocol Identification Number
NCT01590264
Brief Title
rTMS Bimodal Treatment For Tinnitus: A Pilot Study
Official Title
rTMS Bimodal Treatment For Patients With Subjective Idiopathic Tinnitus: A Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
September 2012
Overall Recruitment Status
Completed
Study Start Date
May 2012 (undefined)
Primary Completion Date
September 2012 (Actual)
Study Completion Date
September 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Repetitive Transcranial Magnetic Stimulation (rTMS) is a novel brain stimulation technique that uses pulsating magnetic fields to stimulate underlying neurons in the cerebral cortex. The investigators propose an open-label pilot study investigating the effectiveness of rTMS in the treatment of tinnitus stimulation of the left dorsolateral prefrontal cortex (DLPFC), an area known to be important for mood and attention, along with stimulation of the left temporoparietal cortex (TPC). This is a feasibility pilot study.
Detailed Description
Converging data implicate structures of the brain that are important for mood and attention as playing a role in the maintenance of tinnitus; suggesting an alternative rTMS treatment approach that targets these structures. A growing number of studies demonstrate involvement of the prefrontal cortex in the generation and maintenance of tinnitus. rTMS stimulation in the dorsolateral prefrontal cortex in association with stimulation in the temporoparietal cortex has been shown to increase the durability of the TPC stimulation. The independent effect of rTMS stimulation to the DLPFC is not known. Studies in depression suggest that increasing the intensity and duration of stimulation has beneficial treatment effects. However, the field is new and more work is needed to assess the effectiveness of this treatment, predictors and correlates of response, and safety. Recent exciting work in schizophrenia used a bimodal (DLPFC and TPC) treatment approach in pharmacologically non-responsive patients. The study used high-frequency stimulation to the left DLPFC and low-frequency stimulation to the left TPC. Bimodal rTMS stimulation of left DLPFC and left TPC induced clinical improvement in pharmacologically non-responsive schizophrenia patients and may have improved their short-term verbal memories.57

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Tinnitus
Keywords
tinnitus, bimodal stimulation, rTMS, Repetitive Transcranial Magnetic Stimulation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bimodal rTMS
Arm Type
Other
Arm Description
Open-label and single-arm rTMS bimodal treatment with placement of magnet over Dorsolateral Prefrontal Cortex (DLPFC) and Temporoparietal Junction (TPJ) for 2 weeks of treatment (10 days) Stimulation Settings: DLPFC Stimulation Frequency 10 Hz Intensity 110% of motor threshold On 5 seconds Off 15 seconds Total Trains 80 per session Total pulses session 4000/session Duration session 26.6 minutes Total pulses (study) 40000 TPJ Stimulation Frequency 1 Hz Intensity 110% of motor threshold On 900 seconds Off 60 seconds Total Trains 2 per session Total Pulses session 1800 Duration session 31 minutes Total Pulses study 18000
Intervention Type
Device
Intervention Name(s)
Bimodal rTMS
Other Intervention Name(s)
The rTMS system is a Magpro R 30 stimulator.
Intervention Description
High frequency (10 Hz) at 110% of the motor threshold TMS delivered over the left dorsolateral prefrontal cortex, subsequently, a low frequency TMS (1 Hz) at 110% motor threshold will be delivered over 31 minutes over the TPJ area, according to the protocol below. DLPFC Stimulation Frequency 10 Hz Intensity 110% of motor threshold On 5 seconds Off 15 seconds Total Trains 80 per session Total pulses session 4000/session Duration session 26.6 minutes Total pulses (study) 40000 TPJ Stimulation Frequency 1 Hz Intensity 110% of motor threshold On 900 seconds Off 60 seconds Total Trains 2 per session Total Pulses session 1800 Duration session 31 minutes Total Pulses study 18000
Primary Outcome Measure Information:
Title
Adverse Events
Description
Subject will be queried for Adverse Events daily for 2 weeks of treatment. This is foremost a feasibility study, so measure of Adverse Events and relation to treatment is primary outcome.
Time Frame
Daily for 2 weeks.
Secondary Outcome Measure Information:
Title
Change in Tinnitus Handicap Inventory
Description
Participant will complete the Tinnitus Handicap Inventory (THI)at the end of 2 weeks of treatment. Difference of the THI post treatmement minus baseline THI was calculated. Scale ranges in scores from 0 to 100 with 0 = no bother and 100 being the most bothered.
Time Frame
Baseline, 2 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must be between the ages of 18 and 60 years. Subjective, idiopathic, troublesome, unilateral or bilateral, non-pulsatile tinnitus of ≥ 2 month's duration but no greater than 5 year's duration. Bothersome Tinnitus according to Tinnitus Handicap Inventory score. Must be able to understand, speak, read and write English proficiently Able to provide informed consent Women who are of childbearing potential must agree to use a medically acceptable form of birth control and must have a negative urine pregnancy test at screening Exclusion Criteria: •• Patients with tinnitus related to cochlear implantation, retrocochlear lesion, or other known anatomic/structural lesions of the ear and temporal bone. Patients with a history of stapedectomy and insertion of implant will be excluded. Hypersensitive to noises (hyperacusis) Patients with history of head injury with 15 minutes or more loss of consciousness or required medical treatment. Patients with cardiac pacemakers; intracardiac lines; implanted medication pumps; implanted electrodes in the brain; other implanted electrical or magnetic medical devices; or other intracranial metal objects or shrapnel, with the exception of dental fillings. Patients with additional significant neurological disorders including increased intracranial pressure, brain mass, epileptic seizures (or family history of epileptic seizures), history of stroke, transient ischemic attack within 2 years, cerebral aneurysm, Huntington's chorea or multiple sclerosis. Patients with an acute or unstable medical condition including all patients with any significant heart disease, pneumonia, uncontrolled hypertension, or other disorders which would require stabilization prior to initiation of transcranial magnetic stimulation. Active alcohol and/or drug dependence or history of alcohol and/or drug dependence within the last year. Patients with moderate to severe clinical depression as evidenced by a score of 15 or greater on the PHQ-9. Patients who, in the opinion of the psychiatric sub-investigator, demonstrate moderate to severe depressive symptoms according to DSM-IV-TR criteria for Major Depressive Disorder. Patients with psychiatric illness or trauma which would prohibit participation in the study. Patients with active psychotic symptoms or a history of psychotic disorder Female patients of child-bearing potential, unless sterilized or using an appropriate form of birth control acceptable to the research team. Currently breastfeeding Currently pregnant Patients will be excluded if a motor threshold cannot be elicited, Patients whose ability to give informed consent is in question Undiagnosed symptomatic hypertension: . Undiagnosed asymptomatic hypertension: Any patient who has scheduled an elective surgery or change in medication during the 5 weeks of the study. Use of Neuromonics Device during duration of study or currently in Tinnitus Retraining Program during course of study. Any medical condition that, in the opinion of the investigators, confounds study results or places the subject at greater risk. Patients currently taking psychotropic medications including antidepressants, benzodiazepines, anticonvulsants, stimulants, antipsychotics, or anxiolytics. Tinnitus related to a Workman's Compensation claim or litigation-related event that is still pending.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jay F Piccirillo, MD
Organizational Affiliation
Washington University School of Medicine, St. Louis
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
22217183
Citation
Burton H, Wineland A, Bhattacharya M, Nicklaus J, Garcia KS, Piccirillo JF. Altered networks in bothersome tinnitus: a functional connectivity study. BMC Neurosci. 2012 Jan 4;13:3. doi: 10.1186/1471-2202-13-3.
Results Reference
background
PubMed Identifier
21422304
Citation
Piccirillo JF, Garcia KS, Nicklaus J, Pierce K, Burton H, Vlassenko AG, Mintun M, Duddy D, Kallogjeri D, Spitznagel EL Jr. Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus. Arch Otolaryngol Head Neck Surg. 2011 Mar;137(3):221-8. doi: 10.1001/archoto.2011.3.
Results Reference
background
PubMed Identifier
22168528
Citation
Pierce KJ, Kallogjeri D, Piccirillo JF, Garcia KS, Nicklaus JE, Burton H. Effects of severe bothersome tinnitus on cognitive function measured with standardized tests. J Clin Exp Neuropsychol. 2012;34(2):126-34. doi: 10.1080/13803395.2011.623120. Epub 2011 Dec 14.
Results Reference
background
PubMed Identifier
21840364
Citation
Oh SY, Kim YK. Adjunctive treatment of bimodal repetitive transcranial magnetic stimulation (rTMS) in pharmacologically non-responsive patients with schizophrenia: a preliminary study. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Dec 1;35(8):1938-43. doi: 10.1016/j.pnpbp.2011.07.015. Epub 2011 Aug 5.
Results Reference
background

Learn more about this trial

rTMS Bimodal Treatment For Tinnitus: A Pilot Study

We'll reach out to this number within 24 hrs