重复经颅磁刺激治疗耳鸣的安全性研究

Safety of repetitive transcranial magnetic stimulation in suppression of intractable tinnitus: report of 52 cases

摘要:

目的 评估经颅磁刺激（TMS）治疗慢性顽固性耳鸣的安全性。方法 选取2014年12月至2015年1月来上海交通大学附属第六人民医院就诊的慢性顽固性耳鸣患者52例，将其随机分为A、B、C、D四组，分别接受不同刺激方案的TMS治疗。5次/周，2周为1个疗程。A组：治疗频率1Hz，1000次脉冲刺激；B组：治疗频率1Hz，2000次脉冲刺激；C组：治疗频率5Hz，500次脉冲刺激；D组：治疗频率5Hz，1000次脉冲刺激。治疗前后行纯音听阈、运动皮层阈值测定。结果 4组患者经不同频率、不同治疗时间治疗后的纯音测听结果显示，治疗前后各频率的纯音听阈阈值相比，差异无统计学意义；运动皮质阈值较治疗前略降低，差异无统计学意义；1例患者出现头晕，停止治疗后次日消失；1例出现头痛，停止治疗后次日消失；耳鸣加重1例，停止治疗后次日改善。所有患者未出现与电极接触处头皮灼伤及诱发癫痫发作。结论 重复TMS治疗耳鸣安全可靠，可在临床上广泛应用。

Abstract:

Objective To determine the safety of repetitive transcranial magnetic stimulation (rTMS) on chronic intractable tinnitus. Methods A total of 52 patients diagnosed as chronic intractable tinnitus in our hospital from December 2014 to January 2015 were perspectively enrolled in this study. They were randomly divided into 4 groups, named as groups A to D (n＝13 for each group). They respectively received a 2-week course of active 1Hz rTMS (1 000 or 2 000 pulses), 5 Hz rTMS (500 or 1 000 pulses) to the left temporoparietal cortex region, 5 times/week. The measurements of pure tone auditory and motor cortex evoked potential were taken before and immediately after the end of the interventions. Results There was no significant difference in pure tone audiometry threshold in the 4 groups before and after the interventions. A slight decrease was seen in the motor cortex threshold, but with no significant difference. One patient was attacked with dizziness, one case experienced headache, and one patient had aggravated tinnitus, but which all disappeared or was alleviated at the next day after stopping treatment. No injury at the site of stimulation or epileptic seizure was seen in the whole course of treatment. Conclusion rTMS is safe and reliable in the suppression of tinnitus, and could be widely applied in clinical practice.