Deep Brain Stimulation (DBS) for Tinnitus

[Fightthearmy]

How is efficacy substantiated? With a control group in mind, I don't suppose they drill holes into people's heads just for make-believe, do they? Although there needs to be a control group, or it's not science.

 

[Gb3]

How is efficacy substantiated? With a control group in mind, I don't suppose they drill holes into people's heads just for make-believe, do they? Although there needs to be a control group, or it's not science.

They turn the stimulation off and on.

 

[KoolKat]

So what's the verdict on DBS again?

i have a bad memory. Isn't this the stuff that they insert into your brain? *Sigh* I really would prefer an injection, something like the Susan Shore device, and of course
pills.

DBS is not a game. One mistake and it's lights out or blindness...

 

[Jammer]

Probably they did it in the wrong spot, or with a wrong kind of stimulation pattern.

Theoretically, DBS should work, the only exception is if it targets a wrong area.

I gave up before they could try every permutation of voltage and electrode stimulation pattern as the increasing tinnitus caused me deep depression.

What was surprising was the high level of pain I had post removal, as the cables from the stimulator to the electrodes were covered in scar tissue and any slight head movements caused excruciating pain. This lasted for over a month before it finally eased up.

 

[Nick47]

How is efficacy substantiated? With a control group in mind, I don't suppose they drill holes into people's heads just for make-believe, do they? Although there needs to be a control group, or it's not science.

They turn the stimulation off and on.

@Fightthearmy, that is the control. Patients are asked to rate their tinnitus at different times, without knowing if it's switched on or off. When switched off, there is in effect no intervention, so it serves as a control for each patient.

 

[Diego LR]

I gave up before they could try every permutation of voltage and electrode stimulation pattern as the increasing tinnitus caused me deep depression.

What was surprising was the high level of pain I had post removal, as the cables from the stimulator to the electrodes were covered in scar tissue and any slight head movements caused excruciating pain. This lasted for over a month before it finally eased up.

Wow, it sounds devastating. Do you still have that level of tinnitus?

 

[Jammer]

Wow, it sounds devastating. Do you still have that level of tinnitus?

It's much worse now. I won't put a number on it as numbers are meaningless.

 

[Gb3]

I gave up before they could try every permutation of voltage and electrode stimulation pattern as the increasing tinnitus caused me deep depression.

What was surprising was the high level of pain I had post removal, as the cables from the stimulator to the electrodes were covered in scar tissue and any slight head movements caused excruciating pain. This lasted for over a month before it finally eased up.

@Jammer, at what hospital did you have this procedure done?

 

[Jammer]

@Jammer, at what hospital did you have this procedure done?

San Francisco VA Medical Center.

 

[duesseldorf]

I would do the surgery, honestly. I hope they will do some more clinical trials, preferably in Germany, so I can apply.

 

[Christiaan]

This concerns a case report that is published by the University of Maastricht about successful DBS intervention in a patient with severe tinnitus.

Effective treatment of refractory tinnitus by bilateral deep brain stimulation of the medial geniculate body of the thalamus: A case report (Devos et al., 2023)

In this patient with severe refractory tinnitus, MGB DBS resulted in major improvement of tinnitus burden. No undesired side effects occurred, except from a transient tingling. It is important to note that no change in hearing thresholds occurred. In our case, MGB was safe and there was a clinically relevant decrease in tinnitus complaints. In comparison, conventional treatment with CBT results in a mean decrease of 16 points on the tinnitus questionnaire.

Therefore, in this case the observed change of 36 points on TQ is a considerable reduction. However, safety and effectiveness of MGB DBS need to be confirmed in a larger cohort before a firm conclusion can be made.
The rationale of choosing MGB as a DBS target was based on animal data. Tinnitus-like behavior was alleviated by MGB DBS using high-frequency stimulation.

It was proposed that DBS has a suppressive effect on a pathological, hyperactive tinnitus network. MGB DBS may cause inhibitory effects via the activation of GABA-A receptors, which are highly present in the MGB.

MGB DBS might also alter the aberrant cortico-thalamic oscillations. Earlier, we showed that MGB DBS suppresses thalamocortical synchronization in the beta and gamma band.

Currently, other invasive neuromodulative approaches in the auditory circuit have been investigated for the treatment of tinnitus, such as, auditory brainstem implants (ABI) and cochlear implants (CI). An advantage of MGB DBS is that patients with normal hearing thresholds can be treated, since normal hearing is an exclusion criterion for ABI and CI. A handful of case studies and retrospective cohorts have shown that DBS targets outside the auditory circuit, such as area LC (locus of caudate neurons), ventral anterior limb of the internal capsule, subthalamic nucleus, ventralis intermedius nucleus of the thalamus and one within the auditory circuit, Heschl's gyrus, may also attenuate tinnitus burden.

Even though the rationale for these targets is often based on coincidental findings without preclinical support, these results are encouraging. DBS anywhere within the tinnitus network might have a positive effect on tinnitus. However, the optimal brain target remains to be studied.

To our best knowledge, this is the first case report that demonstrates that bilateral MGB DBS is safe and reduces tinnitus complaints effectively in a patient with severe refractory tinnitus. The increasing evidence that tinnitus can be alleviated by MGB DBS is promising for patients suffering from severe tinnitus.

Here's also a video of one of the researchers who is involved in this DBS study.



In this video, neurologist and neurophysiologist Mark Janssen tells about his research to find a treatment for tinnitus patients by using Deep Brain Stimulation. He also explains how it is to be both a doctor and a patient and the benefits of being a clinician and a researcher.

 

[JRC1]

What is the "tinnitus questionnaire"? I am familiar with TFI and THI. Is this something different?

Dr. Steven Cheung has done research in this field. He seems to be working on some sort of non-invasive stimulation. But I am not clear exactly what he is doing. Does anyone know what he is doing?

 

[Christiaan]

What is the "tinnitus questionnaire"? I am familiar with TFI and THI. Is this something different?

Dr. Steven Cheung has done research in this field. He seems to be working on some sort of non-invasive stimulation. But I am not clear exactly what he is doing. Does anyone know what he is doing?

The main difference between those questionnaires is the focus on questions concerning tinnitus-related distress (TQ), tinnitus handicap severity (THI) & negative tinnitus impact (TFI).

You can find more info in this paper.

Are you talking about this article?

While Cheung has used DBS to chart this new biological understanding of tinnitus, the goal is to translate those findings into a less invasive treatment. He's also drawing on the research to improve diagnostic methods. Cheung and his team are currently recruiting patients for a diagnostic study using neuroimaging techniques to investigate differences in brain signals between people with and without tinnitus.

 

[ploughna]

I've been in touch with Dr. Cheung on and off about this. His method is invasive (similar to above). Further trials were on hold due to COVID-19, but more recently (June), he told me that he received, in his words, "surprisingly mixed reviews" in response to his NIH grant application to continue this work and that "regrettably, there is now a very narrow path to attract NIH funding for this treatment approach."

 

[JRC1]

Are you talking about this article?

Yes, that must be the article I was thinking of.

 

[Nick47]

A news article on DBS from Holland:

Deep Brain Stimulation to Treat Tinnitus - Maastricht University

 

[R0B]

I've been in touch with Dr. Cheung on and off about this. His method is invasive (similar to above). Further trials were on hold due to COVID-19, but more recently (June), he told me that he received, in his words, "surprisingly mixed reviews" in response to his NIH grant application to continue this work and that "regrettably, there is now a very narrow path to attract NIH funding for this treatment approach."

That's tough to hear especially since there was success with it. It's hard to imagine why the reviews would be mixed on something so promising I hope you stay in touch with him and can provide us with another update in the future.

 

[Jammer]

That's tough to hear especially since there was success with it. It's hard to imagine why the reviews would be mixed on something so promising I hope you stay in touch with him and can provide us with another update in the future.

I was a part of his clinical study and had the DBS implanted on June 26th, 2016. I spent a lot of effort working with the team at the SF VA and self-adjusting the stimulation via the protocol and never achieved relief; I believe that it actually made my tinnitus worse. My system was explanted 8 months later. I wish I had never read about their study on Tinnitus Talk.

I gave it a shot and it failed me, but I was told it helped others somewhat. I wanted to help myself and the US veterans that have tinnitus post service, but alas, it didn't work for me.

 

[R0B]

I was a part of his clinical study and had the DBS implanted on June 26th, 2016. I spent a lot of effort working with the team at the SF VA and self-adjusting the stimulation via the protocol and never achieved relief; I believe that it actually made my tinnitus worse. My system was explanted 8 months later. I wish I had never read about their study on Tinnitus Talk.

I gave it a shot and it failed me, but I was told it helped others somewhat. I wanted to help myself and the US veterans that have tinnitus post service, but alas, it didn't work for me.

I'm sorry to hear it didn't work for you. If I'm understanding right, the tinnitus got worse after the surgery and didn't revert to how it was before, even after removing the device? It's an experimental surgery at this point but even so, it's still heartbreaking to hear of your experience.

I wonder if there have been any insights gained from looking into where these DBS probes should be located...

One patient responded exceptionally well, with a 70-point drop in her Tinnitus Functional Index (TFI) score, while another had only a 2.4-point drop in his TFI. What accounted for the difference? Cheung suspected it was due to differing connections to the striatum from parts of the brain involved with hearing that may be specific to individual patients.

→ New Tinnitus Research Focused on Neural Networks Shows Promise for Precision Treatment

By the way, here's a very comprehensive (150+ pages) report I found on DBS for tinnitus. A good read if you are interested in this topic:

→ Exploring Deep Brain Stimulation as a Treatment for Tinnitus (PDF)

 

[Jammer]

I'm sorry to hear it didn't work for you. If I'm understanding right, the tinnitus got worse after the surgery and didn't revert to how it was before, even after removing the device? It's an experimental surgery at this point but even so, it's still heartbreaking to hear of your experience.

Didn't get better and only got worse.

 

[SarahMLFlemmer]

Didn't get better and only got worse.

I am so sorry.

 

[Jammer]

I am so sorry.

Don't be sorry for me. I knew the risks more than most as a medical device engineer who was involved with the design of De Novo medical devices and clinical trials. Sucks to be worse, but I had hoped to advance a treatment option to help both injured vets and myself.

 

[SarahMLFlemmer]

Don't be sorry for me. I knew the risks more than most as a medical device engineer who was involved with the design of De Novo medical devices and clinical trials. Sucks to be worse, but I had hoped to advance a treatment option to help both injured vets and myself.

Yeah, I feel the same way about taking Accutane. I knew the potential of having some side effects but was ignorant in my thinking that they go away once you're off the medication. I also had no idea that chronic non-stop tinnitus was even a thing. Aaaand, here I am.

It's so cool that I get to talk to someone who was an engineer and a pioneer in all this stuff! I'm still very sorry that the turnout wasn't better for you. This ailment sucks, bad.

 

[R0B]

I was a part of his clinical study and had the DBS implanted on June 26th, 2016. I spent a lot of effort working with the team at the SF VA and self-adjusting the stimulation via the protocol and never achieved relief; I believe that it actually made my tinnitus worse. My system was explanted 8 months later. I wish I had never read about their study on Tinnitus Talk.

I gave it a shot and it failed me, but I was told it helped others somewhat. I wanted to help myself and the US veterans that have tinnitus post service, but alas, it didn't work for me.

@Jammer, I'm surprised that your negative outcome wasn't reported on the results of the trial unless I missed something. I would think that this would be included. It makes me curious about these reports and if they sometimes omit information.

Yeah, I feel the same way about taking Accutane. I knew the potential of having some side effects but was ignorant in my thinking that they go away once you're off the medication. I also had no idea that chronic non-stop tinnitus was even a thing. Aaaand, here I am.

@SarahMLFlemmer, it is surprising how many products/drugs can trigger tinnitus. Now that I have it I am extra keen on checking any product/drug I take because I cannot afford to make it worse.

 

[Jammer]

@Jammer, I'm surprised that your negative outcome wasn't reported on the results of the trial unless I missed something. I would think that this would be included. It makes me curious about these reports and if they sometimes omit information.

I don't know. Maybe because I didn't complete the trial.

 

[Nick47]

A systematic review of DBS:

Conclusions: DBS is a promising treatment option for refractory subjective tinnitus, with early data, from small patient cohorts in multiple studies, suggesting its safety and efficacy. Further studies with a larger patient population are needed to support this safety and efficacy before implementing this treatment to daily practice.

→ Deep Brain Stimulation for Primary Refractory Tinnitus: A Systematic Review