Transcranial Stimulation Treatments (rTMS & tDCS & tACS)

[grate_biff]

tDCS

What is it?

 

[Nick47]

What is it?

Transcranial Direct Current Stimulation.

 

[Nick47]

We can certainly rule out rTMS for now.

Low-Frequency Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

So best evidence is still with tDCS out of this varied cohort.

 

[redsoultraveler]

I contacted UCLA TMS Los Angeles (they boast a 50% success rate of some relief) and they say that some insurances cover the costs. Unfortunately my insurance Kaiser Permanente does not. My doctor sent a referral letter but said that since it is not FDA approved, it is not covered.

This is their website:
https://tmslosangeles.com/

I spoke with someone there and they said it costs out of pocket $3,000 and there are 10 sessions. It was not clear if you paid it all up front or $300 per session.

I would like to know if anyone has tried this.

 

[AfroSnowman]

I contacted UCLA TMS Los Angeles (they boast a 50% success rate of some relief) and they say that some insurances cover the costs. Unfortunately my insurance Kaiser Permanente does not. My doctor sent a referral letter but said that since it is not FDA approved, it is not covered.

This is their website:
https://tmslosangeles.com/

I spoke with someone there and they said it costs out of pocket $3,000 and there are 10 sessions. It was not clear if you paid it all up front or $300 per session.

I would like to know if anyone has tried this.

The trick is to get it prescribed for depression, which insurance will pay for, then have it administered for tinnitus.

 

[redsoultraveler]

The trick is to get it prescribed for depression, which insurance will pay for, then have it administered for tinnitus.

Mmm, interesting. Funny enough I didn't think of that.

I just sent UCLA TMS a referral letter from my doctor and I am waiting for their response.

When I go in for the consultation I will bring that up

 

[AfroSnowman]

Mmm, interesting. Funny enough I didn't think of that.

I just sent UCLA TMS a referral letter from my doctor and I am waiting for their response.

When I go in for the consultation I will bring that up

In fact, when I went to the website, it explicitly states in the tinnitus section that if you are diagnosed with depression it might be covered. I'm taking that angle but I have to go through a couple hoops first (x weeks of unsuccessful antidepressant treatment) before insurance will cover it.

 

[Nick47]

Another to add to the list...

Combined Bifrontal Transcranial Direct Current Stimulation and Auditory Stroop Training in Chronic Tinnitus

Can't find the full study but p <0.5 and THI in intervention arm down from 50 to 43, so slight but significant. Placebo, which was a sham, was down 2 THI points I think.

Poke around and see if you can access the full write-up.

 

[Diego LR]

Another to add to the list...

Combined Bifrontal Transcranial Direct Current Stimulation and Auditory Stroop Training in Chronic Tinnitus

Can't find the full study but p <0.5 and THI in intervention arm down from 50 to 43, so slight but significant. Placebo, which was a sham, was down 2 THI points I think.

Poke around and see if you can access the full write-up.

What is Auditory Stroop Training?

 

[Nick47]

What is Auditory Stroop Training?

@Diego LR, no idea.

 

[Nick47]

Not treatment as such but more research going on at Flinders University in Australia carried out by Dr. Raj Shekhawat, due to wrap up in 14 months. This is HD-tDCS rather than standard tDCS. @DebInAustralia, maybe this is something you can try?

Testing brain stimulation as a possible long-term treatment for tinnitus

 

[UKBloke]

Not treatment as such but more research going on at Flinders University in Australia carried out by Dr. Raj Shekhawat, due to wrap up in 14 months. This is HD-tDCS rather than standard tDCS. @DebInAustralia, maybe this is something you can try?

Testing brain stimulation as a possible long-term treatment for tinnitus

Being that the Flinders University HD-tDCS study is happening in Australia, wouldn't it be amazing if they could tie in with The Bionics Institute on pre and post objective tinnitus measurement? I don't think for one minute that will happen but we have to put it out there.

 

[Nick47]

Being that the Flinders University HD-tDCS study is happening in Australia, wouldn't it be amazing if they could tie in with The Bionics Institute on pre and post objective tinnitus measurement? I don't think for one minute that will happen but we have to put it out there.

Hey @UKBloke from another UK bloke. Well, many have called for more collaboration (Dr. Dirk De Ridder/Dr. Shore) and it MUST happen as we move towards Tinnitus Week next February. Let's do it!

As far as institutions go, I think money, prestige and patents get in the way. Don't get me started on the gushing lines of 'we are a non-profit organisation' again. I think in the UK that holds more ethically than many other countries, especially America.

There has been a flurry of activity with tDCS recently and this is another one. It differs being the HD variety, although I'm pretty sure it's already used at the Brai3n clinic.

 

[UKBloke]

patents get in the way

Where these various flavours of modern-day electric medicine are concerned, I'm sure the issue of patents plays a much more significant role in preventing useful advancement than many of us give credit.

I've been doing a lot of research into the electric medicine that evolved at the back end of the 1800s and into the 1900s, up to circa 1940. The work of Georges Lakhovsky has been of particular interest.

Unlike modern EMF and direct current machines that (to the best of my understanding) output specific ranges of frequencies in an attempt to treat specific conditions, Lakhovsky's devices outputted broadband frequencies and let nature do the work by having the body's dysfunctional cells absorb the energy they needed through the phenomenon of resonance.

I've long suspected that a broadband model like Lakhovsky's would be difficult to patent. This has begged the question, is the priority of the modern-day frequency specific protocols more about creating or protecting patents than it is about alleviating patient suffering?

 

[Christiaan]

New transcranial magnetic stimulation array can help stimulate deeper tissue within the brain (Henderson, 2022)

As a noninvasive neuromodulation method, transcranial magnetic stimulation (TMS) shows great potential to treat a range of mental and psychiatric diseases, including major depression.

Stimulating the deep brain helps researchers explore the causes of and possible treatments for psychiatric diseases, but current methods don't go quite deep enough and are largely restricted to superficial targets within the brain.

In AIP Advances, from AIP Publishing, a group of researchers in China from Chengdu University of Technology and Huazhong University of Science and Technology present a new TMS array with a special geometrical-shaped magnet structure to help stimulate deeper tissue within the brain.

"Considering the approximate spherical structure of the human head, I wondered if special-shaped coils could be more advantageous than flat coils," said Xiao Fang, a co-author who has worked on TMS for nearly eight years. "When I was studying at Wuhan National High Magnetic Field Center in 2016, we had a magnet design department in our lab, and they did some research regarding special-shaped magnets for electromagnetic shaping. After seeing their research posters, it inspired us to try to use shaped magnets in bioelectromagnetic stimulation."

Inside the brain, external stimuli transmit information through neurons with electrical and chemical signals.

''Deep brain stimulation taps into the penetrating ability of an electromagnetic field or signal to target the membrane potential of deep brain neurons and change the polarization or depolarization effect to achieve neuromodulation." - Xiao Fang, Co-Author

The group's new spatially symmetric array, based on a curved type of coil, offers advantages over traditional TMS coils in deep brain stimulation performance.

"It enables focalized stimulation within the deep brain so fewer untargeted tissues are exposed to strong stimulation," said Fang. "And the location of the stimulation target generated by the array can be flexibly and continuously adjusted."

This array's special geometric design enables deep brain focused stimulation 11 centimeters below the scalp.

"That is 1.67 times deeper than conventional planar stimulation arrays when producing the same focusing area, which effectively improves the stimulation effect," Fang said.

The group's design is mainly intended for deep brain stimulation, such as the treatment of major depression, and its target area is the ventromedial prefrontal cortex region located 7 centimeters beneath the human scalp.

Journal reference:
Fang, X., et al. (2022) Noninvasive focalized stimulation in deep brain using the spatially symmetric array. AIP Advances. doi.org/10.1063/5.0121692.

 

[Lane]

As a noninvasive neuromodulation method, transcranial magnetic stimulation (TMS) shows great potential to treat a range of mental and psychiatric diseases, including major depression.

Thanks for posting this @Christiaan. As promising as some of these technologies are, I've come to believe there has to be a very strong nutritional component when addressing just about any kind of "mental" or "psychiatric" illness. So often the problem with conventional approaches to health care is they ignore the foundational issue of nutrition, which alone can often solve seemingly intractable physical and "mental disorders".

 

[UKBloke]

Deep brain stimulation taps into the penetrating ability of an electromagnetic field or signal to target the membrane potential of deep brain neurons

This is exactly what the Lakhovsky machines were doing back in the 1920s.

I can't understand how that technology that showed such amazing potential with many positive citations in medical literature from doctors across Europe at the time, suddenly dropped into obscurity never to be seen again.

And then nearly 100 years later, institutional scientists resurrect the science, rebrand it and start the whole ball rolling once more. Very strange.

 

[DeanD]

Are all the rTMS and tDCS treatments only tackling depression and stress as a result of tinnitus - and not trying to target tinnitus itself?

I read someone on here stating that, yet some studies I have read on PubMed cited participants claimed a reduction of loudness and severity, particularly after tDCS.

 

[Nick47]

Are all the rTMS and tDCS treatments only tackling depression and stress as a result of tinnitus - and not trying to target tinnitus itself?

I read someone on here stating that, yet some studies I have read on PubMed cited participants claimed a reduction of loudness and severity, particularly after tDCS.

@DeanD, look back through the thread for a meta-analysis

 

[DeanD]

@DeanD, look back through the thread for a meta-analysis

@Nick47, I have been through the entire thread, read many studies and information on all the treatments and even spoke to a clinic offering one of the services - but I seem to be seeing mixed answers as to what these treatments are actually aiming to target, and what they are trying to achieve.

My very summarised understanding is to reduce excitability in the auditory and emotional response pathways, and to increase inhibition pathways.

This sounds very much an attempt to reduce the severity and potentially the volume of tinnitus - but having read a few comments about only tackling the symptoms such as stress and depression, I wanted to make sure I was understanding the logic correctly.

 

[duesseldorf]

I am looking Into rTMS treatments in Germany - thankful for any references. I am still early in my tinnitus and it varies strongly over the day, so I might be a good candidate...

Update:

I called a German clinic which is a leading facility in Neuromodulation research; and they said to me that they rarely have success with tinnitus patients and rTMS and tDCS treatments. Devastating.

 

[Nick47]

→Brain alterations in patients with intractable tinnitus before and after rTMS: A resting-state functional magnetic resonance imaging study

"Conclusion: RTMS is effective in the treatment of tinnitus. It significantly reduces the THI/VAS score and improves the symptoms of tinnitus. No serious adverse reaction during rTMS were reported. The changes in the left fusiform gyrus and right superior part of the cerebellum may explain the mechanism of rTMS treatment in intractable tinnitus."

40% mean reduction in THI and VAS, which correlate nicely.

All participants had chronic tinnitus lasting >1 year, but up to about 4.5 years.

Mean age 45.

67% improved.

 

[JRC1]

→Brain alterations in patients with intractable tinnitus before and after rTMS: A resting-state functional magnetic resonance imaging study

"Conclusion: RTMS is effective in the treatment of tinnitus. It significantly reduces the THI/VAS score and improves the symptoms of tinnitus. No serious adverse reaction during rTMS were reported. The changes in the left fusiform gyrus and right superior part of the cerebellum may explain the mechanism of rTMS treatment in intractable tinnitus."

40% mean reduction in THI and VAS, which correlate nicely.

All participants had chronic tinnitus lasting >1 year, but up to about 4.5 years.

Mean age 45.

67% improved.

Why is this post not getting more attention? Is it because of no "double-blind crossover"?

Results, if real, seem substantial to me.

 

[KoolKat]

Why is this post not getting more attention? Is it because of no "double-blind crossover"?

Results, if real, seem substantial to me.

Unfortunately, in our world, when something seems too good to be true, it most definitely is.

 

[duesseldorf]

Why is this post not getting more attention? Is it because of no "double-blind crossover"?

Results, if real, seem substantial to me.

For me, because the real world applications still apparently lack success - so I do not like to get my hopes up too much.

 

[Nick47]

Three weeks bilateral tDCS over auditory cortex significantly improves tinnitus: A double blinded randomized controlled clinical trial

Results: Ten sessions anodal tDCS significantly reduced THI after last session and after 1-month follow-up (P< 0.001), in 21 of 28 participants. In addition, significant reduced in distress VAS and loudness VAS were found (P< 0.001). The sham tDCS showed no statistically significant differences for any response variables. Age, sex, evolution time, laterality, basal THI, basal distress and basal loudness VAS showed no significant correlation with the treatment response.

Conclusion: The repeated sessions of bilateral AC tDCS may serve as a potential therapeutic modality for chronic tinnitus.

Effect of transcranial Direct Current Stimulation for tinnitus treatment: A systematic review and meta-analysis

Conclusion: tDCS may improve tinnitus loudness and distress with a small to moderate effect size. Despite the overall positive effect, 'only LTA tDCS yielded a significant effect.'(p=0.009) Further well-controlled studies with larger sample sizes and broader exploration of tDCS montages and doses are warranted.

 

[tomytl]

Three weeks bilateral tDCS over auditory cortex significantly improves tinnitus: A double blinded randomized controlled clinical trial

Results: Ten sessions anodal tDCS significantly reduced THI after last session and after 1-month follow-up (P< 0.001), in 21 of 28 participants. In addition, significant reduced in distress VAS and loudness VAS were found (P< 0.001). The sham tDCS showed no statistically significant differences for any response variables. Age, sex, evolution time, laterality, basal THI, basal distress and basal loudness VAS showed no significant correlation with the treatment response.

Conclusion: The repeated sessions of bilateral AC tDCS may serve as a potential therapeutic modality for chronic tinnitus.

Effect of transcranial Direct Current Stimulation for tinnitus treatment: A systematic review and meta-analysis

Conclusion: tDCS may improve tinnitus loudness and distress with a small to moderate effect size. Despite the overall positive effect, 'only LTA tDCS yielded a significant effect.'(p=0.009) Further well-controlled studies with larger sample sizes and broader exploration of tDCS montages and doses are warranted.

Is a treatment like this offered somewhere?

 

[Nick47]

a treatment like this offered somewhere?

Only place I know is Brai3n in Belgium.

 

[ErikaS]

Only place I know is Brai3n in Belgium.

I have read how TMS systems are super loud with the clicking and buzzing, do you know at all if this is the same for this kind of system? Apparently there have been non-tinnitus sufferers who have gotten TMS for depression and due to the loud noise, have ended up with tinnitus. Apparently it can get as loud as 100 dB or more. So I would hope that if something showed to truly help FOR tinnitus, the machine noises wouldn't become an issue!

 

[Nick47]

I have read how TMS systems are super loud with the clicking and buzzing, do you know at all if this is the same for this kind of system? Apparently there have been non-tinnitus sufferers who have gotten TMS for depression and due to the loud noise, have ended up with tinnitus. Apparently it can get as loud as 100 dB or more. So I would hope that if something showed to truly help FOR tinnitus, the machine noises wouldn't become an issue!

Hi @ErikaS, yes, the magnetic stimulation is loud and I wouldn't consider it. Electrical stimulation is not loud at all. Electrical stimulation seems to be the future as TMS appears rarely studied, at least in the UK. A trial based on a meta-analysis took place here last year. No results as of yet, however, they are starting new trials on "personalised" tDCS this year.