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28.10.2014

Tinnitus treatment electrical stimulation, insomniac - Reviews

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Tinnitus is a debilitating condition thought to be caused by the brain generating a signal in areas no longer stimulated by the auditory system. The Serenity System couples an implantable vagus nerve stimulator with a tone generator that plays sounds of various frequencies while electric signals are delivered by the neurostimulator.
Electrical stimulation has been used by neurosurgeons to treat various conditions for many years.
In a revolutionary series of experimental surgeries, Michael Seidman, MD, and his team have now shown that an electrode array implanted directly into the auditory cortex area of the brain can control tinnitus levels. Author’s Note: This procedure is still very early in the discovery process and this procedure is not available as a treatment option.
Author’s note: Neural hyperactivity in the auditory cortex has long been associated with tinnitus. Upon recovering from surgery, at the first post-operative visit, the selection of the electrical stimulating paradigm, or model, was decided for each patient. It is important to note that initially the effect was greater for the opposing ear but subsequently it had effectively eliminated the tinnitus in both ears.
Four months later, MV underwent transcranial magnetic stimulation, which suppressed her tinnitus by 20-50% but did not last for any appreciable time. Two patients underwent intracranial electrical stimulation of their auditory cortex in an attempt to reduce or eliminate tinnitus. It has been suggested that tinnitus can be affected through cortical and auditory pathway stimulation, provided that reorganization of auditory signals has not yet reached the ultimate phase of irreversibility. Stimulating the vagus nerve through electrical impulses causes the release of neurotransmitters and elevated levels of the inhibitory neurotransmitter GABA, which reduces heart rate, controls epileptic seizures and alters mood patterns. Because the vagus nerve is associated with many different functions and brain regions, research is being done to determine its usefulness in treating other illnesses, including various anxiety disorders, Alzheimer’s disease, migraines, fibromyalgia, and, as we shall soon investigate, tinnitus. Investigators at UT Dallas also investigated the ability of VNS to stimulate cortical reorganization to restore neuronal activity to normal and reverse tinnitus in laboratory rats. The theory behind VNS for tinnitus is as follows: When one neuron sends a signal to another neuron in the brain, it is typically referred to as a ‘spike’. By consistently pairing VNS with all other tones except the tinnitus tone, the other neuron groups expand and the tinnitus tone neurons shrink. Assessments were made using standard tinnitus questionnaires and a measure called minimum masking level (MML). While the promise of VNS for tinnitus is great, there is a lot of work to be accomplished before it can become a widespread, effective therapy.
There are significant, though not life-threatening, side effects of the therapy, which has been used on about 50,000 people for severe epilepsy and treatment resistant depression. Stimulating the vagus nerve releases chemicals involved in neuroplasticity, so doing so while playing the tones will hopefully train the brain to correlate the various sound frequencies to their normal areas in the auditory cortex.


Early experiments using DC current applied directly to the ear or mastoid bone showed promise in reducing tinnitus symptoms. 118 in March, 2008 with the title Direct Electrical Stimulation of Heschl’s Gyrus for Tinnitus Treatment by Michael D. Seidman begins by noting that tinnitus affects 50 million Americans and more than 300 million people worldwide. Seidman first experimented on animals to examine whether electrical stimulation of the auditory cortex suppresses tinnitus-related neural hyperactivity and found it to be effective. These determined the hearing levels at precise frequencies and pitch and loudness matching of their tinnitus. The skull was breached and electrodes were implanted in the opposing auditory cortex for the patient who had unilateral tinnitus and in the dominant ear of the patient who had bilateral tinnitus.
The electrode was turned on and off several times with the patient blinded to the presence or absence of stimulation. Three months after surgery he reported his tinnitus was essentially gone when the electrode was active and recurred only several days after turning the device off. Seven years after she developed her tinnitus, a microvascular decompression was performed and resulted in successfully treating her vertigo but failed to reduce her tinnitus.
By altering the stimulation paradigm, she eventually had a 30% to 35% reduction in her tinnitus.
In patient one, the suppression of tinnitus was near complete, whereas in the other, it was moderate and did not last. The primary pitfall is determining which “structures” (areas of the brain) to target to minimize the perception of tinnitus. It is known that the limbic system plays a major role in the annoyance and aggravation of tinnitus.
This implies that tinnitus should be treated as soon as possible, preferably within 5 years of onset.
Therapies of this type include cochlear implantation and direct stimulation by means of implanted electrodes.
There is not an audiological device in the world that can measure and quantify tinnitus without the subject being able to communicate with the doctor, and rats can’t speak!” This led to the writing of a previous article on “An Animal Model of Tinnitus”. In recent years developments in microelectronics and microtransponders allow for the implantation of tiny semiconductor devices no bigger than a grain of salt to the sites of stimulation.
It is also important to note that VNS, while FDA approved for treating depression and seizures, is not FDA approved for treating tinnitus and remains in clinical trials. Repeatedly pairing vagus nerve stimulation with a movement reorganizes primary motor cortex.
Implanted electrodes used to control muscle spasms in Parkinson’s disease patients were found to reduce the sound of tinnitus, even though they were not implanted in the auditory cortex, where hearing occurs.


The tinnitus would return when the electrode was off for 30-60 seconds and would decrease significantly when the electrode was active. Several subsequent stimulation regimens applied over the succeeding 4 months failed to adequately diminish her tinnitus.
However at her 2-year follow-up examination, her tinnitus had returned to its original levels.
Whether this was due to the more longstanding nature of patient two’s tinnitus or to another reason is still unknown.
Preliminary animal data clearly suggests that auditory cortex stimulation can affect other downstream structures within the auditory pathway. They found the rats that received the stimulation and the movement training displayed large changes in the organization of the brain’s movement control system. Pairing several of these tones (except the tinnitus tone) helped subdue the abnormal hyperactivity and restored the auditory cortex activity back to normal in a rat model of tinnitus. The obstructive events can be controlled by decreasing the frequency or intensity of the stimulation or by having the patient sleep in a partial sitting position. Two years after the accident, a sudden left-sided tinnitus developed and was associated with short-lasting spells of vertigo.
Whether stimulation of the primary auditory cortex will have the greatest effect in alleviating the perception of tinnitus or whether stimulation of other structures, such as those within the limbic system, will have the greatest effect requires further study.
Electrical stimulation of the vagus nerve has been shown to be helpful for chronic depression and in controlling seizures in people with intractable epilepsy. Those rats that received identical movement training without paired stimulation did not experience any brain changes, or plasticity. In the tinnitus brain, however, the neurons at the tinnitus frequency are highly excitable. Electrical stimulation of the skin near the ear, cochlea and brainstem has also provided some degree of tinnitus suppression.
New research shows this same stimulation, coupled with sound therapy, has the potential to reduce noise levels in those with tinnitus. Hundreds of thousands of nearby neurons fire simultaneously in the tinnitus frequency whether there is outside stimulus or not.
A prior article discussing the early history of electrical stimulation can be found in our Tinnitus Library.
This simultaneous firing of brain cells is referred to as synchrony, which is thought to be one of the mechanisms responsible for sounds perceived by tinnitus patients.



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