title: Theta, alpha and beta burst transcranial magnetic stimulation: brain modulation in tinnitus.
abstract: BACKGROUND
  Some forms of tinnitus are considered to be auditory phantom phenomena related to reorganization and hyperactivity of the auditory central nervous system. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool capable of modulating human brain activity, using single pulse or burst stimuli. Burst rTMS has only been performed in the theta range, and has not been used clinically. The authors analyze whether burst TMS at theta (5 Hz), alpha (10 Hz) and beta (20 Hz) frequencies can temporarily suppress narrow band noise/white noise tinnitus, which has been demonstrated to be intractable to tonic stimulation.
  
  
  METHODS
  rTMS is performed both in tonic and burst mode in 46 patients contralateral to the tinnitus side, at 5, 10 and 20 Hz. Fourteen placebo negative rTMS responders are further analyzed.
  
  
  RESULTS
  In 5 patients, maximal tinnitus suppression is obtained with theta, in 2 with alpha and in 7 with beta burst stimulation. Burst rTMS suppresses narrow band/white tinnitus much better than tonic rTMS t(13)=6.4, p<.000. Women experience greater suppression of their tinnitus with burst stimulation than men, t(12)=2.9, p<.05. Furthermore left sided tinnitus is perceived as more distressing on the TQ than right sided tinnitus, t(12)=3.2, p<.01. The lower the tinnitus pitch the more effectively rTMS suppresses tinnitus(r=-0.65, p<0.05).
  
  
  CONCLUSIONS
  Burst rTMS can be used clinically, not only theta burst, but also alpha and beta burst. Burst rTMS is capable of suppressing narrow band/white noise tinnitus very much better than tonic rTMS. This could be due the simple fact that burst neuromodulation is more powerful than tonic neuromodulation or to a differential effect of burst and tonic stimulation on the lemniscal and extralemniscal auditory system. In some patients only alpha or beta burst rTMS is capable of suppressing tinnitus, and theta burst not. Therefore in future rTMS studies it could be worthwhile not to limit burst stimulation to theta burst rTMS.
authors.affiliation: Dept of Neurosurgery, ENT, University Hospital Antwerp, Edegem, Belgium. dirk.de.ridder@neurosurgery.be
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ridder
authors.forename: Elsa
authors.initials: E
authors.lastname: van der Loo
authors.forename: Karolien
authors.initials: K
authors.lastname: Van der Kelen
authors.forename: Tomas
authors.initials: T
authors.lastname: Menovsky
authors.forename: Paul
authors.initials: P
authors.lastname: van de Heyning
authors.forename: Aage
authors.initials: A
authors.lastname: Moller
mesh_terms: D000328:Adult; D000368:Aged; D001303:Auditory Cortex / Q000503:physiopathology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D014012:Tinnitus / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*