title: Maintenance repetitive transcranial magnetic stimulation can inhibit the return of tinnitus.
abstract: OBJECTIVE
  A single patient was tested to examine the safety and feasibility of using maintenance sessions of low-frequency repetitive transcranial magnetic stimulation (1 Hz rTMS) to reduce tinnitus loudness and prevent its return over time.
  
  
  METHODS
  Interrupted time series with multiple replications.
  
  
  METHODS
  Tinnitus loudness was assessed using a visual analogue rating (VAR) with 0 = no tinnitus, and 100 = loudest tinnitus experienced; 1,800 TMS pulses delivered at 1 Hz and 110% of motor threshold were administered over the posterior, superior lateral temporal gyrus of the subject's right hemisphere until subjective tinnitus fell to a VAR of 25. TMS was reapplied as tinnitus returned to a VAR of 25 or higher. Cerebral metabolism was measured using positron emission tomography before and after treatment.
  
  
  RESULTS
  In this patient, tinnitus could be reduced to a VAR of 6 or lower each time it reoccurred using one to three maintenance sessions of rTMS. Tinnitus loudness remained at or below a VAR of 25 and was reported to be unobtrusive in daily life when last assessed 4 months after the third and final round of maintenance treatment. Asymmetric increased cerebral metabolism in the right hemisphere reduced following treatment and as tinnitus improved. Maintenance treatment was well tolerated with no side effects.
  
  
  CONCLUSIONS
  Although a case study cannot establish treatment efficacy, this study demonstrates for the first time that it is feasible to use maintenance rTMS to manage chronic tinnitus. Maintenance rTMS might impede cortical expansion of the tinnitus frequency into adjacent cortical areas, but group studies are necessary to confirm this speculation.
authors.affiliation: Department of Neurobiology and Developmental Science, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. msmennemeier@uams.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Mennemeier
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Chelette
authors.forename: Jeffery
authors.initials: J
authors.lastname: Myhill
authors.forename: Patricia
authors.initials: P
authors.lastname: Taylor-Cooke
authors.forename: Twyla
authors.initials: T
authors.lastname: Bartel
authors.forename: William
authors.initials: W
authors.lastname: Triggs
authors.forename: Timothy
authors.initials: T
authors.lastname: Kimbrell
authors.forename: John
authors.initials: J
authors.lastname: Dornhoffer
mesh_terms: D000328:Adult; D004292:Dominance, Cerebral / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology; D004869:Equipment Safety; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D010147:Pain Measurement; D049268:Positron-Emission Tomography; D019233:Retreatment; D055502:Secondary Prevention; D013702:Temporal Lobe / Q000503:physiopathology; D014012:Tinnitus / Q000503:physiopathology / Q000534:rehabilitation*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*