title: Anterior cingulate implants for tinnitus: report of 2 cases.
abstract: Tinnitus can be distressful, and tinnitus distress has been linked to increased beta oscillatory activity in the dorsal anterior cingulate cortex (dACC). The amount of distress is linked to alpha activity in the medial temporal lobe (amygdala and parahippocampal area), as well as the subgenual (sg)ACC and insula, and the functional connectivity between the parahippocampal area and the sgACC at 10 and 11.5 Hz. The authors describe 2 patients with very severely distressing intractable tinnitus who underwent transcranial magnetic stimulation (TMS) with a double-cone coil targeting the dACC and subsequent implantation of electrodes on the dACC. One of the patients responded to the implant and one did not, even though phenomenologically they both expressed the same tinnitus loudness and distress. The responder has remained dramatically improved for more than 2 years with 6-Hz burst stimulation of the dACC. The 2 patients differed in functional connectivity between the area of the implant and a tinnitus network consisting of the parahippocampal area as well as the sgACC and insula; that is, the responder had increased functional connectivity between these areas, whereas the nonresponder had decreased functional connectivity between these areas. Only the patient with increased functional connectivity linked to the target area of repetitive TMS or implantation might transmit the stimulation current to the entire tinnitus network and thus clinically improve.
authors: Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, New Zealand;
authors: Dirk
authors: D
authors: De Ridder
authors: Department of Neurosurgery, University Hospital Antwerp, Belgium; and.
authors: Kathleen
authors: K
authors: Joos
authors: Lab for Auditory & Integrative Neuroscience, School of Behavioral and Brain Sciences, University of Texas at Dallas, Texas.
authors: Sven
authors: S
authors: Vanneste
mesh_terms: D002540:Cerebral Cortex / Q000601:surgery; D004351:Drug Resistance; D004567:Electrodes, Implanted; D004569:Electroencephalography; D005260:Female; D006179:Gyrus Cinguli / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D020534:Parahippocampal Gyrus / Q000601:surgery; D014012:Tinnitus / Q000601:surgery*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: ACC = anterior cingulate cortex; BA = Brodmann area; BOLD = blood oxygen level-dependent; DLPFC = dorsolateral prefrontal cortex; EEG = electroencephalography; HADS = Hospital Anxiety Depression Scale; MEG = magnetoencephalography; NRS = numeric rating scale; TENS = transcutaneous electrical nerve stimulation; TMS = transcranial magnetic stimulation; TQ = tinnitus questionnaire; anterior cingulate cortex; d = dorsal; fMRI = functional MRI; functional neurosurgery; homeostatic emotion; r = repetitive; sLORETA = standardized low-resolution electromagnetic tomography; sg = subgenual; tDCS = transcranial direct current stimulation; tinnitus