C-STIM: Protocol for a randomized, single-blind, crossover study of cerebellar repetitive transcranial magnetic stimulation (rTMS) for postural instability in people with progressive supranuclear palsy (PSP).

Background: Methods for modulating the cerebellum with transcranial magnetic stimulation (TMS) are well established, and preliminary data from our group and others has shown evidence of transient improvements in balance after cerebellar repetitive transcranial magnetic stimulation (rTMS) in progressive suprancuclear palsy (PSP). This study examines extensive posturography measures before and after 10 sessions of cerebellar rTMS and sham TMS in PSP. Methods: Thirty subjects with PSP and postural instability will undergo cerebellar active and sham rTMS in a single-blind, crossover design with a randomized order of a 10-day intervention. Primary outcomes will be changes in sway area and medio-lateral range of sway with eyes open while standing on a stationary force-plate, and safety, tolerability, and blindedness. Secondary outcomes will include posturography and gait analysis with body-worn, triaxial inertial sensors, clinical balance scales and questionnaires, and a bedside test of vestibular function. Exploratory outcomes are changes in functional near infrared spectroscopy (fNIRS) signal over the prefrontal, supplementary motor, and primary motor cortices while standing and walking, and speech samples for future analysis. Discussion: The C-STIM crossover intervention study adds a longer duration of stimulation and extensive posturography measures to more finely measure the improvements in balance and exploratory functional near-infrared spectroscopy (fNIRS) over the prefronal, supplementary motor, and primary motor cortices during balance assessments before and after 10 sessions of cerebellar rTMS and 10 sessions of sham cerebellar TMS. This project will improve our understanding of the importance of the cerebellum for control of postural stability in PSP.

Chronic tinnitus as phantom auditory pain.

OBJECTIVES: To investigate similarities between patients who experience chronic tinnitus or pain and to formulate treatment strategies that are likely to be effective for patients who experience phantom auditory pain. STUDY DESIGN: A total of 160 patients rated the severity and loudness of their tinnitus and completed the State-Trait Anxiety Inventory (STAI) and an abbreviated version of the Beck Depression Inventory (aBDI). Patients received counseling, audiometric testing, and matched the loudness of their tinnitus to sounds played through headphones. SETTING: A specialized tinnitus clinic within an urban medical center. RESULTS: Tinnitus severity was highly correlated with patients' degree of sleep disturbance, STAI, and aBDI scores. The self-rated (on a 1-to-10 scale)--but not the matched--loudness of tinnitus was correlated with tinnitus severity, sleep disturbance, STAI, and aBDI scores. CONCLUSIONS: The severity of chronic tinnitus is correlated with the severity of insomnia, anxiety, and depression. These relationships are the same for many patients with chronic pain. Treatment recommendations are discussed in reference to these results.

Tinnitus and insomnia.

PURPOSE: To investigate the effects of insomnia on tinnitus severity and to determine how this relationship may evolve with the passage of time. MATERIALS AND METHODS: Questionnaires were mailed to patients before their initial appointment at the Oregon Health Sciences University Tinnitus Clinic between 1994 and 1997. These questionnaires requested information pertaining to insomnia, tinnitus severity, and loudness. During their initial appointment, patients received counseling, education, and reassurance about tinnitus; audiometric and tinnitus evaluations; and treatment recommendations. Follow-up questionnaires were mailed to 350 patients 1 to 4 years (mean = 2.3 yr) after their initial appointment at the clinic. RESULTS: One hundred seventy-four patients (130 men, 44 women; mean age 55.9 yr) returned follow-up questionnaires. Although many of these patients improved in both sleep interference and tinnitus severity, a significant number (43) reported on the follow-up questionnaire that they continued to have difficulty sleeping. Reported loudness and severity of tinnitus were significantly greater for this group than for groups of patients who reported that they never or only sometimes have difficulty sleeping. The relationship between sleep disturbance and tinnitus severity became more pronounced with the passage of time. CONCLUSIONS: Insomnia is associated with greater perceived loudness and severity of tinnitus. These findings underscore the importance of identification and successful treatment of insomnia for patients with tinnitus.

Tinnitus severity, loudness, and depression.

Answers to questionnaires filled out by 436 patients who visited our tinnitus clinic were analyzed. Patients were asked to report the presence or absence of depression and to rate the loudness and severity of their tinnitus. Responses to questions about tinnitus loudness and severity from 121 patients who reported current depression were compared with responses from 285 patients who reported no history of depression. There was no significant difference in reported loudness of tinnitus between patients with and without depression. However, patients with current depression scored significantly higher than patients without depression on all 12 questions relating to tinnitus severity. We conclude that depression and tinnitus severity are linked in some patients. Treatment of depression with medications and psychotherapy is likely to reduce tinnitus severity for many of these patients.

Auditory P3 responses to name stimuli.

Auditory evoked potentials (AEPs) were recorded from 10 normal adults in response to their own first names and to other first names spoken on tape. The following experimental conditions were used: 30 repetitions of the subject's first name; 80 other assorted first names from the same gender; 30 repetitions of a first name other than the subject's name. A P3 component was recorded from all ten subjects in response to their own first name, but not to other first names. Utility of this procedure could include assessment of cognitive processing of nonresponsive populations such as comatose patients, stroke patients, demented patients, autistics, infants, and children.