P309 Tinnitus rTMS treatment guided by local synchronicity of the resting state fMRI – A case report. Issue 9 (September 2017) - Starck, Tuomo
Abstract : Objectives: In tinnitus rTMS treatment, the inhibitory 1 Hz stimulation is commonly delivered to left auditory cortex and/or left temporoparietal junction (TPJ). We aimed to improve rTMS-targeting with fMRI measurements. Methods: A patient with whiplash and head trauma originated brain injury leading to constant headache, bilateral tinnitus and hearing deficit, and depression. Tinnitus handicap index (0–100) (THI) was 74 before therapy. The patient received two 4-week rTMS therapy series. Primary treatment side was left based on literature and MRI perfusion images. Targets were on primary auditory cortex bilaterally and on left TPJ. Several adjustments to target locations were tested in chasing of the positive patient feedback. Inhibitory TMS-parameters for each target were 1 Hz and 1000–1500 pulses. Before and after treatment series resting-state fMRI was acquired and a local synchrony measure (ReHo) was computed. Results: After the first treatment series the left side tinnitus was relieved (THI dropped from 74 to 22) but right side tinnitus remained and later THI got back to 74. After three months, patient received the second series and left side tinnitus was again attenuated, but right side tinnitus remained. Then fMRI ReHo analysis was re-checked and a hypersyncronous right posterior temporal cortex spot was noticed. Using that as an rTMS-target led to a quick attenuation of the remaining right side tinnitus. THI dropped to 12 and the treatment effect has persisted. Conclusions: fMRI informed personalized rTMS-treatment has the potential to target the correct gyrus and hemisphere without extensive trial and error, at least in tinnitus.