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Article: Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies.
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ABSTRACT: Objectives. Tinnitus is related to alterations in neuronal activity of auditory and nonauditory brain areas. Targeted modulation of these areas by repetitive transcranial magnetic stimulation (rTMS) has been proposed as a new therapeutic approach for chronic tinnitus. Methods. Two randomized, double-blind, parallel-group, controlled clinical trials were performed subsequently and pooled for analysis. A total of 192 tinnitus patients were randomly allocated to receive 10 stimulation sessions of either sham rTMS, PET-based neuronavigated 1 Hz rTMS, 1Hz r TMS over the left auditory cortex, or combined 20 Hz rTMS over the left frontal cortex, followed by 1 Hz rTMS over the left auditory cortex. Results. rTMS treatment was well tolerated and no severe side effects were observed. All active rTMS treatments resulted in significant reduction of the TQ as compared to baseline. The comparison between treatment groups failed to reach significant differences. The number of treatment responders was higher for temporal rTMS(38%) and combined frontal and temporal rTMS (43%), as compared to sham (6%). Conclusions. This large study demonstrates the safety and tolerability of rTMS treatment in patients with chronic tinnitus. While the overall effect did not prove superior to placebo, secondary outcome parameters argue in favour of the active stimulation groups, and specifically the combined frontal and temporal rTMS protocol.The World Journal of Biological Psychiatry 08/2012; · 2.38 Impact Factor -
Article: Hypothermie unter Olanzapin
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ABSTRACT: HintergrundHypothermien unter Antipsychotikabehandlung sind seit Jahrzehnten bekannt, finden jedoch im klinischen Alltag nur geringe Beachtung. Material und MethodenDie vorliegende Arbeit beschreibt eine Serie von 3Fällen ausgeprägter Hypothermie nach Applikation von Olanzapin. Risikofaktoren und Pathomechanismen der neuroleptikainduzierten Hypothermie werden anhand der vorgestellten Fälle und einer Literaturübersicht zum Thema diskutiert. ErgebnisseEine 51-jährige Frau mit katatoner Schizophrenie und Hypothyreose entwickelte bei kachektischem Ernährungszustand unter antipsychotischer Medikation mit 30mg Olanzapin pro Tag eine Hypothermie von 30,0°C Körperkerntemperatur unter Komedikation mit Lorazepam und L-Thyroxin. Bei einer 48-jährigen Patientin mit ebenfalls katatoner Schizophrenie kam es nach Einmalgabe von 10mg Olanzapin per os und 3mg Lorazepam auf 3Einzeldosen verteilt zu einer Hypothermie auf 31,0°C. Die dritte kasuistische Darstellung berichtet von einem 69-jährigen Patienten mit akuter schizophreniformer Störung, welcher nach Einmalgabe von 5mg Olanzapin ohne weitere Komedikation eine Hypothermie von 33,0°C in Verbindung mit einem reversiblen AV-Block 3. Grades entwickelte. SchlussfolgerungAntipsychotika können bei individueller Disposition und in Kombination mit unabhängigen Risikofaktoren wie Umgebungstemperatur, somatischer Begleiterkrankung, endokrinologischen Störungen (z.B. Hypothyreose) oder organischer ZNS-Vorschädigung sowohl zu Hypo- als auch zu Hyperthermie führen. Ursächlich hierfür erscheint ein komplexes Zusammenspiel dopaminerger Regulationsmechanismen im ventralen Hypothalamus mit Veränderungen der Thermoregulation im Bereich der Vasomotorik von Hautgefäßen. Im klinischen Alltag sollte an die antipsychotikaassoziierte Hypothermie gedacht werden, da sie eine hochrelevante unerwünschte Arzneimittelwirkung mit potenziell lebensbedrohlichem Charakter darstellt. BackgroundAntipsychotic drugs may lead to hypothermia as well as hyperthermia. Although known for decades and clinically highly relevant, the mechanisms by which antipsychotic drugs alter thermoregulatory processes in the human body are still far from being fully understood. In clinical practice, much attention is paid to antipsychotic drug-induced elevation of body core temperature as observed in the neuroleptic malignant syndrome (NMS). But also hypothermia is a clinically highly relevant adverse reaction to antipsychotic drugs. Material and methodsHere we report a case series of three patients who developed severe hypothermia after administration of olanzapine. A review of the current literature is given with a focus on risk factors for the development of antipsychotic drug-induced hypothermia and its pathophysiologic mechanisms. ResultsA 51-year-old female patient suffering from catatonic schizophrenia, cachectic nutritional condition and hypothyroidism developed severe hypothermia of 30.0°C body core temperature after administration of 30mg olanzapine per day under comedication with lorazepam and L-thyroxine. A 48-year-old female patient with catatonic schizophrenia showed hypothermia of 31.0°C (rectal measurement) after single-dose administration of olanzapine 10mg orally and a total of 3mg lorazepam (1–1–1mg). The third case report describes a 69-year-old male patient with acute delusional disorder exhibiting hypothermia of 33.0°C (rectal measurement) in combination with a reversible atrioventricular block grade III without any further comedication. ConclusionA review of the current literature reveals that thermoregulatory disturbances as sequelae of antipsychotic drug administration depend on individual disposition as well as various independent risk factors such as environmental temperature, somatic comorbidities, endocrinological abnormalities (e.g. hypothyroidism) and structural damage of the brain. A complex interaction of dopaminergic regulatory mechanisms in the ventral hypothalamus and peripheral vaso- and sudomotor adjustments seems to be causative. Hypothermia following antipsychotic drug administration represents a serious adverse drug reaction and a potentially life-threatening event. SchlüsselwörterHypothermie–Neuroleptika–Antipsychotika–Thermoregulation–Hypothalamus KeywordsHypothermia–Neuroleptics–Antipsychotics–Thermoregulation–HypothalamusDer Nervenarzt 04/2012; · 0.68 Impact Factor -
Article: [Hypothermia under olanzapine treatment: clinical case series and review of current literature].
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ABSTRACT: Antipsychotic drugs may lead to hypothermia as well as hyperthermia. Although known for decades and clinically highly relevant, the mechanisms by which antipsychotic drugs alter thermoregulatory processes in the human body are still far from being fully understood. In clinical practice, much attention is paid to antipsychotic drug-induced elevation of body core temperature as observed in the neuroleptic malignant syndrome (NMS). But also hypothermia is a clinically highly relevant adverse reaction to antipsychotic drugs. Here we report a case series of three patients who developed severe hypothermia after administration of olanzapine. A review of the current literature is given with a focus on risk factors for the development of antipsychotic drug-induced hypothermia and its pathophysiologic mechanisms. A 51-year-old female patient suffering from catatonic schizophrenia, cachectic nutritional condition and hypothyroidism developed severe hypothermia of 30.0°C body core temperature after administration of 30 mg olanzapine per day under comedication with lorazepam and L-thyroxine. A 48-year-old female patient with catatonic schizophrenia showed hypothermia of 31.0°C (rectal measurement) after single-dose administration of olanzapine 10 mg orally and a total of 3 mg lorazepam (1-1-1 mg). The third case report describes a 69-year-old male patient with acute delusional disorder exhibiting hypothermia of 33.0°C (rectal measurement) in combination with a reversible atrioventricular block grade III without any further comedication. A review of the current literature reveals that thermoregulatory disturbances as sequelae of antipsychotic drug administration depend on individual disposition as well as various independent risk factors such as environmental temperature, somatic comorbidities, endocrinological abnormalities (e.g. hypothyroidism) and structural damage of the brain. A complex interaction of dopaminergic regulatory mechanisms in the ventral hypothalamus and peripheral vaso- and sudomotor adjustments seems to be causative. Hypothermia following antipsychotic drug administration represents a serious adverse drug reaction and a potentially life-threatening event.Der Nervenarzt 06/2011; 83(5):630-7. · 0.68 Impact Factor -
Article: rTMS for the treatment of tinnitus: the role of neuronavigation for coil positioning.
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ABSTRACT: Tinnitus affects 10% of the population, its pathophysiology remains incompletely understood, and treatment is elusive. Both animal models and functional imaging data in tinnitus patients suggest that tinnitus is associated with increased neuronal activity, increased synchronicity and functional reorganisation in the auditory cortex. Therefore, targeted modulation of auditory cortex has been proposed as a new therapeutic approach for chronic tinnitus. Repetitive transcranial magnetic stimulation (rTMS), a non invasive method for modulation of cortical activity, has been applied in different ways in patients with chronic tinnitus. Single sessions of high-frequency rTMS over the temporal cortex have been used to transiently interfere with the intensity of tinnitus. Repeated sessions of low-frequency rTMS have been investigated as a treatment for tinnitus. Here, we review data from clinical trials and discuss potential neurobiological mechanisms with special focus on the relevance of the stimulation target and the method of TMS coil positioning. Different functional neuroimaging techniques are used for detecting tinnitus-related changes in brain activity. They converge in the finding of increased neuronal activity in the central auditory system, but they differ in the exact localisation of these changes, which in turn results in uncertainty about the optimal target for rTMS treatment. In this context, it is not surprising that the currently available studies do not demonstrate clear evidence for superiority of neuronavigational coil positioning. Further development of rTMS as a treatment for tinnitus will depend on a more detailed understanding of both the neuronal correlates of the different forms of tinnitus and of the neurobiological effects mediating the benefit of TMS on tinnitus perception.Neurophysiologie Clinique/Clinical Neurophysiology 03/2010; 40(1):45-58. · 1.98 Impact Factor -
Article: Left temporal low-frequency rTMS for the treatment of tinnitus: clinical predictors of treatment outcome--a retrospective study.
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ABSTRACT: There is increasing evidence that repetitive transcranial magnetic stimulation (rTMS) can reduce chronic tinnitus. However, treatment results are characterized by high interindividual variability. Therefore, the identification of predictors for treatment response is of high clinical relevance. Clinical data of 194 patients with tinnitus were evaluated. All patients were treated with a standardized rTMS procedure (1 Hz, 10 days, 2000 stimuli/day, over the left temporal cortex). A potential influence on the outcome was analysed for the following parameters: age, gender, depression scores in Beck Depression Inventory (BDI) and tinnitus severity (TQ) before rTMS, lateralization, frequency and duration of tinnitus and extent of hearing loss. An effect of tinnitus laterality was observed. In patients with left-sided or bilateral tinnitus, rTMS resulted in a statistically significant reduction of TQ scores, whereas patients with right-sided tinnitus did not show a significant improvement after rTMS treatment. However, in correlation analyses, we found a trend which did not reach statistical significance that in the subgroup of treatment responders tinnitus duration influenced rTMS outcome. In addition, a multiple regression analysis identified the TQ score at baseline as a significant predictor for treatment outcome. For all other investigated parameters, no statistically significant effects were found. This study suggests that left temporal low-frequency rTMS has beneficial effects in left-sided and bilateral tinnitus, but not in right-sided tinnitus. In line with the results from earlier studies involving smaller samples, tinnitus duration was found to influence rTMS outcome.European Journal of Neurology 02/2010; 17(7):951-6. · 3.69 Impact Factor
