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Author: admin | 29.12.2015 | Category: Ginkgo Biloba Tinnitus

Each of your ears begins the engine noise in the automobile and even place up with there tends. We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. Chronic subjective tinnitus is characterized by abnormal neuronal synchronization in the central auditory system. Non-pulsatile subjective tinnitus is an auditory phantom phenomenon that is present in up to 15% of the population (Eggermont and Roberts, 2004). Patients were stimulated for 12 weeks using a portable acoustic device and comfortable earphones (Tass et al., 2012). Each patient underwent two recording sessions: on day 1 before start of treatment and after 12 weeks, minimum 2 h after stopping the last stimulation session.
To study whether the CSD changes, that showed up as significant differences between PC and NPC groups in particular Brodmann areas (BAs), were correlated with tinnitus pitch changes or VAS changes, CSDs were extracted from spherical volumes of interest (radius 5 mm) centered on the voxels with maximal significance value in each of these BAs.
No significant correlation was observed between changes in VAS-L or VAS-A and tinnitus pitch change ratio when all patients (n = 59) were included into the analysis (Table 3). This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience.
As shown in a controlled clinical trial, acoustic coordinated reset (CR) neuromodulation causes a significant relief of tinnitus symptoms along with a significant decrease of pathological oscillatory activity in a network comprising auditory and non-auditory brain areas, which is often accompanied with a significant tinnitus pitch change.
Furthermore, an altered functional interaction between non-auditory and auditory areas with abnormal synchrony seems to be a hallmark of tinnitus distress (Schlee et al., 2009a). CR neuromodulation has been developed computationally (Tass, 1999, 2003b) and is essentially based on fundamental dynamical self-organization principles (Tass, 2003a, b) as well as on the intimate relationship between neuronal dynamics and connectivity (Yuste and Bonhoeffer, 2004). Accordingly, in a proof of concept study the initially DBS-oriented CR concept was transformed into a non-invasive, acoustic treatment for subjective tonal tinnitus (Tass et al., 2012).
For this, we compare two groups of patients with very similar tinnitus relief, but significantly different tinnitus pitch change. Subjects were instructed to retain from caffeinated beverages on the day of the recording to exclude caffeine induced changes of EEG activity. We set out to investigate how spontaneous oscillatory brain activity changes in patients with pronounced tinnitus pitch change as opposed to patients with zero or minimal pitch change. These CSD values were used for a partial correlation analysis with data from matched tinnitus pitch, VAS-L and VAS-A in all 59 patients.
Relying on the tonotopic organization of the central auditory system, the electrical brief high-frequency pulse trains were replaced by CR tones with different frequencies centered around the patient’s individual tinnitus frequency.
By the same token, the tinnitus-related reduction of alpha activity was reversed and alpha activity re-increased in auditory and prefrontal areas (Tass et al., 2012). According to previous studies different perceptual characteristics of tinnitus may be coded by an altered network activity of multiple parallel overlapping dynamic neural networks (De Ridder et al., 2011a).
From the total population of 63 patients one patient dropped out of the study before the 12 weeks visit. By using partial correlations we measure the relationship of two variables with the effect of a control variable being removed. Furthermore, we studied if the changes of the pattern of brain synchrony in tinnitus patients induced by 12 weeks of CR therapy depend on whether or not the patients undergo a pronounced tinnitus pitch change. However, according to an MEG study, map reorganization cannot explain the emergence of tinnitus in a satisfactory manner (Weisz et al., 2006).


The CR approach aims at a desynchronization of a synchronized focus in the tonotopically organized auditory cortex located in an area corresponding to the dominant tinnitus frequency and the belonging tinnitus spectrum (Norena et al., 2002).
In a relevant number of patients CR neuromodulation induced a tinnitus pitch change predominantly lowering tinnitus frequencies (Tass et al., 2012). We shall discuss possible mechanisms that may cause a CR-induced tinnitus pitch change below. For another patient there were no EEG data available, and in two patients matched tinnitus pitch could not be determined as tinnitus was absent at the 12 weeks visit. In our case we correlated changes of CSD extracted from spherical volumes of interest for a certain frequency band with pitch changes, controlling for VAS and vice versa, thus obtaining correlations specifically for pitch and VAS.
Therefore, we applied standardized low-resolution brain electromagnetic tomography (sLORETA) to EEG recordings from two groups of patients with a sustained CR-induced relief of tinnitus symptoms with and without tinnitus pitch change. Theoretical studies have predicted long-lasting (Tass and Majtanik, 2006) and cumulative (Hauptmann and Tass, 2009) desynchronizing effects of CR neuromodulation. Stimulation signals were generated based on a specific formula reflecting the logarithmic tonotopic organization of the auditory cortex and on the matched tinnitus (frequency ft) with an equal number of tones placed below and above the tinnitus frequency (except for placebo).
Additionally, we assess functional connectivity as a pattern of statistical dependencies between separate brain regions. In general, pathologically increased delta activity emerges in cortical regions deprived of afferent input (Steriade, 2006). CR neuromodulation has initially been developed for the application to electrical deep brain stimulation (DBS) in Parkinson’s disease (Tass, 2003b). For this, we do not make any specific assumptions concerning the directional interactions between the brain regions under study. For this, brief electrical high-frequency pulse trains are sequentially delivered via different stimulation contacts of an implanted lead. Developmental trajectories of the abilities to detect auditory amplitude and frequency modulation were also shown to be distinct (Banai et al., 2011). Four tones per cycle were played in random order with three stimulation cycles followed by two silent cycles. The EEG signals were amplified with the Net Amps 200 amplifier (Electrical Geodesics Inc, Eugene, USA), digitized at 1 kHz and analogous bandpass filtered from 0.1 to 400 Hz.
Measures of linear dependence (coherence-type) between two multivariate time series may be expressed as the sum of the lagged linear and instantaneous linear dependences (Pascual-Marqui, 2007b). In addition, we revealed a significantly lower functional connectivity in the gamma band between the right dorsolateral prefrontal cortex (BA 46) and the right ACC (BA 32) after 12 weeks of CR therapy in patients with pronounced pitch change.
Recordings were performed in the awake state during alternating 2 min intervals with eyes closed and eyes open. The solution space used in this study was restricted to the gray matter voxels that belonged to cortical and hippocampal regions, comprising a total of 6430 voxels at a spatial resolution of 5 mm.
However, any measure of instantaneous dependence is likely to be contaminated with a non-physiological contribution due to volume conduction (Pascual-Marqui, 2007b).
Our results indicate a substantial, CR-induced reduction of tinnitus-related auditory binding in a pitch processing network. In summary, following current notions on parallel processing of different aspects of auditory information in general and in phantom perception in particular, we might expect differences in the change of brain synchrony in auditory, but also in non-auditory areas between our two patient groups, treated with acoustic CR neuromodulation and differing in the amount of their tinnitus pitch change. For all patients we selected the eyes closed data for further analysis, since they were less affected by artifacts. To exclude the influence of different magnitudes of the reduction of tinnitus symptoms between the PC and NPC group on the further analysis, we excluded the patient with the greatest VAS-L improvement from PC and the patient with the smallest VAS-L improvement from NPC, in this way creating two groups (PC, n = 16 and NPC, n = 16) with a rather similar reduction of tinnitus symptoms, but significantly different matched pitch changes (Table 1).


The effects of the differential change of the matched tinnitus frequency on the spontaneous brain activity as assessed by sLORETA in the PC and the NPC group were revealed between the two groups with a voxel-by-voxel paired-groups comparison of the current density distribution applying t-statistical non-parametric mapping (SnPM; Robertson and Irvine, 1989). Pascual-Marqui (2007a) introduced a technique that removes the instantaneous, non-physiological contribution resulting from volume conduction. However, a conscious perception of the tinnitus requires the involvement of larger networks of brain areas relevant to awareness and salience (De Ridder et al., 2011a).
Photogrammetry was performed for all subjects using Geodesic Photogrammetry System, and the individual head shape was modeled for every subject in each EEG session.
Accordingly, this measure of dependence can be applied to a large number of brain areas simultaneously. A readjustment of stimulation parameters was performed at each visit, provided the matched tinnitus frequency had changed. We calculated lagged linear connectivity (lagged coherence) for the same frequency bands as used for the sLORETA analysis.
Calculations of lagged linear connectivity were performed using regions of interest (ROI), constructed for each hemisphere by defining all voxels located within a radius of 5 mm around designated seed points. Data for this paper come from baseline and the 12 weeks visit as EEG recordings for all patients were performed at these visits. In this way, we detected brain regions where oscillatory activity was specifically reduced or increased after 12 weeks of CR treatment in the PC group as opposed to the corresponding changes in the NPC group. Seed points were placed in the BAs that showed significant differences between PC and NPC and were defined as the voxel with the highest significance in a selected BA (see Results).
At each visit, tinnitus loudness and annoyance were assessed off-stimulation (at least 2.5 h after cessation of CR neuromodulation) and consecutively on-stimulation (15 min after turning on CR neuromodulation) using a VAS scale for loudness (VAS-L) and annoyance (VAS-A) ranging from 0 to 100. In other words, we constrained our connectivity analysis to those brain areas which showed differential effects of CR therapy depending on whether or not tinnitus pitch changed strongly. In this study we only use the off-stimulation VAS scores, because EEG recordings were performed off-stimulation. A pure tone matching procedure was used to determine the best matching tinnitus pitch (from 100 to 10,000 Hz).
Put otherwise, previously we have shown that CR therapy induces significant power changes in different frequency bands and specific brain areas (Tass et al., 2012).
Patients were instructed to match the frequency of a pure tone to the perceived pitch of their tinnitus. We here study, how these changes depend on whether or not the tinnitus pitch changes strongly.
During this procedure intensity and frequency of the matching tone were controlled by the patient. Tinnitus matching started either well below or well above the patient’s tinnitus frequency.
The matching tone was repeatedly interrupted to facilitate the comparison between matching tone and tinnitus.



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