Efficacy and safety of bilateral continuous theta burst stimulation (cTBS) for the treatment of chronic tinnitus: design of a three-armed randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Tinnitus, the perception of sound and noise in absence of an auditory stimulus, has been shown to be associated with maladaptive neuronal reorganization and increased activity of the temporoparietal cortex. Transient modulation of tinnitus by repetitive transcranial magnetic stimulation (rTMS) indicated that these areas are critically involved in the pathophysiology of tinnitus and suggested new treatment strategies. However, the therapeutic efficacy of rTMS in tinnitus is still unclear, individual response is variable, and the optimal stimulation area disputable. Recently, continuous theta burst stimulation (cTBS) has been put forward as an effective rTMS protocol for the reduction of pathologically enhanced cortical excitability.</p> <p>Methods</p> <p>48 patients with chronic subjective tinnitus will be included in this randomized, placebo controlled, three-arm trial. The treatment consists of two trains of cTBS applied bilaterally to the secondary auditory cortex, the temporoparietal associaction cortex, or to the lower occiput (sham condition) every working day for four weeks. Primary outcome measure is the change of tinnitus distress as quantified by the Tinnitus Questionnaire (TQ). Secondary outcome measures are tinnitus loudness and annoyance as well as tinnitus change during and after treatment. Audiologic and speech audiometric measurements will be performed to assess potential side effects. The aim of the present trail is to investigate effectiveness and safety of a four weeks cTBS treatment on chronic tinnitus and to compare two areas of stimulation. The results will contribute to clarify the therapeutic capacity of rTMS in tinnitus.</p> <p>Trial registration</p> <p>The trial was registered with the clinical trials register of <url>http://www.clinicaltrials.gov</url> (NCT00518024).</p

Functional imaging reveals rapid reorganization of cortical activity after parietal inactivation in monkeys

Impairments of spatial awareness and decision making occur frequently as a consequence of parietal lesions. Here we used event-related functional MRI (fMRI) in monkeys to investigate rapid reorganization of spatial networks during reversible pharmacological inactivation of the lateral intraparietal area (LIP), which plays a role in the selection of eye movement targets. We measured fMRI activity in control and inactivation sessions while monkeys performed memory saccades to either instructed or autonomously chosen spatial locations. Inactivation caused a reduction of contralesional choices. Inactivation effects on fMRI activity were anatomically and functionally specific and mainly consisted of: (i) activity reduction in the upper bank of the superior temporal sulcus (temporal parietal occipital area) for single contralesional targets, especially in the inactivated hemisphere; and (ii) activity increase accompanying contralesional choices between bilateral targets in several frontal and parieto-temporal areas in both hemispheres. There was no overactivation for ipsilesional targets or choices in the intact hemisphere. Task-specific effects of LIP inactivation on blood oxygen level-dependent activity in the temporal parietal occipital area underline the importance of the superior temporal sulcus for spatial processing. Furthermore, our results agree only partially with the influential interhemispheric competition model of spatial neglect and suggest an additional component of interhemispheric cooperation in the compensation of neglect deficits

Cosmic Ray Energy Spectra and Mass Composition at the Knee - Recent Results from KASCADE -

Recent results from the KASCADE experiment on measurements of cosmic rays in the energy range of the knee are presented. Emphasis is placed on energy spectra of individual mass groups as obtained from an two-dimensional unfolding applied to the reconstructed electron and truncated muon numbers of each individual EAS. The data show a knee-like structure in the energy spectra of light primaries (p, He, C) and an increasing dominance of heavy ones (A > 20) towards higher energies. This basic result is robust against uncertainties of the applied interaction models QGSJET and SIBYLL which are used in the shower simulations to analyse the data. Slight differences observed between experimental data and EAS simulations provide important clues for further improvements of the interaction models. The data are complemented by new limits on global anisotropies in the arrival directions of CRs and by upper limits on point sources. Astrophysical implications for discriminating models of maximum acceleration energy vs galactic diffusion/drift models of the knee are discussed based on this data.Comment: 8 pages, 7 figures, to appear in Nuclear Physics B, Proceedings Supplements, as part of the volume for the CRIS 2004, Cosmic Ray International Seminar: GZK and Surrounding

Radio Emission in Atmospheric Air Showers: First Measurements with LOPES-30

When Ultra High Energy Cosmic Rays interact with particles in the Earth's atmosphere, they produce a shower of secondary particles propagating toward the ground. LOPES-30 is an absolutely calibrated array of 30 dipole antennas investigating the radio emission from these showers in detail and clarifying if the technique is useful for largescale applications. LOPES-30 is co-located and measures in coincidence with the air shower experiment KASCADE-Grande. Status of LOPES-30 and first measurements are presented.Comment: Proceedings of ARENA 06, June 2006, University of Northumbria, U

Radio detection of cosmic ray air showers with LOPES

In the last few years, radio detection of cosmic ray air showers has experienced a true renaissance, becoming manifest in a number of new experiments and simulation efforts. In particular, the LOPES project has successfully implemented modern interferometric methods to measure the radio emission from extensive air showers. LOPES has confirmed that the emission is coherent and of geomagnetic origin, as expected by the geosynchrotron mechanism, and has demonstrated that a large scale application of the radio technique has great potential to complement current measurements of ultra-high energy cosmic rays. We describe the current status, most recent results and open questions regarding radio detection of cosmic rays and give an overview of ongoing research and development for an application of the radio technique in the framework of the Pierre Auger Observatory.Comment: 8 pages; Proceedings of the CRIS2006 conference, Catania, Italy; to be published in Nuclear Physics B, Proceedings Supplement

The KASCADE-Grande Experiment and the LOPES Project

KASCADE-Grande is the extension of the multi-detector setup KASCADE to cover a primary cosmic ray energy range from 100 TeV to 1 EeV. The enlarged EAS experiment provides comprehensive observations of cosmic rays in the energy region around the knee. Grande is an array of 700 x 700 sqm equipped with 37 plastic scintillator stations sensitive to measure energy deposits and arrival times of air shower particles. LOPES is a small radio antenna array to operate in conjunction with KASCADE-Grande in order to calibrate the radio emission from cosmic ray air showers. Status and capabilities of the KASCADE-Grande experiment and the LOPES project are presented.Comment: To appear in Nuclear Physics B, Proceedings Supplements, as part of the volume for the CRIS 2004, Cosmic Ray International Seminar: GZK and Surrounding

Radio emission of highly inclined cosmic ray air showers measured with LOPES

LOPES-10 (the first phase of LOPES, consisting of 10 antennas) detected a significant number of cosmic ray air showers with a zenith angle larger than 50$^{\circ}$, and many of these have very high radio field strengths. The most inclined event that has been detected with LOPES-10 has a zenith angle of almost 80$^{\circ}$. This is proof that the new technique is also applicable for cosmic ray air showers with high inclinations, which in the case that they are initiated close to the ground, can be a signature of neutrino events.Our results indicate that arrays of simple radio antennas can be used for the detection of highly inclined air showers, which might be triggered by neutrinos. In addition, we found that the radio pulse height (normalized with the muon number) for highly inclined events increases with the geomagnetic angle, which confirms the geomagnetic origin of radio emission in cosmic ray air showers.Comment: A&A accepte

A Randomized Double-Blind Crossover Study of Phase-Shift Sound Therapy for Tinnitus

Objective. The purpose of this study was to compare the efficacy of the treatment of tinnitus with a phase-shifting pure tone to that of the same tone treatment without phase shifting. Study Design. A double-blind crossover randomized controlled trial. Setting. This study was conducted at the University Medical Center Groningen. Subjects and Methods. Twenty-two patients with predominantly tonal tinnitus underwent both intervention and control treatments. Each treatment consisted of three 30-minute sessions in 1 week. The control treatment was identical to the intervention treatment, except that the stimulus was a pure tone without phase shifting. Questionnaires, tinnitus loudness match, and annoyance and loudness ratings were used to measure treatment effects. Results. Pure-tone treatment and phase-shift treatment had no significant effect on tinnitus according to questionnaires (Tinnitus Handicap Index, Tinnitus Reaction Questionnaire, Hospital Anxiety and Depression Scale, and Maastricht Questionnaire), audiological matching procedures, and loudness and annoyance ratings of tinnitus. Furthermore, phase-shift treatment showed no additional significant improvement in comparison with pure-tone treatment. Changes in questionnaire scores due to pure-tone and the phase-shift treatment were correlated. Conclusion. On average across the group, both treatments failed to demonstrate a significant effect. Both treatments were beneficial for some patients. However, a positive effect was not demonstrated that could be attributed to the periodic shifting of the phase of the stimulus tone

Radio emission of highly inclined cosmic ray air showers measured with LOPES

LOPES (LOFAR Prototype Station) is an array of dipole antennas used for detection of radio emission from air showers. It is co-located and triggered by the KASCADE (Karlsruhe Shower Core and Array Detector) experiment, which also provides informations about air shower properties. Even though neither LOPES nor KASCADE are completely optimized for the detection of highly inclined events, a significant number of showers with zenith angle larger than 50$^o$ have been detected in the radio domain, and many with very high field strengths. Investigation of inclined showers can give deeper insight into the nature of primary particles that initiate showers and also into the possibility that some of detected showers are triggered by neutrinos. In this paper, we show the example of such an event and present some of the characteristics of highly inclined showers detected by LOPES

Investigation of the Properties of Galactic Cosmic Rays with the KASCADE-Grande Experiment

The properties of galactic cosmic rays are investigated with the KASCADE-Grande experiment in the energy range between $10^{14}$ and $10^{18}$ eV. Recent results are discussed. They concern mainly the all-particle energy spectrum and the elemental composition of cosmic rays.Comment: Proc. RICAP 09, Nucl. Instr. and Meth. in pres