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magnetic resonance guided high-intensity focused ultrasound

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Daedalus	magnetic resonance guided high-intensity focused ultrasound	Lead	[-]
Posts: 1144 12/25/11 10:39 AM Reply Quote More My Recent Posts	Tags : None A physician friend from the French forum drew my attention to this technique. It consists in very localised (3-4 mm) ablations of cerebral tissue in the thalamus. My crude understanding of the thing is that by destroying the right part of the thalamus they disrupt the thalamocortical loop responsible of thalamocortical disrythmia. They say they have treated tinnitus cases with a success rate of "between 50 and 70%". Why these people don't have cleans statistics i wonder. The French text says you need a lesion of the auditory nerve to be treatable this way but i wonder if they simply mean a lesion of the auditory tract in general. They speak of tinnitus as a TCD like De Ridder. The only difference is they treat the thalamus by ablation while De Ridder (and others) treat cortical zones by neuromodulation. They use the same diagnostic tools like the LORETA-EEG but with a better resolution. 64 electrodes in lieu of the 19 in Antwerp. More information here: http://www.sonimodul.ch/ Choose English. The texts aren't too technical. I can post more material if someone shows interest.
cologne		#1	[-]
Posts: 158 12/25/11 3:13 PM Reply Quote More My Recent Posts	Hi Daedelus, I am always interested in new research approaches so thank you for posting this. but even after checking their homepage I still do not understand what the "theory" behind this approach should be for tinnitus. They also do not really say much about potential side effects of such a treatment.but ablation of celebral tissue does not sound totally riskfree. last but not least, where did you find the success rate of 50 to 70% and do you know how the definde a success case?
Daedalus		#2	[-]
Posts: 1144 12/25/11 3:43 PM Reply Quote More My Recent Posts	The 50 to 70% success rates for tinnitus was communicated by email by one of the researchers to someone who posted on the French forums. I don't know how they define a success and it is a good question. It is late here and i am not home but i suggest you google thalamocortical disrythmia. It is the model of tinnitus used by De Ridder, Will Rosellini and these Swiss. Just that instead of targeting the cortical part, they target the thalamus, the regulator.
.		#3	[-]
Posts: 229 12/25/11 9:18 PM Reply Quote More My Recent Posts	I had not heard about this particular procedure until I read this thread. However, nerve ablation (radio frequency ablation) is becoming more and more prevalent in treating chronic pain so I am familiar with ablation in general terms. It stands to reason if an area of the brain that harbors or facilitates the tinnitus signal is disrupted or wiped out, it might indeed be an effective treatment in reducing or eliminating tinnitus for some people. Certainly there would be risks... ablate too much cerebral tissue and a patient might experience any number of side effects, such as the loss or impairment of one or more of the many functions the thalamus is responsible for regulating. I have often wondered if electroconvulsive therapy (ECT) also might be effective in treating tinnitus. I'm sure this has been explored to some degree, but likely there would be so much trial and error involved in getting it right, and human subjects are probably not as easy to recruit as they would be for treatments involving a pill or shot despite the great strides medicine has made reducing side effects of ECT. This ablation technique is promising because it sounds very localized, though certainly not everyone w/ tinnitus is a potential candidate for this procedure as has been pointed out. Thanks Daedalus, for this interesting link. I enjoy your posts and appreciate your insights and your sharing of these types of articles. Last Edited By: 12/26/11 3:17 PM. Edited 2 times.
Daedalus		#4	[-]
Posts: 1144 12/26/11 4:42 AM Reply Quote More My Recent Posts	Here is a little abstract talking about the general theory concerning thalamocortical loops and disrythmia. I find it interesting that tinnitus is included in a more general theory. http://www.em-consulte.com/article/39434 Of course it is not the complete article and is a bit succinct as an explanation. Here is a .pdf with some diagrams about TCDs and HIFU surgery effects. Of course without the context of the conference it is moderately useful. http://www.fondation-fond...11_for_fondamental_2.pdf
lucavb.dryrun28158		#5	[-]
Posts: 610 12/26/11 9:17 AM TSMB Supporter Reply Quote More My Recent Posts	I still have this document, seems dodgy, but Ill post it again since that "loop" pops up in it too. http://dl.dropbox.com/u/1...662/Tinnitus-Therapy.pdf
cologne		#6	[-]
Posts: 158 12/26/11 9:28 AM Reply Quote More My Recent Posts	..wow, they state that 61% of their patients experienced complete restitution and another 30% an important decrease. If these numbers were trustworthy, I would immediately fly to Argentina, I guess.Lucavb: Do you more about the "reliability" of these researchers? Last Edited By: cologne 12/26/11 9:39 AM. Edited 1 times.
lucavb.dryrun28158		#7	[-]
Posts: 610 12/26/11 9:32 AM TSMB Supporter Reply Quote More My Recent Posts	cologne wrote: ..wow, they state that 61% of their patients experienced complete restitution and another 30% an important decrease. If these numbers were trustworthy, I would immediately fly to Argentina, I guess. They wanted 3.5k EUR for basically the tests and a prescription of drugs we know aren't the solution.
darkenspirit		#8	[-]
Posts: 2190 12/26/11 2:40 PM Reply Quote More My Recent Posts	Interesting - Lizzy
Daedalus		#9	[-]
Posts: 1144 01/04/12 7:44 AM Reply Quote More My Recent Posts	I have talked with prof Jeanmonod by telephone. A very nice person indeed. i have more precisions. On the website they talk about "nerve damage". It means a damage on the auditory tract implying a deafferentation. A loss of auditory input. As in a neuroma, a vascular compression or a classical loss of hearing by death of cochlear cilia. There would be no secondary effects since the tissue destruction is very localized. He said on the phone their tinnitus sample was a bit too small but he was expecting the same results as with other thalamocortical disrythmias : around 60% of good results. By "good" results they mean a dimishing of symptoms by 50 to 100%. He seems very knowleadgable about tinnitus as a TCD. He is aware of the TRI and the works of De Ridder. His opinion is it will be very difficult to tame tinnitus by targetting the cortical areas only. If i recall well he said HIFU for tinnitus was going to be validated in about a year.
picktingag		#10	[-]
Posts: 167 01/04/12 8:04 AM Reply Quote More My Recent Posts	Well, a year is not a long time... If it works, probably I'll fly to wherever that place is for treatment... Keeping my finger cross that something good might come up this year for us T sufferer... By then, let's organise a farewell party to this ... ermm... T forum... Hah!
cologne		#11	[-]
Posts: 158 01/04/12 2:05 PM Reply Quote More My Recent Posts	Hi Daedalus, thanks for the update - this sounds very interesting. I understand a "nerve damage" is a requirement for the success of the treatment. Do they have an opportunity to find out whether such a damage exists before they are doing HIFU?
Daedalus		#12	[-]
Posts: 1144 01/04/12 2:50 PM Reply Quote More My Recent Posts	Hi cologne, Normally the patient should know. The most common neurogenic tinnitus would be the one following a hearing loss like with a trauma. The rationale would be that if you have a tinnitus following a hearing trauma you have always some sort of hearing loss. Albeit invisble to classical audiograms. That is a thing we discussed together the professor and i. He would like to have finer hearing diagnosis tools. Like an audioscan. There are other diagnosis tools for detecting otosclerosis, acoustic neuromas and vascular compressions of the auditory nerve. Also, by very precise EEGs they can locate via the cortex the faulty part of the thalamus. So the main tool to set the surgery target would be the EEG. He thinks it would probably give less results with psychogenic tinnitus but it is not certain.
Daedalus		#13	[-]
Posts: 1144 02/03/12 7:17 AM Reply Quote More My Recent Posts	Again, i have had prof. Jeanmonod at the telephone. 1°) It is confirmed, the surgery would pose very few risks. He explained at length why there should be no neurological side effects. There is a small risk of small bleeding: 1%. Before HIFU it was 4% with a brain probe. 2°)There would be probably no use of cumulating this surgery with TMS or an extradural implant. Once the thalamic pole of a TCD would be treated, it would not be useful to treat the cortical pole since they are linked. Besides, he told me he thinks it should be "very difficult" to treat tinnitus by targeting the cortical (also called "executory") pole of the TCD. Berthold Langguth, a very knowledgeable tinnitus researcher from the TRI said prof. Jeanmonod was probably right since TMS gives usually only temporary effects. 3°) If a psychological cause of the tinnitus is present and not treated, the surgery could be ineffective. He says he has an extensive experience with hundreds of neuropathic pain patients. 4°) The costs of a consultation (including ENT evaluation) would be 3-4000 CHF (swiss francs: nearly 3300 €). A whole day of work. A surgery would be grossissimo-modo 30-40000 CHF. It won't be disponible before several months. Gasp !
goodsonora		#14	[-]
Posts: 69 02/03/12 11:04 AM TSMB Supporter Reply Quote More My Recent Posts	I wish someday health care insurance covers some of the costs!!(a pipe dream?).
cologne		#15	[-]
Posts: 158 02/03/12 12:44 PM Reply Quote More My Recent Posts	Thanks for the update. I liked what I read until i reached 4.). Wow, 30 to 40 thousand € for the treatment and a success rate of 50 to 70%. I think we will have to wait quiet long here to get some field reports..
Scott Kuz		#16	[-]
Posts: 574 02/03/12 1:44 PM Reply Quote More My Recent Posts	Would hate to have shock therapy and have it get way worse as well.....
wise25663	Ok	#17	[-]
Posts: 169 04/28/12 4:23 AM Reply Quote More My Recent Posts	I have a question about this. Let's say you have this surgery done and it is succesful(and this may be a stupid question, I AM a Carpenter). Down the road if they figure out a way to correct hearing loss by repairing the cochlear, do you think it would prevent your brain from hearing those tones. Nate
Daedalus		#18	[-]
Posts: 1144 04/28/12 8:23 AM Reply Quote More My Recent Posts	Actually it is a good question. I have not phoned again Pr Jeanmonod but my guess is it would not prevent you from hearing all tones because the auditory cortex itself is not touched. He has a mail on the website but he usually does not answer by mail. He gives you his number and he answers by telephone.
danik		#19	[-]
Posts: 2413 04/28/12 11:32 AM Reply Quote More My Recent Posts	There's a cure for everything if you have enough money.
Julia		#20	[-]
Posts: 458 04/30/12 1:58 AM Reply Quote More My Recent Posts	Hi Daedalus, Just one thing: to me "psychological cause" sounds quite vague... could you please explain? To my understanding, "psychological" T is stress induced damage somewhere in the nervous system, i. e., it is physical as well. Or did I get the wrong end of the stick? Is there T without ANY physical cause? And in that case, is it rather some kind of auditory hallucination? I'm a bit confused.

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