Burst stimulation of the auditory cortex: a new form of neurostimulation for noise-like tinnitus suppression.

OBJECT Tinnitus is an auditory phantom percept related to tonic and burst hyperactivity of the auditory system. Two parallel pathways supply auditory information to the cerebral cortex: the tonotopically organized lemniscal system, and the nontonotopic extralemniscal system, which fire in tonic and burst mode, respectively. Electrical cortex stimulation is a method capable of modulating activity of the human cortex by delivering stimuli in a tonic or burst way. Burst firing is shown to be more powerful in activating the cerebral cortex than tonic firing, and bursts may activate neurons that are not activated by tonic firing. METHODS Five patients with an implanted electrode on the auditory cortex were asked to rate their tinnitus distress and intensity on a visual analog scale before and after 40-Hz tonic and 40-Hz burst (5 pulses at 500 Hz) stimulation. All patients presented with both high-pitched pure tone and white noise components in their tinnitus. RESULTS A significantly better suppression for narrowband noise tinnitus with burst stimulation in comparison with tonic stimulation (Z = -2.03, p = 0.04) was found. For pure tone tinnitus, no difference was found between tonic and burst stimulation (Z = -0.58, p = 0.56). No significant effect was obtained for stimulation amplitude (Z = -1.21, p = 0.23) and electrical charge per pulse (Z = -0.67, p = 0.50) between tonic and burst stimulation. The electrical current delivery per second was significantly different (Z = -2.02, p = 0.04). CONCLUSIONS Burst stimulation is a new form of neurostimulation that might be helpful in treating symptoms that are intractable to conventional tonic stimulation. Further exploration of this new stimulation design is warranted.