This means that the development of the TQ score during the intertreatment interval is a good predictor for the outcome of the second treatment course and that the outcome of the first treatment course provides hardly any additional predictive information.
As can be seen in Figure 1, the average TQ scores decreased after the first treatment, increased in the intertreatment interval, and improved again during the second treatment course.
Study developers required five monthly doses of aflibercept before extending the intertreatment interval to 8 weeks.
A second treatment attempt is especially promising for patients who had experienced a worsening of their tinnitus during the intertreatment interval.
These group data suggest that the beneficial effect of the first rTMS treatment vanishes over time during the intertreatment interval but can be renewed by repeated rTMS.
This would also explain why the baseline score of the second treatment course, the duration of the intertreatment interval, and the change of the stimulation protocol did not correlate significantly with the outcome of the second treatment course the baseline score alone tells us little about the process the brain is currently in nor does the duration of the intertreatment interval.
Repeated application of rTMS seems to be useful in tinnitus management and should preferentially be offered to patients who experience a worsening of their tinnitus during the intertreatment interval, irrespective of their response to the first treatment course.
Furthermore, the TQ difference of the intertreatment interval (ITI) was calculated to represent the development of tinnitus severity in the phase between both treatment courses ("TQ difference ITI"; baseline of the second treatment minus day 12 of the first treatment).
The product-moment correlations with TQ difference 2 were not significant for the duration of the intertreatment interval (r = −0.167, p = 0.223) and the baseline score of the second treatment course (r = −0.128, p = 0.351).
In summary, this study demonstrated that (a) repeated courses of rTMS treatment cause a significant change of tinnitus severity and (b) the change of tinnitus severity during the intertreatment interval is a good predictor for treatment outcome of the second treatment course with patients whose tinnitus worsens during this interval benefitting most from the second treatment.
