Tinnitus, Deafness and Ear Problems Support Group
This group is for those coping with Tinnitus (ringing ears or ear noise), hearing loss, and all ear issues. Join to find support and get advice from others.
This group is for those coping with Tinnitus (ringing ears or ear noise), hearing loss, and all ear issues. Join to find support and get advice from others.
Enjoy the article / Daniel
GP and Klonopin: A Receptor-Targeted Therapy
The rationale for our innovative drug therapy of GP and Klonopin was twofold. One aspect called for providing tinnitus control by increasing inhibition of an epileptogenic focus of activity identified in brain cortex and metabolic alteration in brain function in the medial temporal lobe system of the brain, known to have a high density of GABA A receptor (i.e., to provide an RTT). A second consideration was to provide neuroprotection to the identified abnormal neural substrates by control of its antiseizure activity.
In the publication of interest [1], GP was selected as the "next" drug in a menu-driven approach attempting tinnitus relief. Klonopin was recommended as a supplement for increasing the inhibitory effect. Patients reported improvement in sleep and also in the control of anxiety.
GP is a drug with antidepressant and antinociceptive as well as antiseizure actions. Our team recommended GP in 1996, as stated, for treatment of the sensory component of the tinnitus symptom, for its purported GABAergic inhibitory effect and reported antiseizure side effects. Klonopin was recommended for treatment of the affect component of the tinnitus symptom. The dosage of both has been reported to be individualized for each patient with diagnosed predominantly severe, disabling, central-type tinnitus. The dosage established for both is not arbitrary but based for GP on a subjective outcome report scale of tinnitus intensity and for Klonopin on a scale of tinnitus annoyance [2].
Tinnitus patients who have been selected as described for this combined treatment (ongoing since 1996; approximately in excess of 100 patients) have reported significant tinnitus relief within 2-4 weeks. It has been maintained over the long term (more than 1 year) in approximately 90%. Adverse effects have included drowsiness and unsteadiness [2,23].
Concerning the mechanism of action of GP, this is a work in progress, with a history of more than 10 years. Important is to consider the relationship between calcium channel blockade and neurotransmitter release, a common failing in discussions of the action of antiepileptic pharmacological drugs [24]. Designed as a GABAmimetic to freely pass the blood-brain barrier [25], GP was subsequently reported to be without significant activity at GABA receptors; functional studies demonstrated calcium channel-blocking properties of the drug at therapeutically relevant levels [26,27]. Most recent has been the report of interaction between GP and the GABA B receptor on glutamatergic nerve terminals in neocortical brain slices, resulting in reduction in evoked glutamate release [28]. This may explain the anticonvulsant and antinociceptive actions of GP. However, these findings are inconsistent with other reports [29,30]. Significant for tinnitus patients is the search for underlying mechanisms of GP action, that antiseizure and antinociceptive actions have been identified, and that in a selected cohort of tinnitus patients, relief has been established and maintained long term.
In the opinion of our team, the difficulty in identifying the actions of GP does not contradict our patients' reports of tinnitus relief with GP. Significant clinical subjective reports cite long-term tinnitus control in patients selected for this therapy and its correlation with objective improvement in neural substrates identified with nuclear medicine SPECT of brain and QEEG after RTT-GABA therapy.
Long-Term Tinnitus Relief
Long-term tinnitus relief (i.e., > 1 year) is missing in the report in question [1]. In our experience, long-term tinnitus relief with GP supplemented with Klonopin was reported initially at the American Academy of Otolaryngology-Head and Neck Surgery meeting in 2001 and published in 2002 in the International Tinnitus Journal [2]. The positive subjective results of RTT-GABA therapy have been supported in selected cases by objective metabolic evidence of alteration in activity with sequential SPECT of brain: improvement in perfusion in neural substrates initially diagnosed as abnormal (the number limited by the cost of the procedures) and, more recently, with objective electrophysiological evidence using QEEG [3,4]. Significantly, tinnitus relief was seen in patients who reported such associated complaints prior to RTT-GABA therapy.
Hopefully this helps you for a long time. Just be wary of Benzo withdrawal. Some people can get it even while staying at a steady dosage.
They know I need it, they know it helps me, and they know I don't abuse it.