Randomized Sham Controlled Double-blind Trial of Repetitive Transcranial Magnetic Stimulation for Adults With Severe Tourette Syndrome.
BACKGROUND
A small proportion of individuals with Tourette syndrome (TS) have a lifelong course of illness that fails to respond to conventional treatments. Open label studies have suggested that low frequency (1-Hz) repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area (SMA) may be effective in reducing tic severity.


OBJECTIVE
To examine the efficacy of rTMS over the SMA for TS in a randomized double-blind sham-controlled trial (RCT).


METHODS
We conducted a two-site RCT-rTMS with 20 adults with severe TS for 3 weeks. Treatment consisted of 15 sessions (1-Hz; 30 min; 1800 pulses per day) of active or sham rTMS at 110% of the motor threshold over the SMA. A subsequent 3 week course of active rTMS treatment was offered.


RESULTS
Of the 20 patients (16 males; mean age of 33.7 ± 12.2 years), 9 received active and 11 received sham rTMS. After 3 weeks, patients receiving active rTMS showed on average a 17.3% reduction in the YGTSS total tic score compared to a 13.2% reduction in those receiving sham rTMS, resulting in no statistically significant reduction in tic severity (P = 0.27). An additional 3 week open label active treatment for those patients (n = 7) initially randomized to active rTMS resulted in a significant overall 29.7% reduction in tic severity compared to baseline (P = 0.04).


CONCLUSIONS
This RCT did not demonstrate efficacy of 3-week SMA-targeted low frequency rTMS in the treatment of severe adult TS. Further studies using longer or alternative stimulation protocols are warranted.
Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
Angeli
A
Landeros-Weisenberger
Department of Physiology, Pharmacology & Neuroscience, Sophie Davis School of Biomedical Education, City University of New York, NY, USA; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA.
Antonio
A
Mantovani
Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Maria G
MG
Motlagh
Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
Pedro Gomes
PG
de Alvarenga
Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
Liliya
L
Katsovich
Child Study Center, Yale University School of Medicine, New Haven, CT, USA. Electronic address: james.leckman@yale.edu.
James F
JF
Leckman
Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
Sarah H
SH
Lisanby
D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D005879:Tourette Syndrome / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Magnetic stimulation; Randomized controlled trial; Tourette syndrome; Transcranial