Abstract
Background: Traditional medical treatments are not effective for some patients with Tourette syndrome (TS). According to the literature, repetitive transcranial magnetic stimulation (rTMS) may be effective for the treatment of TS; however, different targets show different results.Objective: To assess the efficacy and safety of low-frequency rTMS in patients with TS, with the bilateral parietal cortex as the target.Methods: Thirty patients with TS were divided into two groups: active and sham groups. The active group was subjected to 0.5-Hz rTMS at 90% of resting motor threshold (RMT) with 1,200 stimuli/day/side, whereas the sham group was subjected to 0.5-Hz rTMS at 10% of RMT with 1,200 stimuli/day/side with changes in the coil direction. Both groups were bilaterally stimulated over the parietal cortex (P3 and P4 electrode sites) for 10 consecutive days. The symptoms of tics and premonitory urges were evaluated using the Yale Global Tic Severity Scale (YGTSS), Modified Scoring Method for the Rush Video-based Tic Rating Scale (MRVBTS), and Premonitory Urge for Tics Scale (PUTS) scores at baseline, the end of the 10-day treatment, 1 week after treatment, and 1 month after treatment.Results: At the end of the 10-day treatment, the YGTSS total, YGTSS motor tic, YGTSS phonic tic, MRVBTS, and PUTS scores in the active group significantly improved and improvements were maintained for at least 1 month.Conclusions: Low-frequency bilateral rTMS of the parietal cortex can markedly alleviate motor tics, phonic tics, and premonitory urges in patients with TS.
Highlights
Tourette syndrome (TS) manifests as a variety of motor tics and at least one phonic tic lasting for more than 1 year [1]
The active group was subjected to 0.5-Hz Repeated TMS (rTMS) at 90% of resting motor threshold (RMT) with 1,200 stimuli/day/side, whereas the sham group was subjected to 0.5-Hz rTMS at 10% of RMT with 1,200 stimuli/day/side with changes in the coil direction
Low-frequency bilateral rTMS of the parietal cortex can markedly alleviate motor tics, phonic tics, and premonitory urges in patients with TS
Summary
Tourette syndrome (TS) manifests as a variety of motor tics and at least one phonic tic lasting for more than 1 year [1]. Premonitory urges are more common in patients with TS who typically describe them as uncomfortable cognitive or physical sensations prior to tics and strong motor urges [5,6,7] They may be internally generated and may prompt the release of motor or phonic tics as well as be associated with the severity of tics [8, 9]. High-frequency (>5 Hz) stimulation increases cortical excitability, whereas lowfrequency (≤1 Hz) stimulation inhibits it [12] This method may become a new and effective treatment approach for a variety of neuropsychiatric disorders [13,14,15,16,17]. Repetitive transcranial magnetic stimulation (rTMS) may be effective for the treatment of TS; different targets show different results
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