Abstract
Gilles de la Tourette Syndrome is a multifaceted neuropsychiatric disorder typically commencing in childhood and characterized by motor and phonic tics. Its pathophysiology is still incompletely understood. However, there is convincing evidence that structural and functional abnormalities in the basal ganglia, in cortico-striato-thalamo-cortical circuits, and some cortical areas including medial frontal regions and the prefrontal cortex as well as hyperactivity of the dopaminergic system are key findings. Conventional therapeutic approaches in addition to counseling comprise behavioral treatment, particularly habit reversal therapy, oral pharmacotherapy (antipsychotic medication, alpha-2-agonists) and botulinum toxin injections. In treatment-refractory Tourette syndrome, deep brain stimulation, particularly of the internal segment of the globus pallidus, is an option for a small minority of patients. Based on pathophysiological considerations, non-invasive brain stimulation might be a suitable alternative. Repetitive transcranial magnetic stimulation appears particularly attractive. It can lead to longer-lasting alterations of excitability and connectivity in cortical networks and inter-connected regions including the basal ganglia through the induction of neural plasticity. Stimulation of the primary motor and premotor cortex has so far not been shown to be clinically effective. Some studies, though, suggest that the supplementary motor area or the temporo-parietal junction might be more appropriate targets. In this manuscript, we will review the evidence for the usefulness of repetitive transcranial magnetic stimulation and transcranial electric stimulation as treatment options in Tourette syndrome. Based on pathophysiological considerations we will discuss the rational for other approaches of non-invasive brain stimulation including state informed repetitive transcranial magnetic stimulation.
Highlights
Whereas single or paired-pulse transcranial magnetic stimulation (TMS) allowing to measure the excitability and activity of motor cortical and interconnected areas is of great interest for studying the pathophysiology of Gilles de la Tourette syndrome (GTS) [34], repetitive TMS provides the opportunity of inducing effects outlasting the time of stimulation
Given that short-interval intracortical inhibition (SICI) is predominantly mediated by GABA-A interneurons [66], these findings suggest a potential reductions of synaptic GABA-A activity in GTS
In children, applying 1 Hz repetitive TMS (rTMS) over the supplementary motor areas (SMA) with a posterior-anterior current flow using an intensity of 110% of resting motor threshold (RMT) positive effects, i.e., a significant reduction both of Yale Global Tic Severity Scale and clinical global impression as well as a significant decrease of attention deficit hyperactivity disorder (ADHD) symptoms measured by Swanson, Nolan and Pelham Rating Scale, version 4, was found
Summary
Gilles de la Tourette syndrome (GTS) is a multifaceted neuropsychiatric disorder typically commencing in childhood. These measures are not sufficiently helpful, or cause intolerable side effects. Alternative non-invasive therapeutic brain stimulation options would be welcome
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