• Angeli Landeros-Weisenberger, Antonio Mantovani, Maria G Motlagh, Pedro Gomes de Alvarenga, Liliya Katsovich, James F Leckman, and Sarah H Lisanby.
• Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
• Brain Stimul. 2015 May 1;8(3):574-81.

BackgroundA 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/HypothesisTo examine the efficacy of rTMS over the SMA for TS in a randomized double-blind sham-controlled trial (RCT).MethodsWe 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.ResultsOf 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).ConclusionThis 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.Copyright © 2015 Elsevier Inc. All rights reserved.

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