Objective: To determine if accelerated repetitive transcranial magnetic stimulation (rTMS) administered prior to Comprehensive Behavioral Intervention for Tics (CBIT) will improve tics in Tourette Syndrome (TS) adults.

Background: Up to 20% of individuals with TS manifest persistent impairing tics during adulthood. CBIT may only reduce tics by 40%. rTMS targeting the supplementary motor area (SMA) has shown tic reduction and may have synergistic effects when added prior to CBIT.

Method: Patients with TS ≥ 18 years and moderate tics (Yale Global Tic Severity Scale (YGTSS) ≥ 20) were randomized to active vs sham 1-Hz rTMS, targeting the SMA at 110% resting motor threshold with 6 trains of 5-min pulses with a 1-min intertrain interval for 1800 pulses/session. Participants received 4 sessions/day for 4 days followed by 10 weeks of CBIT. Primary outcomes included YGTSS and modified Rush Videotape Tic Rating Scale (mRVTRS). Secondary outcomes included Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Adult ADHD Self-Reports Scale (ASRS), the Gilles de la Tourette Syndrome–Quality of Life scale (GTS-QOL), and fMRI. Outcomes were measured at baseline (T0), post-rTMS (T1), and post-CBIT (T2).

Results: Participants (N=5) were randomized to active (N=4) or sham (N=1) rTMS. There were 3/5 female participants; mean age = 38.6 years; ave. age at tic onset = 5.2 years. rTMS was well-tolerated without significant adverse events. Following active rTMS, there was a trend toward clinical improvement in YGTSS total tic (T0: 30.5; T1: 22.3; p=0.09) and global severity scores (T0: 55.5; T1: 37.3; p=0.07), and mRVTRS scores (T0: 11.3; T1: 7.8; p=0.218). There was no statistical difference between active and sham rTMS. A trend toward clinical improvement was observed in secondary outcomes following active rTMS: BDI (T0: 17.75, T1: 14.5, p=0.522); BAI (T0: 14.25, T1: 10.75, p=0.379), Y-BOCS (T0: 14.5, T1: 12.75, p=0.391), ASRS (T0: 50.75, T1: 43.75, p=0.232), GTS-QOL (T0: 56.25, T1: 61, p=0.551). Post-CBIT outcome and fMRI analysis are ongoing.

Conclusion: There are 5-10 additional participants anticipated for enrollment. Accelerated rTMS + CBIT to date was safe and well-tolerated. This study will determine whether active rTMS will significantly reduce tics compared to a sham intervention.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/stop-tic-study-strengthening-tourette-treatment-options-using-tms-to-improve-cbit-a-randomized-sham-controlled-trial/