Repetitive Transcranial Magnetic Stimulation to Reduce Tics
Condition: Tourette Syndrome
MeSH terms: Tourette Syndrome
Study type: Interventional

Summary: 
      Specific Aim1: Using a paradigm of Transcranial Magnetic Stimulation called Continuous Theta
      Burst Stimulation (cTBS) to reduce tics in Tourette Syndrome subjects

      Hypothesis1: cTBS, compared to sham stimulation, will reduce tic severity by at least 25% as
      measured by the Yale Global Tic Severity Scale

      Specific Aim2: Using cTBS to further understand neural correlates of tic generation

      Hypothesis2: Functional MRI BOLD signal activation pattern will change after cTBS and this
      change will correlate with clinical improvement in tic severity
    

Detailed description: 
      Tourette syndrome (TS) is characterized by multiple motor and phonic tics. Current
      understanding of tic generation is thought involve the cortico-basal-thalamic-cortical
      circuit. At this time, only two medications are FDA-approved for tic treatment, while many
      more are used in an off-label fashion with only partial success. Despite multiple approaches
      for tic suppression, patients with severe tics are often left with inadequate relief.
      Repetitive Transcranial Magnetic Stimulation (RTMS) is a new technology which allows for
      noninvasive stimulation of the brain. In few pilot studies, RTMS reduced tic severity when
      targeting the Supplementary Motor Area (SMA). In this study, we propose to use a specific
      paradigm of RTMS called Continuous Theta Burst Stimulation (cTBS) over SMA to treat pediatric
      and adult patients with tics. We will utilize functional MRI (fMRI) to identify each
      subject's SMA for individualized stimulation. We hypothesize that this stimulation technique
      can reduce tic severity when compared to sham stimulation. This proposal is novel because 1)
      cTBS is offered as a new RTMS paradigm to reduce tics and 2) combination of RTMS and fMRI
      allows us to investigate the effects of cortical stimulation on the neural correlates of tic
      generation.
    

Intervention name(s): Sham Repetitive Transcranial Magnetic Stimulation; Active Repetitive Transcranial Magnetic Stimulation
Intervention type(s): Device; Device
Intervention description(s): Repetitive Transcranial Magnetic Stimulation (RTMS) is a relatively new technology that allows for targeted noninvasive stimulation of the brain. RTMS is currently FDA-cleared for the treatment of refractory depression. It is also used experimentally to treat seizures, spasticity, dystonia and other neuropsychiatric conditions. The Sham intervention uses a sham magnetic coil.; Repetitive Transcranial Magnetic Stimulation (RTMS) is a relatively new technology that allows for targeted noninvasive stimulation of the brain. RTMS is currently FDA-cleared for the treatment of refractory depression. It is also used experimentally to treat seizures, spasticity, dystonia and other neuropsychiatric conditions. The Active intervention uses an active magnetic coil.
Other intervention name(s): rTMS, TBS, TMS; rTMS, TBS, TMS
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: TS; tics; tourette