An Exploratory Study of Continuous Theta Burst Stimulation (cTBS) Based on fMRI in the Treatment of Tic Disorder

Study Overview
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Brief Summary
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continuous theta burst stimulation (cTBS) is a safe and effective device for Gilles de la Tourette's syndrome treatment. GPi is an agreed curative target of deep brain stimulation. GPi-based functional connectivity peak voxel in the SMA can be the cTBS target.

Detailed Description
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Tic disorder is a common neuropsychiatric disorder in children and adolescents. Medication is not effective and has side effect. Exploring new treatment methods is one of the research pathway of this disease.Continuous theta burst stimulation (cTBS) is relatively safe and effective, and its efficacy in psychiatric diseases has been gradually recognized. However, the results of current researches of tic disorder treatment are varied, and the evaluation method is relatively single. This project intends to adopt fmri-guided stimulation target and navigated cTBS to intervene patients with tics and explore individualized cTBS treatment parameters of tics, including stimulation frequency, intensity, type, time and stimulation target. Previous studies for deep brain stimulation reported that the medial globus pallidus (GPi) showed an obvious curative effect. And a deep brain area can be modulated indirectly by a superficial target via functional connectivity. Therefore, the present study attempts to stimulate the superficial target in supplementary motor area (SMA), lateral motor area (M1) which functionally connected with GPi or thalamus since the thalamus also a commonly reported abnormal brain area of Tic. Combined with clinical symptoms and neuroimaging, the therapeutic effect of cTBS in children with tic disorder was comprehensively evaluated in order to provide a new therapeutic method and a better therapeutic effect for the disease.

Official Title
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An Exploratory Study of Continuous Theta Burst Stimulation (cTBS) Based on Functional Magnetic Resonance Imaging (fMRI) in the Treatment of Tic Disorder

Conditions
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Tic Disorders, Tourette Syndrome

Intervention / Treatment
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* Device: traditional stimulation site continuous theta burst stimulation (cTBS)
* Device: precise stimulation site cTBS


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: meet the diagnostic criteria of chronic tic disorder or tourette syndrome; Yale Global Tic Severity Scale (YGTSS) score is greater than 20; the symptoms lasted more than 1 year, and the drug regimen was not adjusted within one month; right-handedness; age 6-20 years; able to receive continuous theta burst stimulation (cTBS) therapy, participants and their guardians agree to receive treatment and observation. Exclusion Criteria: age is under 6-year old; can not tolerate MRI or cTBS treatment; adjust medication during treatment.

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: first group is traditional stimulation site group ,second group is precise position stimulation group .
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: traditional stimulation site continuous theta burst stimulation (cTBS)<br>arm: experimental: performing cTBS to tic patients for continuous 5 days ,3 times for a day (0 minute ,15 minute ,60 minute). The stimulation site include left supplementary motor area, right supplementary motor area, left primary motor area, right primary motor area , left superior parietal lobule, right superior parietal lobule. Determination of stimulation target is a common method of determination in previous studies. For example the vertex (Cz) was measured for each patient and the SMA defined at 15% of the distance between inion and nasion anterior to Cz on the sagittal midline. | Device: traditional stimulation site continuous theta burst stimulation (cTBS)<br>* before cTBS treatment, MRI was used to confirm the stimulation site<br>|
| Experimental: precise stimulation site cTBS<br>arm: experimental: performing cTBS to tic patients for 5 days ,3 times for a day (0 minute ,15 minute ,60 minute). The stimulation site include left supplementary motor area, right supplementary motor area, left primary motor area, right primary motor area , left superior parietal lobule, right superior parietal lobule. The stimulation target is determined by the resting-state functional connectivity, which is robust functional connectivity with the GPi or Thalamus. | Device: precise stimulation site cTBS<br>* before cTBS treatment, rs-fMRI was used to confirm the stimulation site<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Yale Global Tic Severity Scale score | to evaluate clinical change | 5 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| fMRI | local neural activity; functional connectivity | 1 day, 5 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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continuous theta burst stimulation (cTBS), fMRI