Steve W Wu1, Thomas Maloney2, Donald L Gilbert3, Stephan G Dixon3, Paul S Horn3, David A Huddleston3, Kenneth Eaton2, Jennifer Vannest4. 1. Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA. Electronic address: steve.wu@cchmc.org. 2. Cincinnati Children's Hospital Medical Center, Division of Radiology, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA. 3. Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA. 4. Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA; Cincinnati Children's Hospital Medical Center, Division of Radiology, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA.
Abstract
BACKGROUND: Open label studies have shown repetitive transcranial magnetic stimulation to be effective in reducing tics. OBJECTIVES: To determine whether 8 sessions of continuous theta burst stimulation (cTBS) over supplementary motor area (SMA) given over 2 days may reduce tics and motor cortical network activity in Tourette syndrome/chronic tic disorders. METHODS: This was a randomized (1:1), double-blind, sham-controlled trial of functional MRI (fMRI)-navigated, 30 Hz cTBS at 90% of resting motor threshold (RMT) over SMA in 12 patientsages 10-22 years. Comorbid ADHD (n = 8), OCD (n = 8), and stable concurrent medications (n = 9) were permitted. Neuro-navigation utilized each individual's event-related fMRI signal. Primary clinical and cortical outcomes were: 1) Yale Global Tic Severity Scale (YGTSS) at one week; 2) fMRI event-related signal in SMA and primary motor cortex (M1) during a finger-tapping motor task. RESULT: Baseline characteristics were not statistically different between groups (age, current tic/OCD/ADHD severities, tic-years, number of prior medication trials, RMT). Mean YGTSS scores decreased in both active (27.5 ± 7.4 to 23.2 ± 9.8) and sham (26.8 ± 4.8 to 21.7 ± 7.7) groups. However, no significant difference in video-based tic severity rating was detected between the two groups. Two-day post-treatment fMRI activation during finger tapping decreased significantly in active vs. sham groups for SMA (P = 0.02), left M1 (P = 0.0004), and right M1 (P < 0.0001). No serious adverse events occurred. CONCLUSION: Active, fMRI-navigated cTBS administered in 8 sessions over 2 days to the SMA induced significant inhibition in the motor network (SMA, bilateral M1). However, both groups on average experienced tic reduction at 7 days. Larger sample size and protocol modifications may be needed to produce clinically significant tic reduction beyond placebo effect.
RCT Entities:
BACKGROUND: Open label studies have shown repetitive transcranial magnetic stimulation to be effective in reducing tics. OBJECTIVES: To determine whether 8 sessions of continuous theta burst stimulation (cTBS) over supplementary motor area (SMA) given over 2 days may reduce tics and motor cortical network activity in Tourette syndrome/chronic tic disorders. METHODS: This was a randomized (1:1), double-blind, sham-controlled trial of functional MRI (fMRI)-navigated, 30 Hz cTBS at 90% of resting motor threshold (RMT) over SMA in 12 patients ages 10-22 years. Comorbid ADHD (n = 8), OCD (n = 8), and stable concurrent medications (n = 9) were permitted. Neuro-navigation utilized each individual's event-related fMRI signal. Primary clinical and cortical outcomes were: 1) Yale Global Tic Severity Scale (YGTSS) at one week; 2) fMRI event-related signal in SMA and primary motor cortex (M1) during a finger-tapping motor task. RESULT: Baseline characteristics were not statistically different between groups (age, current tic/OCD/ADHD severities, tic-years, number of prior medication trials, RMT). Mean YGTSS scores decreased in both active (27.5 ± 7.4 to 23.2 ± 9.8) and sham (26.8 ± 4.8 to 21.7 ± 7.7) groups. However, no significant difference in video-based tic severity rating was detected between the two groups. Two-day post-treatment fMRI activation during finger tapping decreased significantly in active vs. sham groups for SMA (P = 0.02), left M1 (P = 0.0004), and right M1 (P < 0.0001). No serious adverse events occurred. CONCLUSION: Active, fMRI-navigated cTBS administered in 8 sessions over 2 days to the SMA induced significant inhibition in the motor network (SMA, bilateral M1). However, both groups on average experienced tic reduction at 7 days. Larger sample size and protocol modifications may be needed to produce clinically significant tic reduction beyond placebo effect.
Authors: Angeli Landeros-Weisenberger; Antonio Mantovani; Maria G Motlagh; Pedro Gomes de Alvarenga; Liliya Katsovich; James F Leckman; Sarah H Lisanby Journal: Brain Stimul Date: 2014-12-03 Impact factor: 8.955
Authors: Adrienne B Bruce; Weihong Yuan; Donald L Gilbert; Paul S Horn; Hannah S Jackson; David A Huddleston; Steve W Wu Journal: Exp Brain Res Date: 2021-01-18 Impact factor: 1.972
Authors: Yaejee H Hong; Steve W Wu; Ernest V Pedapati; Paul S Horn; David A Huddleston; Cameron S Laue; Donald L Gilbert Journal: Front Hum Neurosci Date: 2015-02-04 Impact factor: 3.169
Authors: Ernest V Pedapati; Donald L Gilbert; Paul S Horn; David A Huddleston; Cameron S Laue; Nasrin Shahana; Steve W Wu Journal: Front Hum Neurosci Date: 2015-02-25 Impact factor: 3.169