Cynthia K Kahl1,2, Adam Kirton2,3, Tamara Pringsheim1,2,3, Paul E Croarkin4, Ephrem Zewdie2, Rose Swansburg1,2, James Wrightson3, Lisa Marie Langevin1,2,5, Frank P Macmaster1,2,6. 1. Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 4. Departments of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. 5. Strategic Clinical Network for Neuroscience, Vision, and Rehabilitation, Calgary, Alberta, Canada. 6. Strategic Clinical Network for Addictions and Mental Health, Calgary, Alberta, Canada.
Abstract
AIM: To explore the feasibility and possible effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) delivered to the supplementary motor area (SMA) on tic severity and motor system neurophysiology in children with Tourette syndrome. METHOD: Ten children with Tourette syndrome (eight males, two females; 9-15y) participated in this open-label, phase 1 clinical trial. Treatment consisted of 1800 low-frequency (1Hz) neuronavigated robotic rTMS (100% resting motor threshold) to the SMA, bilaterally for 15 sessions. The primary outcome was a change in Yale Global Tic Severity Scale (YGTSS) total score from baseline to posttreatment. Secondary outcome measures included changes in magnetic resonance spectroscopy metabolite concentrations, TMS neurophysiology measures, TMS motor maps, and clinical assessments (anxiety, depression) from baseline to the end of treatment. RESULTS: The YGTSS score decreased from baseline after treatment (p<0.001; Cohen's d=2.9). All procedures were well-tolerated. INTERPRETATION: Robot-driven, neuronavigated bilateral rTMS of the SMA is feasible in children with Tourette syndrome and appears to reduce tic severity. What this paper adds Repetitive transcranial magnetic stimulation (rTMS) is feasible to use in children with Tourette syndrome. rTMS is tolerated by children with Tourette syndrome. Precise targeting of the supplementary motor area using functional magnetic resonance imaging is also feasible in these children.
AIM: To explore the feasibility and possible effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) delivered to the supplementary motor area (SMA) on tic severity and motor system neurophysiology in children with Tourette syndrome. METHOD: Ten children with Tourette syndrome (eight males, two females; 9-15y) participated in this open-label, phase 1 clinical trial. Treatment consisted of 1800 low-frequency (1Hz) neuronavigated robotic rTMS (100% resting motor threshold) to the SMA, bilaterally for 15 sessions. The primary outcome was a change in Yale Global Tic Severity Scale (YGTSS) total score from baseline to posttreatment. Secondary outcome measures included changes in magnetic resonance spectroscopy metabolite concentrations, TMS neurophysiology measures, TMS motor maps, and clinical assessments (anxiety, depression) from baseline to the end of treatment. RESULTS: The YGTSS score decreased from baseline after treatment (p<0.001; Cohen's d=2.9). All procedures were well-tolerated. INTERPRETATION: Robot-driven, neuronavigated bilateral rTMS of the SMA is feasible in children with Tourette syndrome and appears to reduce tic severity. What this paper adds Repetitive transcranial magnetic stimulation (rTMS) is feasible to use in children with Tourette syndrome. rTMS is tolerated by children with Tourette syndrome. Precise targeting of the supplementary motor area using functional magnetic resonance imaging is also feasible in these children.
Authors: Cynthia K Kahl; Rose Swansburg; Tasmia Hai; James G Wrightson; Tiffany Bell; Jean-François Lemay; Adam Kirton; Frank P MacMaster Journal: J Psychiatry Neurosci Date: 2022-07-06 Impact factor: 5.699
Authors: Cynthia K Kahl; Adrianna Giuffre; James G Wrightson; Adam Kirton; Elizabeth G Condliffe; Frank P MacMaster; Ephrem Zewdie Journal: Physiol Rep Date: 2022-06
Authors: Cynthia K Kahl; Rose Swansburg; Adam Kirton; Tamara Pringsheim; Gabrielle Wilcox; Ephrem Zewdie; Ashley Harris; Paul E Croarkin; Alberto Nettel-Aguirre; Sneha Chenji; Frank P MacMaster Journal: BMJ Open Date: 2021-12-24 Impact factor: 2.692