Prospective Investigation Into Effects Of Repetitive Transcranial Magnetic Stimulation On The Children With Tourette Syndrome

Objective:To investigate the long-term efficacy of repetitive transcranial magneticstimulation (rTMS) to the supplementary motor area (SMA) in children withTourette Syndrome (TS).Methods:1. Twenty-five subjects (22boys and3girls) who were diagnosed asTS for1-6.5years were recruited in our study, aged between7.2-15.4.2. Subjects treated with rTMS to the SMA for20daily sessions at afrequency of1Hz, intensity of110%of resting motor threshold(RMT).3. The left and right hemisphere RMTs were examined at three timepoints: before treatment,2weeks and4weeks after treatment. Theassessments of Yale Global Tic Severity Scale(YGTSS),ClinicalGlobal Impression(CGI），Swanson, Nolan, and Pelham, versionIV scale for AHDH(SNAP-IV)，Kovacs Children’s Depression Inventory (CDI), Spence Children’s Anxiety Scale (SCAS) andAttention test (error rate) were conducted at five different timepoints: before treatment,2weeks,4weeks,3months and6monthsafter treatment.Results:1. Except a boy had mild sleepiness, the rest of the24cases did notshow serious side effects, suggesting that the rTMS had good safetyand tolerance. The clinical symptoms in19subjects were improvedafter treatment, and the effective rate was76%.2. After two weeks of treatment, the mean scores of YGTSS, CGI,CDI and Attention test(error rate) were significantly decreased, andboth left and right hemispheres RMT was significantly increasedcompared to before treatment (p<0.05).3. Similarly, after four weeks of treatment, the mean scores of YGTSS,CGI, SNAP-IV, SCAS, CDI and Attention test(error rate) weresignificantly decreased, and both left and right hemisphere RMTwas significantly increased compared to before treatment (p<0.05).4. Both of the left and right hemispheres showed no RMT asymmetryduring the treatment.5. In the6months follow-up after treatment, the curative effects of17treated subjects were maintained, and the effective rate was68%.6. In the3months follow-up after treatment, the mean scores of YGTSS, CGI, CDI and SCAS showed no any differences comparedto4weeks of treatment(p>0.05), and the mean scores of SNAP-IVand Attention test(error rate) were significantly decreasedcompared to4weeks of treatment (p <0.05).7. In the6months follow-up after treatment, the mean scores ofYGTSS, CGI and CDI showed no any differences compared to4weeks of treatment(p>0.05), and the mean scores ofSNAP-IV,SCAS and Attention test (error rate) were significantlydecreased compared to4weeks of treatment (p <0.05).Conclusion:1. One Hz rTMS to SMA for four weeks can dramatically improve ticsymptoms in the TS children with poor medication control.2. Compared to10-day treatment,20days’ treatment with rTMS canimprove hyperactivity, depression and inattention symptoms in thelate phase of treatment.3. In this study, benefits from rTMS treatment can last for at least6months in68%of subjects, which improves the life quality of TSchildren and their families. rTMS treatment is an effective and safemethod.4. rTMS improves the symptoms of TS children may be related to thereduction of the cerebral cortex excitability with low-frequencystimulation.