Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPLANDEROS-WEISENBERGER, AngeliMANTOVANI, AntonioMOTLAGH, Maria G.ALVARENGA, Pedro Gomes deKATSOVICH, LiliyaLECKMAN, James F.LISANBY, Sarah H.2015-10-262015-10-262015BRAIN STIMULATION, v.8, n.3, p.574-581, 20151935-861Xhttps://observatorio.fm.usp.br/handle/OPI/11859Background: A small proportion of individuals with Tourette syndrome (TS) have a lifelong course of illness that fails to respond to conventional treatments. Open label studies have suggested that low frequency (1-Hz) repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area (SMA) may be effective in reducing tic severity. Objective/Hypothesis: To examine the efficacy of rTMS over the SMA for TS in a randomized double-blind sham-controlled trial (RCT). Methods: We conducted a two-site RCT-rTMS with 20 adults with severe TS for 3 weeks. Treatment consisted of 15 sessions (1-Hz; 30 min; 1800 pulses per day) of active or sham rTMS at 110% of the motor threshold over the SMA. A subsequent 3 week course of active rTMS treatment was offered. Results: Of the 20 patients (16 males; mean age of 33.7 + 12.2 years), 9 received active and 11 received sham rTMS. After 3 weeks, patients receiving active rTMS showed on average a 17.3% reduction in the YGTSS total tic score compared to a 13.2% reduction in those receiving sham rTMS, resulting in no statistically significant reduction in tic severity (P = 0.27). An additional 3 week open label active treatment for those patients (n = 7) initially randomized to active rTMS resulted in a significant overall 29.7% reduction in tic severity compared to baseline (P = 0.04). Conclusion: This RCT did not demonstrate efficacy of 3-week SMA-targeted low frequency rTMS in the treatment of severe adult TS. Further studies using longer or alternative stimulation protocols are warranted.engrestrictedAccessTourette syndromeTranscranialMagnetic stimulationRandomized controlled trialobsessive-compulsive disordersupplementary motor area1 hz rtmseuropean clinical guidelinescerebral-blood-flowtic disordersfunctional mriscaleinhibitioncortexarticleCopyright ELSEVIER SCIENCE INC10.1016/j.brs.2014.11.015Clinical NeurologyNeurosciences1876-4754