Landeros-Weisenberger Angeli, Mantovani Antonio, Motlagh Maria G, de Alvarenga Pedro Gomes, Katsovich Liliya, Leckman James F, Lisanby Sarah H
Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
Department of Physiology, Pharmacology & Neuroscience, Sophie Davis School of Biomedical Education, City University of New York, NY, USA; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA.
Brain Stimul. 2015 May-Jun;8(3):574-81. doi: 10.1016/j.brs.2014.11.015. Epub 2014 Dec 3.
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).
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.
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).
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.
一小部分患有抽动秽语综合征（TS）的个体病程漫长，对传统治疗无反应。开放标签研究表明，针对辅助运动区（SMA）的低频（1赫兹）重复经颅磁刺激（rTMS）可能有效减轻抽动严重程度。
目的/假设：在一项随机双盲假对照试验（RCT）中检验rTMS作用于SMA治疗TS的疗效。
我们对20名重度TS成年患者进行了一项双中心RCT-rTMS研究，为期3周。治疗包括在SMA运动阈值的110%进行15次（1赫兹；30分钟；每天1800次脉冲）的主动或假rTMS治疗。随后提供为期3周的主动rTMS治疗疗程。
20名患者（16名男性；平均年龄33.7±12.2岁）中，9名接受主动rTMS，11名接受假rTMS。3周后，接受主动rTMS的患者YGTSS总抽动评分平均降低17.3%，而接受假rTMS的患者降低13.2%，抽动严重程度无统计学显著降低（P = 0.27）。最初随机分配接受主动rTMS的患者（n = 7）额外接受3周开放标签主动治疗后，与基线相比，抽动严重程度总体显著降低29.7%（P = 0.04）。
这项RCT未证明为期3周的以SMA为靶点的低频rTMS对重度成年TS患者的治疗效果。有必要开展使用更长疗程或替代刺激方案的进一步研究。
