Table 2.
Summary of rTMS stimulation parameters and results for patients with TS
| Study | Number of patients | Brain target | Frequency | Intensity | Total daily pulses | Number of days | Number of sessions per day | Total pulses | Main findings |
|---|---|---|---|---|---|---|---|---|---|
| Munchau 2002[139] | N = 12; crossover design to 2 different active and 1 sham condition | PMC or MC | 1 Hz | 80% AMT | 1,200 | 2 per condition | 1 | 4,800 active stimuli; 2,400 sham stimuli | No significant improvement in MOVES score |
| Chae 2004[132] | N = 8; crossover design to four different active and 1 sham condition | PFC or MC | 1 Hz or 15 Hz at each target site | 110% RMT | 2,400 | 5 | 1 | 9,600 active stimuli; 2,400 sham stimuli | YGTSS decreased by 24% over the 5 days of stimulation; no difference between target site or frequency; larger improvement in active conditions compared to sham, but this was not statistically significant |
| Orth 2005[140] | N = 5; crossover design to three different stimulation conditions | L PMC followed by R PMC; L PMC followed by sham; sham followed by sham | 1 Hz | 80% AMT | 1,800 | 2 | 2 | 5,400 active stimuli; 5,400 sham stimuli | No significant different in YGTSS, MOVES, or video-rated tic scores following active or sham stimulation |
| Mantovani 2006[137] | N = 10; open-label study | SMA | 1 Hz | 100% RMT | 1,200 | 10 | 1 | 12,000 | Significant improvement in YGTSS, Y-BOCS, HDRS, HARS scores following active stimulation, maintained at 3-month follow-up |
| Mantovani 2007[138] | N = 2; open-label study | SMA | 1 Hz | 110% RMT | 1,200 | 10 | 1 | 12,000 | Significant improvement in YGTSS scores following active stimulation; one patient required booster treatment sessions due to relapse in symptoms |
| Lim 2009[16] | N = 8; open-label study | SMA | 1 Hz | 100% RMT | 1,200 | 5 | 1 | 6,000 | Significant reduction in YGTSS following active stimulation, maintained at 8-week follow-up |
| Kwon 2011[134] | N = 10; open-label study | SMA | 1 Hz | 100% RMT | 1,200 | 10 | 1 | 12,000 | Significant improvement in YGTSS following active stimulation, maintained at 12-week follow-up |
| Le 2013[136] | N = 25; open-label study | SMA | 1 Hz | 110% RMT | 1,200 | 20 | 1 | 24,000 | Significant improvement in YGTSS, ADHD scores, and anxiety following active stimulation, maintained at 6-month follow-up |
| Wu 2014[141] | N = 12; randomized to active vs. sham | SMA | 30 Hz cTBS | 90% RMT | 4,800 | 2 | 8 | 9,600 | Significant reduction in YGTSS scores following stimulation but no significant difference between active and sham stimulation |
| Landeros-Weisenberger 2015[135] | N = 20; randomized to active vs. sham | SMA | 1 Hz | 110% RMT | 1,800 | 15 | 1 | 27,000 | Significant reduction in YGTSS score during the 3-week open-label phase; however, no significant difference in YGTSS score between active and sham stimulation |
| Bloch 2016[145] | N = 12; open-label study | SMA | 1 Hz using H-coil | 110% | 2,400 | 20 | 1 | 24,000 | No significant improvement in tic severity as a whole, but in patients with TS-OCD there was tic improvement following stimulation |
| Singh 2018[146] | N = 3; open-label study | SMA | 1 Hz | 110% RMT | 900 | 20 | 1 | 18,000 | Significant improvement in YGTSS and Y-BOCS scores in patients with TS-OCD phenotype; however no significant improvement in patient with TS only |
| Fu 2021[142] | N = 30; randomized to active vs. sham stimulation | Bilateral parietal cortex | 0.5 Hz | 90% RMT | 2,400 divided equally to each side | 10 | 1 | 24,000 | Significant improvement in YGTSS, MRVBTS, and PUTS scores in the active treatment group compared to sham, which was maintained at 1-month follow-up |
| Kahl 2021[133] | N = 10; open-label study | SMA | 1 Hz | 100% RMT | 1,200 | 15 | 1 | 18,000 | Significant improvement in YGTSS following stimulation; maintained at 4-week follow-up |
Key: AMT, active motor threshold; HARS, Hamilton Anxiety Rating Scale; HDRS, Hamilton Depression Rating Scale; MC, motor cortex; MOVES, Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey; PMC, premotor cortex; RMT, resting motor threshold; SMA, supplementary motor area; Y-BOCS, Yale-Brown Obsessive–Compulsive Scale; YGTSS, Yale Global Tic Severity Score