Clinical Research Case Report

Abstract

Objectives: Low frequency (1 Hz) rTMS has been shown to inhibit cortical excitability and has been investigated as a potential therapeutic tool in tic disorders. Mixed results have been obtained in different studies with some studies showing promising results, whereas other studies have found no therapeutic effect. Here we report a young female who failed to have any beneficial effect.

Methods: A 12 year old female has developed motor tics since last two years. On evaluation her Yale Global Tic Severity Scale (YGTSS) score came out to be (46/100) and patient had received adequate trials of risperidone and pimozide and haloperidol. She was found to be also suffering from anxiety disorder. There was family H/O tic disorder in father and sister and OCD in cousin brother who was receiving treatment. All secondary causes of Tic disorders were ruled out.It was decided to be given a trial of low frequency rTMS after discussing all the treatment options with parents and after taking informed consent. The protocol designed was 1Hz, 110%MT, 900 pulses/session, total 20 sessions over 4 weeks to be given B/L over
supplementary motor area. Assessment was done using YGTSS after 5 and 20 sessions. Side effects are routinely monitored with a check list as a treatment protocol.

Results: There was no significant improvement in the symptoms, the scores on YGTSS showed slight decline, with the final score being 40 without any significant side effect. Relevant clinical issues, related to our case and its failure to show therapeutic effect with low frequency rTMS are reviewed and discussed in the report.

Conclusion: rTMS is a non invasive brain stimulation technique which has shown some promise in treating patients with tic disorder but in our patient’s we failed to have any beneficial effect.