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Function-Specific Localization in the Supplementary Motor Area: A Potential Effective Target for Tourette Syndrome
Jue Wang1, Juan Yue2, Ye Wang3
1Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China.
CNS Neuroscience & Therapeutics
|February 21, 2025
Summary
Function-specific repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area (SMA) shows promise for treating Tourette
Area of Science:
- Neuroscience
- Neurology
- Medical Imaging
Background:
- Tourette's syndrome (TS) is a neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics.
- The cortico-striato-thalamo-cortical (CSTC) circuit, involving the globus pallidus internus (GPi), is implicated in the pathophysiology of TS.
- Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that can modulate neural activity.
Purpose of the Study:
- To investigate the efficacy of rTMS targeting individualized, function-specific supplementary motor area (SMA) regions for treating Tourette's syndrome (TS).
- To examine the impact of rTMS on functional connectivity (FC) within the GPi-centered CSTC circuit.
- To compare the effectiveness of function-specific SMA targets with conventional SMA targets in TS patients.
Main Methods:
- A randomized longitudinal study involving TS patients and typically developing children (TDC) as controls.
- Individualized SMA targets were identified using functional MRI, and compared with conventional scalp-localized targets.
- TS patients received continuous theta burst stimulation (cTBS) over five consecutive days; clinical efficacy (Yale Global Tic Severity Scale - YGTSS) and GPi functional connectivity were assessed.
Main Results:
- TS patients showed reduced GPi-based functional connectivity at baseline compared to TDC.
- cTBS targeting the left SMA resulted in a ≥30% reduction in YGTSS scores in 4 out of 19 patients.
- Changes in GPi-target FC significantly correlated with YGTSS score reduction, and function-specific targets showed greater modulation than conventional targets.
Conclusions:
- Function-specific SMA targets for cTBS may offer enhanced modulatory effects for TS treatment.
- The left SMA target demonstrated effectiveness within one week of cTBS, suggesting accelerated clinical benefits.
- Combining function-specific SMA-targeted cTBS with standard treatments holds potential for improving TS management.
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