Cathodal Transcranial Direct Current Stimulation to Ameliorate the Frequency and Severity of Motor Tics: A Case Study of Tourette Syndrome

Document Type : Case Study

Authors

DANA Brain Health Institute, Shiraz, Iran.

10.32598/jamsat.4.1.21

Abstract

Objectives: Dysregulated neuronal activity in Cortico-Striato-Thalamo-Cortical (CSTC) networks is primarily described as the pathophysiology of Tourette Syndrome (TS). New neuromodulation techniques including noninvasive transcranial Electrical Stimulation (tES) are increasingly considered among potential therapeutic options for TS.Materials and Methods: To test the therapy protocol with transcranial Direct Current Stimulation (tDCS) a 31 year-old male patient with TS was selected to be administered for 10 sessions over five days of bilateral cathodal tDCS (30 minutes, 2 mA) on C3 and FC5, while the anode electrodes were placed on FP2.Results: Tic severity and frequency were subjectively reported by the subject following the treatment on weekly basis and treatment response was objectively assessed by two experts. The patient noted that he was able to control his unwanted movement after over one year follow-up.Discussion: The current study results together with earlier reports support the therapeutic effects of cathodal tDCS on tics in patients with TS. Randomized sham-controlled studies are required to shed more light on such therapeutic impact and the optimized protocols.

Keywords


  1. Albin RL, Mink JW. Recent advances in Tourette Syndrome research. Trends in Neurosciences. 2006; 29(3):175-82. [DOI:10.1016/j.tins.2006.01.001] [PMID]
  2. Association AP. Diagnostic and Statistical Manual of mental disorders (DSM-5®). Philadelphia: American Psychiatric Association; 2013. [DOI:10.1176/appi.books.9780890425596]
  3. Knight T, Steeves T, Day L, Lowerison M, Jette N, Pringsheim T. Prevalence of tic disorders: A systematic review and meta-analysis. Pediatric Neurology. 2012; 47(2):77-90. [DOI:10.1016/j.pediatrneurol.2012.05.002] [PMID]
  4. Kompoliti K, Verhagen L. Encyclopedia of movement disorders. Cambridge: Academic Press; 2010. [PMID]
  5. Perera H, Abayanayaka C. Management of severe pediatric Tourette Syndrome resistant to drug treatment. Case Reports in Psychiatry. 2012; 2012:497160. [DOI:10.1155/2012/497160]
  6. Lin H, Katsovich L, Ghebremichael M, Findley DB, Grantz H, Lombroso PJ, et al. Psychosocial stress predicts future symptom severities in children and adolescents with Tourette Syndrome and/or obsessive‐compulsive disorder. Journal of Child Psychology and Psychiatry. 2007; 48(2):157-66. [DOI:10.1111/j.1469-7610.2006.01687.x] [PMID] [PMCID]
  7. Leckman JF, Cohen DJ. Tourette’s syndrome--tics, obsessions, compulsions: Developmental psychopathology and clinical care. Hoboken: John Wiley & Sons; 1999.
  8. Simpson HA, Jung L, Murphy TK. Update on Attention-Deficit/Hyperactivity Disorder and tic disorders: A review of the current literature. Current Psychiatry Reports. 2011; 13(5):351-6. [DOI:10.1007/s11920-011-0223-1] [PMID]
  9. Eddy CM, Cavanna AE. Tourette Syndrome and obsessive compulsive disorder: Compulsivity along the continuum. Journal of Obsessive-Compulsive and Related Disorders. 2014; 3(4):363-71. [DOI:10.1016/j.jocrd.2014.04.003]
  10. Waldon K, Hill J, Termine C, Balottin U, Cavanna AE. Trials of pharmacological interventions for Tourette Syndrome: A systematic review. Behavioural Neurology. 2013; 26(4):265-73. [DOI:10.1155/2013/626410] [PMID] [PMCID]
  11. Quezada J, Coffman KA. Current approaches and new developments in the pharmacological management of Tourette Syndrome. CNS Drugs. 2018; 32(1):33-45. [DOI:10.1007/s40263-017-0486-0] [PMID] [PMCID]
  12. Eapen V, Baker R, Walter A, Raghupathy V, Wehrman JJ, Sowman PF. The role of transcranial Direct Current Stimulation (tDCS) in Tourette Syndrome: A review and preliminary findings. Brain Sciences. 2017; 7(12):161. [DOI:10.3390/brainsci7120161] [PMID] [PMCID]
  13. Mrakic Sposta S, Marceglia S, Mameli F, Dilena R, Tadini L, Priori A. Transcranial direct current stimulation in two patients with Tourette Syndrome. Movement Disorders Journal. 2008; 23(15):2259-61. [DOI:10.1002/mds.22292] [PMID]
  14. Carvalho S, Gonçalves ÓF, Soares JM, Sampaio A, Macedo F, Fregni F, et al. Sustained effects of a neural-based intervention in a refractory case of Tourette Syndrome. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation. 2015; 8(3):657-9. [DOI:10.1016/j.brs.2014.12.008] [PMID]
  15. Behler N, Leitner B, Mezger E, Weidinger E, Musil RL, Blum B, et al. Cathodal tDCS over motor cortex does not improve Tourette Syndrome: Lessons learned from a case series. Frontiers in Behavioral Neuroscience. 2018; 12:194. [DOI:10.3389/fnbeh.2018.00194] [PMID] [PMCID]