Tourette Syndrome (TS) is a neurodevelopmental disorder characterized
by multiple motor tics and at least one vocal tic. This case report
presents a patient who did not respond adequately to pharmacotherapy,
highlighting the effects of repetitive transcranial magnetic stimulation
(rTMS) and the outcomes of longitudinal follow-up.
The patient is a 25-year-old male with no history of other physical
illnesses. His symptoms began 17 years ago with simple motor tics,
which gradually progressed to include complex motor and vocal tics.
Over time, he also developed irritability and a persistent sense of
impending doom. Clinical evaluation led to diagnoses of Tourette
Syndrome comorbid with generalized anxiety disorder.
Pharmacological treatment included escitalopram (10 mg/day),
followed sequentially by pimozide (4 mg/day), tetrabenazine (3*25
mg/day), and aripiprazole (10 mg/day). Pimozide and aripiprazole
showed no effect on the tics, and tetrabenazine was discontinued due to
intolerable gastrointestinal side effects. Escitalopram, which effectively
managed the patient’s anxiety, was continued at 10 mg/day.
The patient then underwent 40 sessions of rTMS over eight weeks,
targeting the bilateral supplementary motor area. Each session consisted
of 1 Hz stimulation at 110% of the resting motor threshold, delivering
1200 stimuli per day over 20 minutes, five days a week. Following the
treatment, significant improvements were observed: a 75% reduction
in the general functionality score and a 59.7% reduction in the total tic
severity score.
This report suggests that rTMS may be a promising alternative for TS
patients with psychiatric comorbidities, particularly those who cannot
tolerate medications or achieve sufficient symptom control through
pharmacotherapy alone.
Keywords: Tourette’s Syndrome, Repetitive Transcranial Magnetic
Stimulation, Supplementary Motor Area