Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 24:12:194.
doi: 10.3389/fnbeh.2018.00194. eCollection 2018.

Cathodal tDCS Over Motor Cortex Does Not Improve Tourette Syndrome: Lessons Learned From a Case Series

Nora Behler  1 , Bianka Leitner  1 , Eva Mezger  1 , Elif Weidinger  1 , Richard Musil  1 , Bernhard Blum  1   2 , Beatrice Kirsch  1 , Linda Wulf  1   3 , Lisa Löhrs  1 , Christine Winter  4 , Frank Padberg  1 , Ulrich Palm  1
Affiliations

Cathodal tDCS Over Motor Cortex Does Not Improve Tourette Syndrome: Lessons Learned From a Case Series

Nora Behler et al. Front Behav Neurosci. .

Abstract

Introduction: Current pathophysiological hypotheses of Gilles de la Tourette Syndrome (GTS) refer to temporally abnormal neuronal activation in cortico-striato-thalamo-cortical (CSTC) networks. Modifying cortical activity by non-invasive brain-stimulation appears to be a new treatment option in GTS. Background: Previous studies suggested therapeutic effects of cathodal transcranial direct current stimulation (tDCS) to pre-supplementary motor areas (SMA), however, treatment modalities concerning electrode placement, current intensity and stimulation-rate have not been systematically explored. Aim of this study was to assess efficacy of an alternative stimulation regime on GTS symptoms in a pilot study. To test a treatment protocol with tDCS twice a day, we administered 10 sessions over 5 days of bilateral cathodal tDCS (30 min, 2 mA) over the pre-SMA in three patients with severe GTS. Tic severity as well as obsessive-compulsive (OC) symptoms and affective scales were rated before and after tDCS treatment. Discussion: Only one out of three patients showed a 34.5% reduction in tic severity. The two other patients showed an increase in tic severity. All patients showed a mild increase in positive affect and a reduction in negative affect, OC symptom changes were heterogeneous. Our results do not support earlier findings of extensive therapeutic effects of cathodal tDCS on tics in patients with GTS and show that prediction of stimulation effects on a targeted brain area remains inaccurate. Concluding Remarks: Future research will have to focus on the determination of most effective stimulation modes regarding site, polarity and frequency of tDCS in GTS patients.

Keywords: GTS; OCD; obsessive compulsive disorder; supplementary motor areas; tDCS; tourette syndrome; transcranial direct current stimulation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Dorsal lateral view (A) and lateral view (B; Soterix Medical HD-Explore™). Cathodal electrodes (7 × 5 cm = 35 cm2) were placed bilaterally over (pre-)motor cortical areas (C3, C4) with 1 cm space in between. Anodal electrodes were placed ipsilateral over the sternocleidomastoid muscle. Current strength of 2 mA was applied for 30 min.
Figure 2
Figure 2
Yale Global Tic Severity Scale (YGTSS) scores of patients 1–3. x-axis shows measuring time points, y-axis shows YGTSS score.
See this image and copyright information in PMC

References

    1. Batsikadze G., Moliadze V., Paulus W., Kuo M.-F., Nitsche M. A. (2013). Partially non-linear stimulation intensity-dependent effects of direct current stimulation on motor cortex excitability in humans. J. Physiol. 591, 1987–2000. 10.1113/jphysiol.2012.249730 - DOI - PMC - PubMed
    1. Bikson M., Grossman P., Thomas C., Zannou A. L., Jiang J., Adnan T., et al. . (2016). Safety of transcranial direct current stimulation: evidence based update 2016. Brain Stimul. 9, 641–661. 10.1016/j.brs.2016.06.004 - DOI - PMC - PubMed
    1. Brunoni A. R., Moffa A. H., Fregni F., Palm U., Padberg F., Blumberger D. M., et al. . (2016). Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data. Br. J. Psychiatry 208, 522–531. 10.1192/bjp.bp.115.164715 - DOI - PMC - PubMed
    1. Brunoni A. R., Nitsche M. A., Bolognini N., Bikson M., Wagner T., Merabet L., et al. . (2012). Clinical research with transcranial direct current stimulation (tDCS): challenges and future directions. Brain Stimul. 5, 175–195. 10.1016/j.brs.2011.03.002 - DOI - PMC - PubMed
    1. Brunoni A. R., Valiengo L., Baccaro A., Zanão T. A., de Oliveira J. F., Goulart A., et al. . (2013). The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry 70, 383–391. 10.1001/2013.jamapsychiatry.32 - DOI - PubMed

LinkOut - more resources