Tourette Syndrome (TS) is a complex neuropsychiatric disorder that typically begins in childhood and is characterized by motor and vocal tics—sudden, involuntary movements or sounds. Although symptoms often diminish with age, many individuals experience persistent or severe tics that significantly impair social, academic, and emotional functioning. Standard treatment includes behavioral therapy and medications, but these options can be limited by side effects or insufficient symptom control. In this context, Repetitive Transcranial Magnetic Stimulation (rTMS) is emerging as a promising, non-invasive alternative.

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique that uses magnetic pulses to target specific areas of the cortex. It modulates neural activity by delivering repetitive magnetic fields to regions involved in tic generation, primarily the Supplementary Motor Area (SMA) and the dorsolateral prefrontal cortex (DLPFC)—key areas in the cortico-striatal-thalamo-cortical (CSTC) circuits that are dysregulated in Tourette Syndrome.

• Low-frequency (1 Hz) stimulation tends to reduce cortical excitability and is used to calm overactive motor regions.
• High-frequency stimulation can enhance underactive brain areas, although low-frequency rTMS is most commonly applied for Tourette syndrome.

A growing body of research—including randomized controlled trials (RCTs) and meta-analyses—has examined the effects of rTMS in Tourette Syndrome:

• A meta-analysis found that low-frequency rTMS over the SMA significantly reduced tic severity in children and adults with Tourette Syndrome.
• Neuroimaging studies reveal that the SMA plays a crucial role in tic generation and that modulating its activity may help re-balance the motor circuits disrupted inTourette Syndrome.
• In a randomized controlled trial, patients who underwent 15 sessions of low-frequency rTMS (1 Hz) over the SMA experienced a significant reduction in tic severity after a 3-week open-label extension phase.
• Another study demonstrated that 10 daily sessions of rTMS to the SMA led to sustained improvements in tic symptoms for up to six months.

Repetitive Transcranial Magnetic Stimulation (rTMS) is well-tolerated and safe.The most common side effects include mild scalp discomfort or transient headaches.

Repetitive Transcranial Magnetic Stimulation (rTMS) may be particularly suitable for:

• Patients with treatment-resistant Tourette syndrome
• Individuals who experience side effects from medication
• Patients with comorbid conditions like OCD or ADHD
• Those seeking non-pharmacological interventions

Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising adjunctive therapy for Tourette Syndrome. By modulating cortical excitability, improving motor inhibition, and targeting specific brain circuits, rTMS can reduce the frequency and severity of tics and improve patients' quality of life.