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Tic Disorders & tDCS

Tourette syndrome and tic disorders are a neurodevelopmental disorder found in approximately 1% of 5–18 years old, with the expression in males five times more common than females. The tics, which are repetitive, can occur many times throughout the day, and can have both stereotyped movements and/or short vocalizations. Tic disorders may cause physical pain or cause injury due to their strong and repetitive nature. Tic disorders can also increase emotional stress from unwanted attention in social settings. Tics can affect social engagements including schooling and opportunities for employment and thus result in low self-esteem, mood and anxiety disorders, and poor academic performance. 

Tic disorders are often found present in children diagnosed with PANDAS/PANS and improve as clinically appropriate treatment is applied. Evaluation of immune disorders as a cause of tics should include infections, toxins, autoimmunity, and allergens. Additional evidence supports brain stimulation techniques for a variety of neurological disorders such as depression, anxiety, ADHD, and even Autism. Transcranial Direct Current Stimulation (tDCS) is also reported in literature and case studies to have potential in reducing excessive brain activity in the supplementary motor area (SMA) leading to a reduction in symptoms. Larger scale studies are needed to determine the maintenance of symptom improvement over time, but due to its generally safety and flexibility with home use it is worth considering as an early intervention. tDCS sessions last 20 minutes are easily implemented in a flexible at home therapy that is very safe and convenient.

Improve Overall Function

  • Reduce verbal tics
  • Reduces physical tics
  • Reduces social withdrawal
  • Reduces irritability and agitation
  • Reduces hyperactivity
  • Enhances response to other therapies like NFB and HBOT

REFERENCE

  1. Jessica Frey and Irene A. Malaty. Tourette Syndrome Treatment Updates: a Review and Discussion of the Current and Upcoming Literature. Curr Neurol Neurosci Rep. 2022; 22(2): 123–142. Published online 2022 Feb 2. doi: 10.1007/s11910-022-01177-8. PMID: 35107785. PMCID: PMC8809236
  2. Chih-Yi Chou, Julian Agin-Liebes, and Sheng-Han Kuoa. Emerging therapies and recent advances for Tourette syndrome. Heliyon. 2023 Jan; 9(1): e12874.Published online 2023 Jan 7. doi: 10.1016/j.heliyon.2023.e12874. PMID: 36691528. PMCID: PMC9860289
  3. Katherine Dyke et al; Non-invasive brain stimulation as therapy: systematic review and recommendations with a focus on the treatment of Tourette syndrome. Exp Brain Res. 2022; 240(2): 341–363. Published online 2021 Oct 13. doi: 10.1007/s00221-021-06229-y.PMID: 34643763. PMCID: PMC8858270
  4. Giordano D’Urso et al; Cerebellar Transcranial Direct Current Stimulation in Children with Autism Spectrum Disorder: A Pilot Study on Efficacy, Feasibility, Safety, and Unexpected Outcomes in Tic Disorder and Epilepsy. J Clin Med. 2021 Dec 28;11(1):143. doi: 10.3390/jcm11010143. PMID: 35011884. PMCID: PMC8745597
  5. Katherine Dyke et al; Effects of single-session cathodal transcranial direct current stimulation on tic symptoms in Tourette’s syndrome. Exp Brain Res. 2019 Nov;237(11):2853-2863. doi: 10.1007/s00221-019-05637-5. Epub 2019 Aug 28. PMID: 31463531. PMCID: PMC6794240
  6. Valsamma Eapen et al; The Role of Transcranial Direct Current Stimulation (tDCS) in Tourette Syndrome: A Review and Preliminary Findings. Brain Sci. 2017 Dec; 7(12): 161. Published online 2017 Dec 8. doi: 10.3390/brainsci7120161. PMID: 29292730. PMCID: PMC5742764
  7. Robertson MM, Eapen V, Cavanna AE. The international prevalence, epidemiology, and clinical phenomenology of Tourette syndrome: a cross-cultural perspective. J Psychosom Res. 2009;67(6):475–483. doi: 10.1016/j.jpsychores.2009.07.010. PMID: 19913651

Study:  Cerebellar Transcranial Direct Current Stimulation in Children with Autism Spectrum Disorder: A Pilot Study on Efficacy, Feasibility, Safety, and Unexpected Outcomes in Tic Disorder and Epilepsy.

Patients with autism spectrum disorder (ASD) display distinctive neurophysiological characteristics associated with significant cognitive, emotional, and behavioral symptoms. Transcranial direct current stimulation (tDCS) applied to the frontal or temporoparietal lobes has demonstrated potential to reduce the severity of ASD-related symptoms. Recently, the cerebellum has been identified as a brain area involved in ASD pathophysiology. In this open-label pilot study, seven ASD patients aged between 9 and 13 years underwent 20 daily sessions of 20 min cathodal stimulation of the right cerebellar lobe. At the end of the treatment, the Aberrant Behavior Checklist (ABC) scores showed a 25% mean reduction in global severity of symptoms, with a more pronounced reduction in the “social withdrawal and lethargy” (-35%), “hyperactivity and noncompliance” (-26%), and “irritability, agitation, and crying” (-25%) subscales. Minor and no improvement were observed in the “stereotypic behavior” (-18%) and “inappropriate speech” (-0%) subscales, respectively. Improvements were not detected in the two patients who were taking psychotropic drugs during the study. Clinical response showed a symptom-specific time course. Quality of sleep and mood improved earlier than hyperactivity and social withdrawal. The treatment was generally accepted by patients and well tolerated. No serious adverse events were reported. Stimulation also appeared to markedly reduce the severity of tics in a patient with comorbid tic disorder and led to the disappearance of a frontal epileptogenic focus in another patient with a history of seizures. In conclusion, cerebellar tDCS is safe, feasible, and potentially effective in the treatment of ASD symptoms among children. Strategies to improve recruitment and retention are discussed.

REFERENCE

Giordano D’Urso et al; Cerebellar Transcranial Direct Current Stimulation in Children with Autism Spectrum Disorder: A Pilot Study on Efficacy, Feasibility, Safety, and Unexpected Outcomes in Tic Disorder and Epilepsy. J Clin Med. 2021 Dec 28;11(1):143. doi: 10.3390/jcm11010143. PMID: 35011884. PMCID: PMC8745597

These statements have not been evaluated or approved by the FDA. All of the statements made on this document are not anecdotal and have been taken directly from clinical data.