Brain stimulation with tDCS shows helpful and lasting effects in Tourette syndrome, tics and other impulse control problems, but not in everyone. Individual testing and simply “trying it out” will probably be the solution.
This article is Evidence Level 4 – just a couple of research notes, I just had the mother of a Tourettes child in the office and I was interested if there are any studies regarding physical treatment on the brain as an option.
“Try out” brain stimulation?
We’re currently seeing with multiple sclerosis patients (really impressive effects – I now also have an Austrian testimonial that I can show) and also Parkinson’s patients (incredibly quick effects, but they don’t last very long). hold) that the “neurovascular coupling” of brain stimulation may be one of the main factors why you get an improvement. Maybe a “neuroglymphatic coupling” in MS too?
These diseases give us “brain-side issue problems” – we cannot predict with certainty from our neurological examination whether stimulation of the ipsilateral or contralateral brain hemisphere will bring about improvement.
However, we see noticeable changes in 15-30 minutes, and if they don’t happen, we switch to the stimulated side and then possibly get better results.
In 30% of cases you don’t get a result, says Dr. Petros, even with prolonged treatment.
If you are physician and want to be trained in this method please consult this website: https://brain-stimulation.info/en/physicians/waiting-list-en
Even if the examination seems to give clear answers …..
with the examination methods learned from Petros you get the tools to differentiate brainstem and cerebral stimulation as well as to identify the brain region, but the optimal treatment side is not always clear – sometimes we have to stimulate both sides alternately.
That’s why I used the term “try it out”.
Neurovascular coupling: Applying direct current to the head improves blood circulation. Here for colleagues is a lecture by one of the most eminent researchers in this field, Prof. Marom Bikson
2000 studies on Tourette’s and brain stimulation
A certain number of studies are almost euphorically positive: with just a few stimulations there is a lasting improvement in motor tics and impulse control lasting up to6 months strong> stops.
Other studies have again had negative results, even though the treatment conditions appeared to be the same.
–> Here is the link to Scholar
Background of Tourette’s
Motor impulses (=TICs) come from the cortex (cerebral cortex) from the premotor zone (SMA and pre-SMA) and go deep into the motor nuclei (basal ganglia). . Cortical activity comes first, followed by activity in the SMA pathways, as shown by functional tests of the brain. When you inhibit these cortical regions with tDCS, you have fewer motor TICs
Screaming = Disturbance of Self-Control = Impulse control is located in the Prefrontal Cortex (F1)
Information comes from the studies below as well as a special study on brain activity and the influence of tDCS by Univ. Bergen 2023
positive studies
The role of transcranial direct current stimulation (tDCS) in Tourette syndrome: A review and preliminary results
tDCS is a brain stimulation technique that is being studied for a variety of neurological and psychiatric disorders.
Preliminary research suggests that brain stimulation may be useful in treating Tourette syndrome (TS).
In this review, Tourette’s is examined with brain stimulation (positioned over the motor center) in a crossover study:
Patients receive 3 weeks of placebo treatment, then 6 weeks of real treatment or vice versa.
There was a follow-up examination after 3 and 6 months.
During the course of treatment there was a reduction in the frequency and intensity of the patients’ tics and premonitory urges as well as an improvement in the inhibitory function.
Persistent effect of brain stimulation on a “recalcitrant” case of Tourette syndrome
letter2Editor-2014: https://www.brainstimjrnl.com/article/S1935-861X( 14)00445-8/fulltext
Abstract: There are only a few treatment options available for Tourette syndrome (TS). These treatments often do not work in patients with moderate to severe TS.
Neuroimaging studies show a relationship between tic severity and increased activation across motor pathways, along with decreased activation across control areas (Bremser ) of these brain regions.
Furthermore, the temporal pattern of tics shows that cortical activation precedes subcortical activation.
Following this assumption, here we examined the brain effects of10 daily sessions of tDCS brain stimulationadministered to a patient with refractory and severe TS and foundthat changes were long-lasting (up to 6 days). months).
negative studies
Lessons from a case series – 2018
In this 2018 study with 3 patients with severe Tourette syndrome, inhibitory brain stimulation was used on the pre -SMA performed. In one of the patients there was a reduction in motor TICs of around 30% – in the others there was a slight deterioration. In all patients, the mood improved to a positive level and the negative attitude became less.
The compulsive impulses have not really changed as a result of the treatments.
I assume that you need side-specific testing and should probably only inhibit the one hemisphere of the brain that is affected. The compulsive impulses are not controlled from the motor zone, so inhibition there is not a significant factor.
So what does that mean now …..
To be honest, 2000 entries on Scholar regarding brain stimulation for Tourette’s isn’t much, but then again there aren’t many patients. The contradictory study statements with an extremely small sample and short treatment time is not a secure validation for or against this treatment option.
I think an expierienced brain-stimulation office should be able to provide results in a decent time without crazy costs involved – and – there is nothing else anyways available.
By the way
When I search for dTCS and TICs on Scholar, I come across an Italian study from 2021 – FullTextPDF where AUTISTIC children have been examined , they have a 35% improvement in their autistic condition after 20 treatments. I don’t have time to research this exactly, but it’s certainly promising.
I know of one “autistic” mother from Austria who started Brain-Stimulation treatment for her child with a physician in London because non was in Austria until recently, which was incredibly expensive (costs there as much per month as a “service fee” as the entire treatment costs here). She can confirm improvement.
I know from Petros that he doesn’t take autistic kids because the children refuse against tDCS – and – in addition – he only takes Level 1 and Level 2 evidence anyway (= US medicine, don’t try out anything that has no evidence level to be protected).
Practical application
In this context you can also find the following flyer on the Internet from a doctor in Munich who offers tDCS for Tourette’s
https://iv-ts.de/wp-content/uploads/2015/02/Flyer-tDCS-bei-Tourette.pdf
Photos: Midjourney AI images “Boy with Tourette Syndrome”
