Transcranial Magnetic Stimulation (TMS) is a noninvasive technology that is used to study neurophysiology. In a previous TSA-funded study, we found a difference in response to a specific stimulation paradigm called Intermittent Theta Burst Stimulation (iTBS) when comparing controls and subjects with Tourette syndrome. After iTBS, healthy controls exhibited an expected increase in their motor-evoked potential, whereas Tourette syndrome subjects had minimal response. The response to iTBS is thought to be a neuroplastic property that results in a long-term potentiation (LTP)-like process. This study therefore allowed us to identify a possible difference in the neuroplastic property in subjects with Tourette syndrome. In this new study, we will use Repetitive Transcranial Magnetic Stimulation (RTMS) to experimentally treat patients with Tourette syndrome who have moderate to severe tics. In pilot studies, high intensity, daily RTMS reduced tics when targeting the supplementary motor area (SMA). The high intensity and long duration of these treatments limit their clinical applicability. We propose a sham-controlled clinical trial using an easily tolerated RTMS technique, continuous theta burst stimulation (cTBS), administered over 2 days. Targeting will be individualized, based on event-related fMRI BOLD signal at the SMA. We hypothesize that SMA-navigated cTBS will be superior to sham in reducing tics. We also hypothesize that cTBS will change tic-related fMRI activation pattern and iTBS-evoked motor cortex measures and these changes will correlate with tic reduction. Steve Wei Wu, M.D., Kenneth Eaton, Ph.D., Jennifer Vannest, Ph.D. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Award: $65,000 Commentary: Repetitive Transcranial Magnetic Stimulation (RTMS) is a non-invasive technology that is under investigation as a treatment for certain neurologic and psychiatric conditions. In prior small studies, RTMS was found to be effective in treating Tourette syndrome (TS). In this study, the authors plan to use a more easily tolerated RTMS method to treat patients with moderate to severe tics. Essentially they will target the RTMS stimulation according to each individuals’ brain imaging results. The investigators believe that the targeted RTMS stimulation will reduce tic severity. Tourette Association of America Inc. – Research Grant Award 2011-2012