Abstract
Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor tics and at least one vocal tic. This case report presents a patient who did not respond adequately to pharmacotherapy, highlighting the effects of repetitive transcranial magnetic stimulation (rTMS) and the outcomes of longitudinal follow-up. The patient is a 25-year-old male with no history of other physical illnesses. His symptoms began 17 years ago with simple motor tics, which gradually progressed to include complex motor and vocal tics. Over time, he also developed irritability and a persistent sense of impending doom. Clinical evaluation led to diagnoses of Tourette Syndrome comorbid with generalized anxiety disorder. Pharmacological treatment included escitalopram (10 mg/day), followed sequentially by pimozide (4 mg/day), tetrabenazine (3*25 mg/day), and aripiprazole (10 mg/day). Pimozide and aripiprazole showed no effect on the tics, and tetrabenazine was discontinued due to intolerable gastrointestinal side effects. Escitalopram, which effectively managed the patient’s anxiety, was continued at 10 mg/day. The patient then underwent 40 sessions of rTMS over eight weeks, targeting the bilateral supplementary motor area. Each session consisted of 1 Hz stimulation at 110% of the resting motor threshold, delivering 1200 stimuli per day over 20 minutes, five days a week. Following the treatment, significant improvements were observed: a 75% reduction in the general functionality score and a 59.7% reduction in the total tic severity score. This report suggests that rTMS may be a promising alternative for TS patients with psychiatric comorbidities, particularly those who cannot tolerate medications or achieve sufficient symptom control through pharmacotherapy alone. Keywords: Tourette’s Syndrome, Repetitive Transcranial Magnetic Stimulation, Supplementary Motor Area.