The CBIT + TMS trial: study protocol for a two-phase randomized controlled trial testing neuromodulation to augment behavior therapy for youth with chronic tics

作者：Christine A. Conelea, Deanna J. Greene, Jennifer R. Alexander, Kerry Houlihan, Sarah Hodapp, Brianna Wellen, Sunday M. Francis, Bryon A. Mueller, Tim Hendrickson, Angela Tseng, Mo Chen, Mark Fiecas, Kelvin O. Lim, Alexander Opitz, Suma Jacob · 发表于：Trials · 年份：2023 · DOI：10.1186/s13063-023-07455-1 · 被引用次数：14 · 研究领域：Obsessive-Compulsive Spectrum Disorders、Transcranial Magnetic Stimulation Studies、Electroconvulsive Therapy Studies

BACKGROUND: Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for tic disorders that aims to improve controllability over tics that an individual finds distressing or impairing. However, it is only effective for approximately half of patients. Supplementary motor area (SMA)-directed neurocircuitry plays a strong role in motor inhibition, and activity in this region is thought to contribute to tic expression. Targeted modulation of SMA using transcranial magnetic stimulation (TMS) may increase CBIT efficacy by improving patients' ability to implement tic controllability behaviors. METHODS: The CBIT + TMS trial is a two-phase, milestone-driven early-stage randomized controlled trial. The trial will test whether augmenting CBIT with inhibitory, non-invasive stimulation of SMA with TMS modifies activity in SMA-mediated circuits and enhances tic controllability in youth ages 12-21 years with chronic tics. Phase 1 will directly compare two rTMS augmentation strategies (1 Hz rTMS vs. cTBS) vs. sham in N = 60 participants. Quantifiable, a priori "Go/No Go Criteria" guide the decision to proceed to phase 2 and the selection of the optimal TMS regimen. Phase 2 will compare the optimal regimen vs. sham and test the link between neural target engagement and clinical outcomes in a new sample of N = 60 participants. DISCUSSION: This clinical trial is one of few to date testing TMS augmentation of therapy in a pediatric sample. The results will provide insight ...