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ORIGINAL RESEARCH article

Front. Hum. Neurosci.

Sec. Brain Imaging and Stimulation

This article is part of the Research TopicApplications of non-invasive brain stimulation in neurodevelopmental disordersView all 6 articles

Transcranial Magnetic Stimulation to Probe the Role of the Supplementary Motor Area in Tics

Provisionally accepted
Christine ConeleaChristine Conelea1*Brianna WellenBrianna Wellen1S M FrancisS M Francis1Bryon MuellerBryon Mueller1Suma JacobSuma Jacob1,2Kelvin O LimKelvin O Lim1Benjamin GreenbergBenjamin Greenberg3,4,5
  • 1University of Minnesota Twin Cities, St. Paul, United States
  • 2UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, United States
  • 3Butler Hospital, Providence, United States
  • 4Brown University, Providence, United States
  • 5Providence VA Medical Center Center for Neurorestoration and Neurotechnology, Providence, United States

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Supplementary motor area (SMA) hyperactivity is thought to be a key neural mechanism in tics. This study probed SMA's role in tic expression, voluntary tic control, and premonitory urge experiences using one session of 1 Hz "inhibitory" repetitive transcranial magnetic stimulation (rTMS) targeting SMA in a repeated measures, small-N experimental design. Youth with Tourette Syndrome (TS) ages 12-17 years (N = 14) completed a clinical assessment and MRI to localize SMA. The video-based Tic Suppression Task (TST) quantified tic frequency and urges during conditions of Free-to-Tic, Suppression, and Suppression+Reward. The TST was followed by randomly assigned active 1Hz (n = 8) or sham rTMS (n = 6) and TST repetition post-stimulation. Active rTMS led to greater tic frequency reductions during Free-to-Tic (d = 0.34) and Suppression+Reward (d = 0.24) but not Suppression (d = 0.0). A stronger effect size for active rTMS was observed in both suppression conditions (d = 0.26, d = 0.63) when excluding participants classified as baseline "strong suppressors" (n = 5). Urges did not differ group-wise for Free-to-Tic (d = 0.09) but decreased more following active rTMS in both suppression conditions (d = 0.19, d = 0.52). Overall, results suggest that the acute aftereffects of active 1Hz rTMS to SMA may include reduced natural tic frequency, improved tic controllability, and lower urge intensity, especially while engaged in suppression efforts. Results are consistent with prior literature pointing to SMA hyperactivation in TS and suggests the potential therapeutic value of rTMS.

Keywords: TIC, Tourette, Child, Brain Stimulation, Transcranial Magnetic Stimulation, supplementary motor area

Received: 08 Oct 2025; Accepted: 10 Nov 2025.

Copyright: © 2025 Conelea, Wellen, Francis, Mueller, Jacob, Lim and Greenberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Christine Conelea, cconelea@umn.edu

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Supplementary Material