18. Median Nerve Stimulation for Treatment of Tics: A 4-week, Open Trial with Ecological Momentary Assessment

Introduction: Current treatments for Tourette Syndrome (TS) and other chronic tic disorders (CTD) are inadequate, and patients desire new treatment options. Median nerve stimulation (MNS) at 10-12 Hz was recently proposed as a novel treatment for TS/CTD. We report on 31 people ages 15-64 with TS/CTD who participated in an open-label, comparative (within-group, several time points) study of MNS ( registration number NCT05016765). In this study, we aim to gather additional data on the efficacy of MNS, as well as to assess practicality and tolerability outside of a laboratory setting.

Methods: Participants were recruited from completers of a randomized controlled trial (RCT) of MNS and were given a transcutaneous electrical nerve stimulation (TENS) unit to use as desired for MNS for 4 weeks. Participants were instructed to complete surveys regarding tic frequency, tic intensity, and stimulation discomfort each time they began or ended stimulation, as well as twice daily when prompted by text message at random times. Participants also completed an extensive final survey.

Results: Median device use was 1.5 days per week (interquartile range [IQR] =1.4) and 50 minutes per day used (IQR= 93). Tic frequency improved during MNS (mean improvement 1.0 on a 0-5 scale, p <0.001), as did tic intensity (mean improvement 0.9, p <0.001). Mean discomfort was mild (1.2 on a 3-point scale). 21 participants (78%) reported plans to continue using the device. Participants’ results in this study did not correlate significantly with their results in the preceding blinded RCT.

Impact: Although 4 participants did not complete the study, in the remainder we found MNS to improve tic frequency and intensity with minimal side effects. Thus, MNS may have promise as a potential treatment for patients with TS/CTD, although further studies are needed.

OrganizationWashington University in St. Louis

Iverson AM, Arbuckle AL, Song DY, Bihun EC and Black KJ