Modulation of event file coding during response selection and inhibition by repetitive transcranial magnetic stimulation in GTS

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In the first funding period, several studies lent support to the notion that Gilles de la Tourette syndrome (GTS) can be conceptualized as a disorder of abnormal perception-action processing. Clinical symptoms were related to increased binding in an event file paradigm associated with increased activation in the inferior parietal cortex (BA40) in adult GTS patients. In addition, in children and adolescents with GTS altered inhibition in a multi-modal Go/Nogo task was found and associated with increased cortical activity in the BA40 region. Preliminary data has shown that 1Hz repetitive transcranial magnetic stimulation (rTMS) can effectively decrease abnormal cortical excitability and improve symptoms when applied to the supplementary motor area (SMA). However, there is no study combining clinical (e.g. tic frequency and severity) and behavioral/neurophysiological outcome measures of sensorimotor integration processes following rTMS in GTS. Therefore, in this project, we will compare the effects of inhibitory, neuronavigated 1 Hz rTMS applied to the SMA with those of BA40 rTMS both in children/adolescents and adults with GTS combining clinical measures, and behavioral performance along with concomitant EEG recordings during event file processing in response selection and response inhibition. We aim at providing mechanistic insights about the role of parietal and frontal cortical regions for abnormal perception-action integration in GTS during response selection and motor response inhibition in different age groups. This will provide the basis for a transfer of the cognitive-theoretical conceptualization of GTS into clinical applications.