Teen and Adult Tic TMS Study

Inclusion Criteria:

1. Outpatients
2. Ages 15 - 35 years old
3. Meets DSM-5 criteria for persistent (chronic) vocal/motor tic disorder or Tourette's syndrome with screening YGTSS score ≥ 20 (moderate or greater severity).
4. Moderate severity or intolerable side effects with at least one prior trial of an evidence-based anti-tic medication.
5. Stable on chronic psychotropic medications and/or therapy for 6 weeks prior to the study and agreeable to continue current treatments without change throughout the study.
6. Participants may continue to take medications and record daily usage throughout the study.
7. Capacity to provide informed assent or consent and parent or legal guardian able to provide consent for minors.
8. Ability to tolerate clinical study procedures.
9. Successfully complete the screening forms without any contraindications.

Exclusion Criteria:

1. Psychiatric: history of schizophrenia, bipolar disorder, substance /alcohol abuse disorder, current elevated suicide risk, prior psychosurgery.
2. Neurologic: severe neurocognitive disorder, seizure disorder, certain structural brain lesions (e.g., intracranial mass lesions, TBI, hydrocephalus, sequelae of meningitis, frank brain injury).
3. TMS contraindications: implanted device; presence of metal in the head, including eyes and ears (excluding dental implants); certain tics.
4. Subjects with an unstable physical, systemic, or metabolic disorder (e.g., unstable hypertension; malnutrition).
5. Females who are pregnant or nursing (as determined by a questionnaire and urine pregnancy test).
6. Inability to complete the research protocol as determined by the Principal Investigator.