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Parvizi-Wayne D, Severs L. When the interoceptive and conceptual clash: The case of oppositional phenomenal self-modelling in Tourette syndrome. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024; 24:660-680. [PMID: 38777988 PMCID: PMC11233343 DOI: 10.3758/s13415-024-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
Tourette syndrome (TS) has been associated with a rich set of symptoms that are said to be uncomfortable, unwilled, and effortful to manage. Furthermore, tics, the canonical characteristic of TS, are multifaceted, and their onset and maintenance is complex. A formal account that integrates these features of TS symptomatology within a plausible theoretical framework is currently absent from the field. In this paper, we assess the explanatory power of hierarchical generative modelling in accounting for TS symptomatology from the perspective of active inference. We propose a fourfold analysis of sensory, motor, and cognitive phenomena associated with TS. In Section 1, we characterise tics as a form of action aimed at sensory attenuation. In Section 2, we introduce the notion of epistemic ticcing and describe such behaviour as the search for evidence that there is an agent (i.e., self) at the heart of the generative hierarchy. In Section 3, we characterise both epistemic (sensation-free) and nonepistemic (sensational) tics as habitual behaviour. Finally, in Section 4, we propose that ticcing behaviour involves an inevitable conflict between distinguishable aspects of selfhood; namely, between the minimal phenomenal sense of self-which is putatively underwritten by interoceptive inference-and the explicit preferences that constitute the individual's conceptual sense of self. In sum, we aim to provide an empirically informed analysis of TS symptomatology under active inference, revealing a continuity between covert and overt features of the condition.
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Affiliation(s)
- D Parvizi-Wayne
- Department of Psychology, Royal Holloway University of London, London, UK.
| | - L Severs
- Centre for the Philosophy of Science, Faculty of Sciences, University of Lisbon, Lisbon, Portugal
- Ruhr-Universität Bochum, Institute of Philosophy II, Bochum, Germany
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Orth L, Meeh J, Leiding D, Habel U, Neuner I, Sarkheil P. Aberrant Functional Connectivity of the Salience Network in Adult Patients with Tic Disorders: A Resting-State fMRI Study. eNeuro 2024; 11:ENEURO.0223-23.2024. [PMID: 38744491 PMCID: PMC11167695 DOI: 10.1523/eneuro.0223-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 05/16/2024] Open
Abstract
Tic disorders (TD) are characterized by the presence of motor and/or vocal tics. Common neurophysiological frameworks suggest dysregulations of the cortico-striatal-thalamo-cortical (CSTC) brain circuit that controls movement execution. Besides common tics, there are other "non-tic" symptoms that are primarily related to sensory perception, sensorimotor integration, attention, and social cognition. The existence of these symptoms, the sensory tic triggers, and the modifying effect of attention and cognitive control mechanisms on tics may indicate the salience network's (SN) involvement in the neurophysiology of TD. Resting-state functional MRI measurements were performed in 26 participants with TD and 25 healthy controls (HC). The group differences in resting-state functional connectivity patterns were measured based on seed-to-voxel connectivity analyses. Compared to HC, patients with TD exhibited altered connectivity between the core regions of the SN (insula, anterior cingulate cortex, and temporoparietal junction) and sensory, associative, and motor-related cortices. Furthermore, connectivity changes were observed in relation to the severity of tics in the TD group. The SN, particularly the insula, is likely to be an important site of dysregulation in TD. Our results provide evidence for large-scale neural deviations in TD beyond the CSTC pathologies. These findings may be relevant for developing treatment targets.
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Affiliation(s)
- Linda Orth
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
| | - Johanna Meeh
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany
| | - Delia Leiding
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich, 52428 Jülich, Germany
| | - Pegah Sarkheil
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany
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Ding Q, Woods DW, Xu W, Zhao Y, Shen S, Sun J. Exploring the psychometric properties of the premonitory urge for tics scale (PUTS) and its association with psychiatric symptoms in Chinese children with tic disorders. BMC Pediatr 2024; 24:341. [PMID: 38755560 PMCID: PMC11097492 DOI: 10.1186/s12887-024-04801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The Premonitory Urge for Tics Scale (PUTS) is a common self-report measure of premonitory urges for patients with tic disorders. This study aims to evaluate the Chinese version of the PUTS (PUTS-C) and to explore its association with psychiatric symptoms in Chinese children diagnosed with tic disorders. METHODS The psychometric evaluation involved 204 outpatients with tic disorders, aged 7-16 years, who were divided into two age groups: (7-10 years, n = 103; 11-16 years, n = 95). RESULTS The PUTS-C demonstrated good internal consistency (McDonald'sω = 0.84) and two-week test-retest reliability (0.76). We observed a statistically significant correlation between the total PUTS-C score and various Yale Global Tic Severity Scale (YGTSS) subscales and total tic severity scores. The PUTS-C score also showed significant correlations with the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Screening Child Anxiety-Related Emotional Disorders (SCARED), and Children's Depression Inventory (CDI). Notably, premonitory urges independently predicted tic severity, beyond the influence of comorbid symptoms. A two-factor structure of the PUTS-C was identified in the total sample through factor analysis. CONCLUSIONS The PUTS-C possesses acceptable validity and good reliability. It appears that premonitory urges in Chinese patients with tic disorders are associated with obsessive-compulsive symptoms, anxiety, and depression, but can independently predict tic severity. Specific PUTS-C factors possibly related to motor and vocal tics. Future research should continue to investigate age-related differences and the association with tics and other sensory symptoms.
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Affiliation(s)
- Qiang Ding
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, 53233, USA
| | - Wen Xu
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Ying Zhao
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Shuqin Shen
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Jinhua Sun
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
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Desfossés-Vallée S, Leclerc JB, Blanchet P, O’Connor KP, Lavoie ME. Comparing the 'When' and the 'Where' of Electrocortical Activity in Patients with Tourette Syndrome, Body-Focused Repetitive Behaviors, and Obsessive Compulsive Disorder. J Clin Med 2024; 13:2489. [PMID: 38731020 PMCID: PMC11084402 DOI: 10.3390/jcm13092489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Tourette Syndrome (TS), Obsessive Compulsive Disorder (OCD), and Body-Focused Repetitive Behaviors (BFRB) are three disorders that share many similarities in terms of phenomenology, neuroanatomy, and functionality. However, despite the literature pointing toward a plausible spectrum of these disorders, only a few studies have compared them. Studying the neurocognitive processes using Event-Related Potentials (ERPs) offers the advantage of assessing brain activity with excellent temporal resolution. The ERP components can then reflect specific processes known to be potentially affected by these disorders. Our first goal is to characterize 'when' in the processing stream group differences are the most prominent. The second goal is to identify 'where' in the brain the group discrepancies could be. Methods: Participants with TS (n = 24), OCD (n = 18), and BFRB (n = 16) were matched to a control group (n = 59) and were recorded with 58 EEG electrodes during a visual counting oddball task. Three ERP components were extracted (i.e., P200, N200, and P300), and generating sources were modelized with Standardized Low-Resolution Electromagnetic Tomography. Results: We showed no group differences for the P200 and N200 when controlling for anxiety and depressive symptoms, suggesting that the early cognitive processes reflected by these components are relatively intact in these populations. Our results also showed a decrease in the later anterior P300 oddball effect for the TS and OCD groups, whereas an intact oddball effect was observed for the BFRB group. Source localization analyses with sLORETA revealed activations in the lingual and middle occipital gyrus for the OCD group, distinguishing it from the other two clinical groups and the controls. Conclusions: It seems that both TS and OCD groups share deficits in anterior P300 activation but reflect distinct brain-generating source activations.
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Affiliation(s)
- Sarah Desfossés-Vallée
- Laboratoire de Psychophysiologie Cognitive et Sociale, Montréal, QC H1N 3J4, Canada;
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Département de Psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Julie B. Leclerc
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H2X 3P2, Canada
- Centre de Recherche CIUSSS du Nord-de-l’île-de-Montréal, Montréal, QC H4J 1C5, Canada
| | - Pierre Blanchet
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Faculté de Médecine Dentaire, Département de Stomatologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Kieron P. O’Connor
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Département de Psychiatrie et Addictologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Marc E. Lavoie
- Laboratoire de Psychophysiologie Cognitive et Sociale, Montréal, QC H1N 3J4, Canada;
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Département de Sciences Humaines, Lettres et Communication, Université TÉLUQ, Quebec City, QC G1K 9H6, Canada
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Baizabal-Carvallo JF, Cavanna AE, Jankovic J. Tics emergencies and malignant tourette syndrome: Assessment and management. Neurosci Biobehav Rev 2024; 159:105609. [PMID: 38447821 DOI: 10.1016/j.neubiorev.2024.105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/29/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
Tourette syndrome (TS) is a complex neurodevelopmental disorder characterized by the presence of tics, frequently accompanied by a variety of neuropsychiatric comorbidities. A subset of patients with TS present with severe and disabling symptoms, requiring prompt therapeutic intervention. Some of these manifestations may result in medical emergencies when severe motor or phonic tics lead to damage of anatomical structures closely related to the tic. Examples include myelopathy or radiculopathy following severe neck ("whiplash") jerks or a variety of self-inflicted injuries. In addition to self-aggression or, less commonly, allo-aggression, some patients exhibit highly inappropriate behavior, suicidal tendencies, and rage attacks which increase the burden of the disease and are important components of "malignant TS". This subset of TS is frequently associated with comorbid obsessive-compulsive disorder. Therapeutic measures include intensive behavioral therapy, optimization of oral pharmacotherapy, botulinum toxin injections, and deep brain stimulation.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Department of Sciences and Engineering, University of Guanajuato, León, Mexico.
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom; School of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Maruoka H, Hattori T, Hase T, Takahashi K, Ohara M, Orimo S, Yokota T. Aberrant morphometric networks in Alzheimer's disease have hemispheric asymmetry and age dependence. Eur J Neurosci 2024; 59:1332-1347. [PMID: 38105486 DOI: 10.1111/ejn.16225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
Alzheimer's disease (AD) is associated with abnormal accumulations of hyperphosphorylated tau and amyloid-β proteins, resulting in unique patterns of atrophy in the brain. We aimed to elucidate some characteristics of the AD's morphometric networks constructed by associating different morphometric features among brain areas and evaluating their relationship to Mini-Mental State Examination total score and age. Three-dimensional T1-weighted (3DT1) image data scanned by the same 1.5T magnetic resonance imaging (MRI) were obtained from 62 AD patients and 41 healthy controls (HCs) and were analysed by using FreeSurfer. The associations of the extracted six morphometric features between regions were estimated by correlation coefficients. The global and local graph theoretical measures for this network were evaluated. Associations between graph theoretical measures and age, sex and cognition were evaluated by multiple regression analysis in each group. Global measures of integration: global efficiency and mean information centrality were significantly higher in AD patients. Local measures of integration: node global efficiency and information centrality were significantly higher in the entorhinal cortex, fusiform gyrus and posterior cingulate cortex of AD patients but only in the left hemisphere. All global measures were correlated with age in AD patients but not in HCs. The information centrality was associated with age in AD's broad brain regions. Our results showed that altered morphometric networks due to AD are left-hemisphere dominant, suggesting that AD pathogenesis has a left-right asymmetry. Ageing has a unique impact on the morphometric networks in AD patients. The information centrality is a sensitive graph theoretical measure to detect this association.
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Affiliation(s)
- Hiroyuki Maruoka
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Takaaki Hattori
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Hase
- Innovative Human Resource Development Division, Institute of Education, Tokyo Medical and Dental University, Tokyo, Japan
- Faculty of Pharmacy, Keio University, Tokyo, Japan
- Research, The Systems Biology Institute, Tokyo, Japan
- Research, SBX BioSciences, Vancouver, British Columbia, Canada
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Ohara
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Szejko N, Fletcher J, Martino D, Pringsheim T. Premonitory Urge in Patients with Tics and Functional Tic-like Behaviors. Mov Disord Clin Pract 2024; 11:276-281. [PMID: 38468546 PMCID: PMC10928355 DOI: 10.1002/mdc3.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Premonitory urges (PU) are well described in primary tics, but their frequency and intensity in functional tic-like behaviors (FTLB) are unclear. OBJECTIVE To study the experience of PU in patients with FTLB. METHODS We compared the results of the premonitory urge for tics scale (PUTS) in adults with tics and FTLB in the University of Calgary Adult Tic Registry. RESULTS We included 83 patients with tics and 40 with FTLB. When comparing patients with tics, FTLB with tics and FTLB only, we did not detect significant differences either in the total PUTS score (P = 0.39), or in any of the individual PUTS item sub-scores (P values ranging between 0.11 and 0.99). CONCLUSIONS Patients with FTLB report PU at similar frequency and intensity to patients with tics. This finding confirms that PU are not a useful feature to discriminate FTLB from tics.
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Affiliation(s)
- Natalia Szejko
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of BioethicsMedical University of WarsawWarsawPoland
| | - Julian Fletcher
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Mathison Centre for Mental Health Research and EducationCalgaryAlbertaCanada
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Sapozhnikov Y, Vermilion J. Co-Occurring Anxiety in Youth with Tic Disorders: A Review. J Child Adolesc Psychopharmacol 2023; 33:402-408. [PMID: 37870770 DOI: 10.1089/cap.2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Objective: To review the current state of the literature regarding anxiety symptoms and anxiety disorders in chronic tic disorder (CTD). Results: We conducted a literature search on anxiety and tic disorders. Anxiety symptoms and anxiety disorders are common in youth with CTD, with ∼30%-50% of youth with CTD having at least one co-occurring anxiety disorder. Tics often improve by young adulthood but anxiety symptoms tend to persist, or worsen, over time. Anxiety and tics are closely related, but the exact nature of their relationship is poorly understood. We discuss some potential ways in which anxiety and tics are linked with an emphasis on the underlying brain circuitry involved. The relationship between anxiety and tics may be related to the premonitory urge. In addition, stress hormones may link anxiety and tics. Individuals with CTD have greater activation of their hypothalamic-pituitary-adrenal system in response to acute stress. We also review the impact of anxiety on youth with CTD and approaches to management of anxiety in youth. Conclusions: Anxiety is common in youth with CTD, is associated with more severe CTD, and can adversely affect a child's function. Thus, it is important to identify anxiety disorders in CTD and manage them appropriately.
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Affiliation(s)
- Yelizaveta Sapozhnikov
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer Vermilion
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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Desai I, Kumar N, Goyal V. An Update on the Diagnosis and Management of Tic Disorders. Ann Indian Acad Neurol 2023; 26:858-870. [PMID: 38229610 PMCID: PMC10789408 DOI: 10.4103/aian.aian_724_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 01/18/2024] Open
Abstract
Tic disorders (TDs) are a group of common neuropsychiatric disorders of childhood and adolescence. TDs may impact the physical, emotional, and social well-being of the affected person. In this review, we present an update on the clinical manifestations, pathophysiology, diagnosis, and treatment of TDs. We searched the PubMed database for articles on tics and Tourette syndrome. More than 400 articles were reviewed, of which 141 are included in this review. TDs are more prevalent in children than in adults and in males than in females. It may result from a complex interaction between various genetic, environmental, and immunological factors. Dysregulation in the cortico-striato-pallido-thalamo-cortical network is the most plausible pathophysiology resulting in tics. TD is a clinical diagnosis based on clinical features and findings on neurological examination, especially the identification of tic phenomenology. In addition to tics, TD patients may have sensory features, including premonitory urge; enhanced and persistent sensitivity to non-noxious external or internal stimuli; and behavioral manifestations, including attention deficit hyperactivity disorders, obsessive-compulsive disorders, and autism spectrum disorders. Clinical findings of hyperkinetic movements that usually mimic tics have been compared and contrasted with those of TD. Patients with TD may not require specific treatment if tics are not distressing. Psychoeducation and supportive therapy can help reduce tics when combined with medication. Dispelling myths and promoting acceptance are important to improve patient outcomes. Using European, Canadian, and American guidelines, the treatment of TD, including behavioral therapy, medical therapy, and emerging/experimental therapy, has been discussed.
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Affiliation(s)
- Ishita Desai
- Department of Neurology, Teerthankar Mahaveer University, Moradabad, Uttar Pradesh, India
| | - Niraj Kumar
- Department of Neurology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Vinay Goyal
- Department of Neurology, Institute of Neurosciences, Medanta, Gurugram, Haryana, India
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Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
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Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
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Zouki JJ, Ellis EG, Morrison-Ham J, Thomson P, Jesuthasan A, Al-Fatly B, Joutsa J, Silk TJ, Corp DT. Mapping a network for tics in Tourette syndrome using causal lesions and structural alterations. Brain Commun 2023; 5:fcad105. [PMID: 37215485 PMCID: PMC10198704 DOI: 10.1093/braincomms/fcad105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/29/2023] [Accepted: 04/02/2023] [Indexed: 05/24/2023] Open
Abstract
Tics are sudden stereotyped movements or vocalizations. Cases of lesion-induced tics are invaluable, allowing for causal links between symptoms and brain structures. While a lesion network for tics has recently been identified, the degree to which this network translates to Tourette syndrome has not been fully elucidated. This is important given that patients with Tourette syndrome make up a large portion of tic cases; therefore, existing and future treatments should apply to these patients. The aim of this study was to first localize a causal network for tics from lesion-induced cases and then refine and validate this network in patients with Tourette syndrome. We independently performed 'lesion network mapping' using a large normative functional connectome (n = 1000) to isolate a brain network commonly connected to lesions causing tics (n = 19) identified through a systematic search. The specificity of this network to tics was assessed through comparison to lesions causing other movement disorders. Using structural brain coordinates from prior neuroimaging studies (n = 7), we then derived a neural network for Tourette syndrome. This was done using standard anatomical likelihood estimation meta-analysis and a novel method termed 'coordinate network mapping', which uses the same coordinates, yet maps their connectivity using the aforementioned functional connectome. Conjunction analysis was used to refine the network for lesion-induced tics to Tourette syndrome by identifying regions common to both lesion and structural networks. We then tested whether connectivity from this common network is abnormal in a separate resting-state functional connectivity MRI data set from idiopathic Tourette syndrome patients (n = 21) and healthy controls (n = 25). Results showed that lesions causing tics were distributed throughout the brain; however, consistent with a recent study, these were part of a common network with predominant basal ganglia connectivity. Using conjunction analysis, coordinate network mapping findings refined the lesion network to the posterior putamen, caudate nucleus, globus pallidus externus (positive connectivity) and precuneus (negative connectivity). Functional connectivity from this positive network to frontal and cingulate regions was abnormal in patients with idiopathic Tourette syndrome. These findings identify a network derived from lesion-induced and idiopathic data, providing insight into the pathophysiology of tics in Tourette syndrome. Connectivity to our cortical cluster in the precuneus offers an exciting opportunity for non-invasive brain stimulation protocols.
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Affiliation(s)
- Jade-Jocelyne Zouki
- Correspondence to: Jade-Jocelyne Zouki Cognitive Neuroscience Unit School of Psychology, Deakin University 221 Burwood Hwy, Burwood, VIC 3125, Australia E-mail:
| | - Elizabeth G Ellis
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong VIC 3220, Australia
| | - Jordan Morrison-Ham
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong VIC 3220, Australia
| | - Phoebe Thomson
- Department of Paediatrics, The University of Melbourne, Melbourne VIC 3010, Australia
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne VIC 3052, Australia
- Autism Center, Child Mind Institute, New York NY 10022, USA
| | - Aaron Jesuthasan
- Neurology Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Bassam Al-Fatly
- Department of Neurology with Experimental Neurology, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, FI-20014, Finland
- Turku PET Centre, Neurocenter, Turku University Hospital, Turku, FI-20520, Finland
| | | | - Daniel T Corp
- Correspondence may also be addressed to: Daniel T. Corp E-mail:
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12
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Zito GA, Hartmann A, Béranger B, Weber S, Aybek S, Faouzi J, Roze E, Vidailhet M, Worbe Y. Multivariate classification provides a neural signature of Tourette disorder. Psychol Med 2023; 53:2361-2369. [PMID: 35135638 DOI: 10.1017/s0033291721004232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Tourette disorder (TD), hallmarks of which are motor and vocal tics, has been related to functional abnormalities in large-scale brain networks. Using a fully data driven approach in a prospective, case-control study, we tested the hypothesis that functional connectivity of these networks carries a neural signature of TD. Our aim was to investigate (i) the brain networks that distinguish adult patients with TD from controls, and (ii) the effects of antipsychotic medication on these networks. METHODS Using a multivariate analysis based on support vector machine (SVM), we developed a predictive model of resting state functional connectivity in 48 patients and 51 controls, and identified brain networks that were most affected by disease and pharmacological treatments. We also performed standard univariate analyses to identify differences in specific connections across groups. RESULTS SVM was able to identify TD with 67% accuracy (p = 0.004), based on the connectivity in widespread networks involving the striatum, fronto-parietal cortical areas and the cerebellum. Medicated and unmedicated patients were discriminated with 69% accuracy (p = 0.019), based on the connectivity among striatum, insular and cerebellar networks. Univariate approaches revealed differences in functional connectivity within the striatum in patients v. controls, and between the caudate and insular cortex in medicated v. unmedicated TD. CONCLUSIONS SVM was able to identify a neuronal network that distinguishes patients with TD from control, as well as medicated and unmedicated patients with TD, holding a promise to identify imaging-based biomarkers of TD for clinical use and evaluation of the effects of treatment.
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Affiliation(s)
- Giuseppe A Zito
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
- Support Centre for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Andreas Hartmann
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Benoît Béranger
- Center for NeuroImaging Research (CENIR), Paris Brain Institute, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMR, 7225, Paris, France
| | - Samantha Weber
- Psychosomatics Unit of the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Selma Aybek
- Psychosomatics Unit of the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Johann Faouzi
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Inria Paris, Aramis project-team, Paris, France
| | - Emmanuel Roze
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
| | - Marie Vidailhet
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
| | - Yulia Worbe
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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13
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Abnormal dynamics of brain functional networks in children with Tourette syndrome. J Psychiatr Res 2023; 159:249-257. [PMID: 36764224 DOI: 10.1016/j.jpsychires.2023.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/30/2022] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder characterized by the presence of multiple motor and vocal tics. Research using resting-state functional magnetic resonance imaging (rfMRI) have found aberrant static functional connectivity (FC) and its topological properties in the brain networks of TS. Our study is the first to investigate the dynamic functional connectivity (dFC) in the whole brain network of TS patients, focusing on the temporal properties of dFC states and the temporal variability of topological organization. The rfMRI data of 36 male children with TS and 27 matched healthy controls were collected and further analyzed by group spatial independent component analysis, sliding windows approach based dFC analysis, k-means clustering analysis, and graph theory analysis. The clustering analysis identified three dFC states. Of these states, state 2, characterized by increased inter-network connections in subcortical network (SCN), sensorimotor network (SMN), and default mode network (DMN), and decreased inter-network connections between salience network (SAN) and executive control network (ECN), was found to have higher fractional window and dwell time in TS, which was also positively correlated with tic severity. TS patients also exhibited higher temporal variability of whole-brain-network global efficiency and local efficiency, and higher temporal variability of nodal efficiency and local efficiency in SCN, DMN, ECN, SAN, and SMN. Additionally, temporal variability of the efficiency and local efficiency in insula was positively correlated with tic severity. Our findings revealed abnormal temporal property of dFC states and temporal variability of topological organization in TS, providing new insights into clinical diagnoses and neuropathology of TS.
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Marapin RS, van der Horn HJ, van der Stouwe AMM, Dalenberg JR, de Jong BM, Tijssen MAJ. Altered brain connectivity in hyperkinetic movement disorders: A review of resting-state fMRI. Neuroimage Clin 2022; 37:103302. [PMID: 36669351 PMCID: PMC9868884 DOI: 10.1016/j.nicl.2022.103302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hyperkinetic movement disorders (HMD) manifest as abnormal and uncontrollable movements. Despite reported involvement of several neural circuits, exact connectivity profiles remain elusive. OBJECTIVES Providing a comprehensive literature review of resting-state brain connectivity alterations using resting-state fMRI (rs-fMRI). We additionally discuss alterations from the perspective of brain networks, as well as correlations between connectivity and clinical measures. METHODS A systematic review was performed according to PRISMA guidelines and searching PubMed until October 2022. Rs-fMRI studies addressing ataxia, chorea, dystonia, myoclonus, tics, tremor, and functional movement disorders (FMD) were included. The standardized mean difference was used to summarize findings per region in the Automated Anatomical Labeling atlas for each phenotype. Furthermore, the activation likelihood estimation meta-analytic method was used to analyze convergence of significant between-group differences per phenotype. Finally, we conducted hierarchical cluster analysis to provide additional insights into commonalities and differences across HMD phenotypes. RESULTS Most articles concerned tremor (51), followed by dystonia (46), tics (19), chorea (12), myoclonus (11), FMD (11), and ataxia (8). Altered resting-state connectivity was found in several brain regions: in ataxia mainly cerebellar areas; for chorea, the caudate nucleus; for dystonia, sensorimotor and basal ganglia regions; for myoclonus, the thalamus and cingulate cortex; in tics, the basal ganglia, cerebellum, insula, and frontal cortex; for tremor, the cerebello-thalamo-cortical circuit; finally, in FMD, frontal, parietal, and cerebellar regions. Both decreased and increased connectivity were found for all HMD. Significant spatial convergence was found for dystonia, FMD, myoclonus, and tremor. Correlations between clinical measures and resting-state connectivity were frequently described. CONCLUSION Key brain regions contributing to functional connectivity changes across HMD often overlap. Possible increases and decreases of functional connections of a specific region emphasize that HMD should be viewed as a network disorder. Despite the complex interplay of physiological and methodological factors, this review serves to gain insight in brain connectivity profiles across HMD phenotypes.
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Affiliation(s)
- Ramesh S Marapin
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Harm J van der Horn
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - A M Madelein van der Stouwe
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Jelle R Dalenberg
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Bauke M de Jong
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Marina A J Tijssen
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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15
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Schütteler C, Gerlach AL. Die Bedeutung des Vorgefühls bei Tic-Störungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Funktion des Vorgefühls in der Pathogenese und Aufrechterhaltung von Tic-Störungen (TS) wird in den letzten Jahren verstärkt erforscht. Die mögliche funktionelle Bedeutung der Vorgefühle wird aber noch nicht ausreichend verstanden. Methode: Im vorliegenden Review wird der Kenntnisstand zu Vorgefühlen entlang eines integrativen funktionalen Störungsmodells zusammengefasst. Ergebnisse: Im Vergleich zum Jugendalter nehmen Tic-Symptome bei Tic-Störungen im Erwachsenenalter ab, während immer mehr Betroffene ein Vorgefühl berichten. Hierbei kann zwischen einem allgemeinen Vorgefühl (trait) und dem Drang, Tics auszuführen (state) unterschieden werden. Das Vorgefühl als trait ist abhängig von der Interozeptionsfähigkeit. An den Drang, Tics auszuführen, kann habituiert werden, moderiert von Aufmerksamkeits- und Attributionsprozessen. Durch das Auflösen des Vorgefühl-Tic-Reizreaktionsmusters reduzieren sich die Tic-Symptome. Schlussfolgerung: Für weitere Erkenntnisse in Bezug auf die Bedeutung von Vorgefühl und den Drang, Tics auszuführen, sollten zukünftige Forschungsansätze Drang und allgemeine Vorgefühle in therapeutischen Interventionsstudien berücksichtigen, weitere Interozeptionsparadigmen einbeziehen und die Entwicklung von allgemeinem Vorgefühl und Drang über die Lebensspanne hinweg untersuchen.
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Affiliation(s)
- Christina Schütteler
- Institut für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
| | - Alexander L. Gerlach
- Institut für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
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16
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Temiz G, Atkinson-Clement C, Lau B, Czernecki V, Bardinet E, Francois C, Worbe Y, Karachi C. Structural hyperconnectivity of the subthalamic area with limbic cortices underpins anxiety and impulsivity in Tourette syndrome. Cereb Cortex 2022; 33:5181-5191. [PMID: 36310093 DOI: 10.1093/cercor/bhac408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics, which is often associated with psychiatric comorbidities. Dysfunction of basal ganglia pathways might account for the wide spectrum of symptoms in TS patients. Although psychiatric symptoms may be related to limbic networks, the specific contribution of different limbic structures remains unclear. We used tractography to investigate cortical connectivity with the striatal area (caudate, putamen, core and shell of the nucleus accumbens), the subthalamic nucleus (STN), and the adjacent medial subthalamic region (MSR) in 58 TS patients and 35 healthy volunteers. 82% of TS patients showed psychiatric comorbidities, with significantly higher levels of anxiety and impulsivity compared to controls. Tractography analysis revealed significantly increased limbic cortical connectivity of the left MSR with the entorhinal (BA34), insular (BA48), and temporal (BA38) cortices in TS patients compared to controls. Furthermore, we found that left insular-STN connectivity was positively correlated with impulsivity scores for all subjects and with anxiety scores for all subjects, particularly for TS. Our study highlights a heterogenous modification of limbic structure connectivity in TS, with specific abnormalities found for the subthalamic area. Abnormal connectivity with the insular cortex might underpin the higher level of impulsivity and anxiety observed in TS.
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Affiliation(s)
- Gizem Temiz
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière , 75013 Paris, France
| | - Cyril Atkinson-Clement
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière , 75013 Paris, France
| | - Brian Lau
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière , 75013 Paris, France
| | - Virginie Czernecki
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière , 75013 Paris, France
- Department of Neurology, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris , 75013 Paris, France
| | - Eric Bardinet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière , 75013 Paris, France
| | - Chantal Francois
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière , 75013 Paris, France
| | - Yulia Worbe
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière , 75013 Paris, France
- Department of Neurophysiology, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris , 75012 Paris, France
| | - Carine Karachi
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière , 75013 Paris, France
- Department of Neurosurgery, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris , 75013 Paris, France
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17
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Langelage J, Verrel J, Friedrich J, Siekmann A, Schappert R, Bluschke A, Roessner V, Paulus T, Bäumer T, Frings C, Beste C, Münchau A. Urge-tic associations in children and adolescents with Tourette syndrome. Sci Rep 2022; 12:16008. [PMID: 36163482 PMCID: PMC9512906 DOI: 10.1038/s41598-022-19685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Premonitory urges preceding tics are a cardinal feature of Gilles de la Tourette syndrome (GTS), a developmental disorder usually starting during middle childhood. However, the temporal relation between urges and tics has only been investigated in adults. In 25 children and adolescents with GTS (8–18 years), we assess urge-tic associations, including inter-individual differences, correlation to clinical measures, and in comparison to a previously reported sample of adult GTS patients. Group-level analyses confirmed positive associations between urges and tics. However, at the individual level, less than half of participants showed positive associations, a similar proportion did not, and in two participants, the association was reversed. Tic expression and subjective urge levels correlated with corresponding clinical scores and participants with more severe tics during the urge monitor exhibited stronger urge-tic associations. Associations between reported urge levels and instantaneous tic intensity tended to be less pronounced in children and adolescents than in adult GTS patients. The observed heterogeneity of urge-tic associations cast doubt on the notion that tics are directly caused by urges. More severe tics may facilitate anticipation of tics and thereby lead to more pronounced urge-tic associations, consistent with a hypothesis of urges as a byproduct of tics.
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Affiliation(s)
- Jennifer Langelage
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julia Friedrich
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Alina Siekmann
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ronja Schappert
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Theresa Paulus
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.,Department of Neurology, Universität zu Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian Frings
- Cognitive Psychology, Department of Psychology, University of Trier, Trier, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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18
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Ramteke A, Lamture Y. Tics and Tourette Syndrome: A Literature Review of Etiological, Clinical, and Pathophysiological Aspects. Cureus 2022; 14:e28575. [PMID: 36185878 PMCID: PMC9520955 DOI: 10.7759/cureus.28575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022] Open
Abstract
Tourette syndrome (TS) is a condition characterized by tics produced because of neuropsychiatric malfunctioning occurring in childhood, which becomes less severe in adulthood, followed by a difference in the severity of tics between two persons. TS is a diverse variable in which symptoms vary in different patients. It is associated with comorbidities like obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and depression, and hampers the quality of life. Comorbid disorders must be investigated and treated as part of the clinical approach for all TS patients. Clinicians should be aware of the infrequent but serious neurological problems that can occur in these patients and recommend aggressively treating tics. Currently, there is more emphasis on symptom-based treatments by medicines, but as etiological knowledge improves, we will divert to disease-modifying medications in the future. Behavioral, pharmacological, and surgical methods can treat TS. Neuroleptics, other drugs, and behavioral therapies are the first-line options. Deep brain stimulation is evolving but has its pros and cons. The main focus of this review is on tics characteristics, how to manage and assess them, and limitations in the clinical spectrum.
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Baldermann JC, Hennen C, Schüller T, Andrade P, Visser-Vandewalle V, Horn A, Dembek TA, Petry-Schmelzer JN, Strelow JN, Jergas H, Kuhn J, Barbe MT, Huys D. Normative Functional Connectivity of Thalamic Stimulation for Reducing Tic Severity in Tourette Syndrome. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:841-844. [PMID: 35491377 DOI: 10.1016/j.bpsc.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Juan Carlos Baldermann
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Christina Hennen
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thomas Schüller
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Pablo Andrade
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Andreas Horn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Movement Disorders and Neuromodulation Unit, Department of Neurology, Berlin, Germany; Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Till A Dembek
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jan Niklas Petry-Schmelzer
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Joshua Niklas Strelow
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hannah Jergas
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Daniel Huys
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy III, LVR Klinik Bonn, Bonn, Germany
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20
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Dystonic motor and phonic tics in Tourette syndrome. J Neurol 2022; 269:5312-5318. [PMID: 35567613 DOI: 10.1007/s00415-022-11174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Dystonic tics differ from clonic tics by their slower and more sustained nature. Dystonic tics are often present in patients with Tourette syndrome (TS) and other tic-disorders. However, their phenomenology and impact on overall impairment have not been extensively studied. MATERIALS AND METHODS We assessed clinical history and tic duration in video-recordings from patients with TS evaluated at our movement disorders clinic. Dystonic tics were defined as those lasting ≥ 1000 ms (ms). RESULTS Of the total of 201 patients with TS, there were 156 with video-recordings suitable for tic duration analysis, of their tics, 57 (36.5%) of whom had dystonic motor tics, including 9 (5.7%) with dystonic phonic tics. Dystonic motor tics had a duration range between 1033 and 15,000 ms and dystonic phonic tics between 1132 and 17,766 ms. Patients with dystonic tics were older 24.4 vs. 16.5 years (P = 0.005) and had an older age at onset 12.9 vs. 7.2 years (P < 0.001), than patients without dystonic tics. The bivariate analysis showed an association between the presence of dystonic tics, greater tic severity and wider body distribution. The multivariate regression analysis showed a statistical association with older age at evaluation (P = 0.001), greater tic severity on video-recordings (P = 0.001) and co-occurrence with complex motor tics (P = 0.020). The presence of dystonic tics increased the risk for being considered for deep brain stimulation therapy, odds ratio: 15.7 (P = 0.002). CONCLUSION Dystonic tics, observed in about a third of patients with TS, are associated with increased severity of TS.
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He JL, Mikkelsen M, Huddleston DA, Crocetti D, Cecil KM, Singer HS, Edden RA, Gilbert DL, Mostofsky SH, Puts NA. Frequency and Intensity of Premonitory Urges-to-Tic in Tourette Syndrome Is Associated With Supplementary Motor Area GABA+ Levels. Mov Disord 2022; 37:563-573. [PMID: 34854494 PMCID: PMC9014425 DOI: 10.1002/mds.28868] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Individuals with Tourette syndrome (TS) often report that they express tics as a means of alleviating the experience of unpleasant sensations. These sensations are perceived as an urge to act and are referred to as premonitory urges. Premonitory urges have been the focus of recent efforts to develop interventions to reduce tic expression in those with TS. OBJECTIVE The aim of this study was to examine the contribution of brain γ-aminobutyric acid (GABA) and glutamate levels of the right primary sensorimotor cortex (SM1), supplementary motor area (SMA), and insular cortex (insula) to tic and urge severity in children with TS. METHODS Edited magnetic resonance spectroscopy was used to assess GABA+ (GABA + macromolecules) and Glx (glutamate + glutamine) of the right SM1, SMA, and insula in 68 children with TS (MAge = 10.59, SDAge = 1.33) and 41 typically developing control subjects (MAge = 10.26, SDAge = 2.21). We first compared GABA+ and Glx levels of these brain regions between groups. We then explored the association between regional GABA+ and Glx levels with urge and tic severity. RESULTS GABA+ and Glx of the right SM1, SMA, and insula were comparable between the children with TS and typically developing control subjects. In children with TS, lower levels of SMA GABA+ were associated with more severe and more frequent premonitory urges. Neither GABA+ nor Glx levels were associated with tic severity. CONCLUSIONS These results broadly support the role of GABAergic neurotransmission within the SMA in the experience of premonitory urges in children with TS. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jason L. He
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Mark Mikkelsen
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - David A. Huddleston
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Kim M. Cecil
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Harvey S. Singer
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland, USA,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Donald L. Gilbert
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Stewart H. Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicolaas A.J. Puts
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom,MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom,Correspondence to: Dr. Nicolaas Puts, Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AB, London, United Kingdom;
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22
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Bortolato M, Coffey BJ, Gabbay V, Scheggi S. Allopregnanolone: The missing link to explain the effects of stress on tic exacerbation? J Neuroendocrinol 2022; 34:e13022. [PMID: 34423500 PMCID: PMC8800948 DOI: 10.1111/jne.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022]
Abstract
The neurosteroid allopregnanolone (3α-hydroxy-5α-pregnan-20-one; AP) elicits pleiotropic effects in the central nervous system, ranging from neuroprotective and anti-inflammatory functions to the regulation of mood and emotional responses. Several lines of research show that the brain rapidly produces AP in response to acute stress to reduce the allostatic load and enhance coping. These effects not only are likely mediated by GABAA receptor activation but also result from the contributions of other mechanisms, such as the stimulation of membrane progesterone receptors. In keeping with this evidence, AP has been shown to exert rapid, potent antidepressant properties and has been recently approved for the therapy of moderate-to-severe postpartum depression. In addition to depression, emerging evidence points to the potential of AP as a therapy for other neuropsychiatric disorders, including anxiety, seizures, post-traumatic stress disorder and cognitive problems. Although this evidence has spurred interest in further therapeutic applications of AP, some investigations suggest that this neurosteroid may also be associated with adverse events in specific disorders. For example, our group has recently documented that AP increases tic-like manifestations in several animal models of tic disorders; furthermore, our results indicate that inhibiting AP synthesis and signalling reduces the exacerbation of tic severity associated with acute stress. Although the specific mechanisms of these effects remain partially elusive, our findings point to the possibility that the GABAergic activation by AP may also lead to disinhibitory effects, which could interfere with the ability of patients to suppress their tics. Future studies will be necessary to verify whether these mechanisms may apply to other externalising manifestations, such as impulse-control problems and manic symptoms.
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Affiliation(s)
- Marco Bortolato
- Department of Pharmacology and ToxicologyCollege of PharmacyUniversity of UtahSalt Lake CityUTUSA
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
| | - Barbara J. Coffey
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
- Department of Psychiatry and Behavioral ScienceMiller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Vilma Gabbay
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
- Department of Psychiatry and Behavioral SciencesAlbert Einstein College of MedicineBronxNYUSA
| | - Simona Scheggi
- Department of Molecular and Developmental MedicineSchool of MedicineUniversity of SienaSienaItaly
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23
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Narapareddy A, Eckland MR, Riordan HR, Cascio CJ, Isaacs DA. Altered Interoceptive Sensibility in Adults With Chronic Tic Disorder. Front Psychiatry 2022; 13:914897. [PMID: 35800022 PMCID: PMC9253400 DOI: 10.3389/fpsyt.2022.914897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Interoception refers to the sensing, interpretation, integration, and regulation of signals about the body's internal physiological state. Interoceptive sensibility is the subjective evaluation of interoceptive experience, as assessed by self-report measures, and is abnormal in numerous neuropsychiatric disorders. Research examining interoceptive sensibility in individuals with chronic tic disorders (CTDs), however, has yielded conflicting results, likely due to methodologic differences between studies and small sample sizes. OBJECTIVE We sought to compare interoceptive sensibility between adults with CTD and healthy controls, adjusting for co-occurring psychiatric symptoms, and to examine the relationship of interoceptive sensibility with other CTD clinical features, in particular, premonitory urge. METHODS We recruited adults with CTDs and sex- and age-matched healthy controls to complete the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), as well as a battery of measures assessing psychiatric symptoms prevalent in CTD populations. CTD participants additionally completed scales quantifying tic severity, premonitory urge severity, and health-related quality of life. We conducted between-group contrasts (Wilcoxon rank-sum test) for each MAIA-2 subscale, analyzed the effect of psychiatric symptoms on identified between-group differences (multivariable linear regression), and examined within-group relationships between MAIA-2 subscales and other clinical measures (Spearman rank correlations, multivariable linear regression). RESULTS Between adults with CTD (n = 48) and healthy controls (n = 48), MAIA-2 Noticing and Not-Worrying subscale scores significantly differed. After adjusting for covariates, lower MAIA-2 Not-Worrying subscale scores were significantly associated with female sex (β = 0.42, p < 0.05) and greater severity of obsessive-compulsive symptoms (β = -0.028, p < 0.01), but not with CTD diagnosis. After adjusting for severity of tics and obsessive-compulsive symptoms, a composite of MAIA-2 Noticing, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, and Trusting subscales (β = 2.52, p < 0.01) was significantly associated with premonitory urge. CONCLUSION Study results revealed three novel findings: adults with CTD experience increased anxiety-associated somatization and increased general body awareness relative to healthy controls; anxiety-associated somatization is more closely associated with sex and obsessive-compulsive symptoms than with CTD diagnosis; and increased general body awareness is associated with greater severity of premonitory urges.
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Affiliation(s)
| | - Michelle R Eckland
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Heather R Riordan
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
| | - Carissa J Cascio
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, United States.,Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, United States.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David A Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
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24
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Li Y, Yan J, Cui L, Chu J, Wang X, Huang X, Li Y, Cui Y. Protocol of a randomized controlled trial to investigate the efficacy and neural correlates of mindfulness-based habit reversal training in children with Tourette syndrome. Front Psychiatry 2022; 13:938103. [PMID: 36479556 PMCID: PMC9719972 DOI: 10.3389/fpsyt.2022.938103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) is a developmental neuropsychiatric disorder. Behavior therapy, especially habit reversal training (HRT), has gradually become regarded as one of the core therapies for TS. Mindfulness approaches can improve psychological adjustment and reduce stress and anxiety, suggesting potential benefits when incorporated into behavior therapy. To improve the efficacy of HRT, we combined it with mindfulness, an approach named mindfulness-based habitual reversal training (MHRT). The aim of this protocol is to investigate the efficacy and neural mechanisms of MHRT for TS. METHODS/DESIGN We will perform a randomized control trial (RCT) to evaluate the efficacy and neural mechanisms of MHRT. The sample will include 160 participants (including 120 patients with TS and 40 healthy controls). The patient sample will be randomly divided into three groups exposed to three different types of training: MHRT, HRT, and psychoeducation and supportive therapy (PST). Participants will be assessed and undergo resting-state fMRI scans at baseline and at the end of the 12-week training. The Yale Global Tic Severity Scale (YGTSS) and Premonitory Urge for Tic Scale (PUTS) will be used to assess the severity of tic symptoms and premonitory urges. The primary outcomes are change scores on the YGTSS and other assessments from baseline and the end of the training. The secondary outcomes are the neural correlates of these trainings among these groups based on graph theory, which is used to characterize brain functional connectivity networks. The default mode network (DMN) and the salience network (SN) will be assessed (which have been associated with mindfulness as well as the generation of tic symptoms) by network parameters, including clustering coefficients and shortest path lengths. Changes in these network parameters will be regarded as the neural correlates of the behavioral training. DISCUSSION MHRT was newly developed for the treatment of TS. MHRT may lead to greater reductions in tic severity than traditional HRT. Changes in the network parameters of the DMN and SN may show associations with the efficacy of MHRT. CLINICAL TRIAL REGISTRATION http://www.chictr.org.cn, ChiCTR2100053077, China.
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Affiliation(s)
- Yanlin Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Linyu Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jiahui Chu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xianbin Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xi Huang
- Cloud Services Innovation Laboratory, Institute of Intelligent Science and Technology, China Electronics Technology Group Corporation, Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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25
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Pateraki G, Anargyros K, Aloizou AM, Siokas V, Bakirtzis C, Liampas I, Tsouris Z, Ziogka P, Sgantzos M, Folia V, Peristeri E, Dardiotis E. Therapeutic application of rTMS in neurodegenerative and movement disorders: A review. J Electromyogr Kinesiol 2021; 62:102622. [PMID: 34890834 DOI: 10.1016/j.jelekin.2021.102622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive form of brain stimulation that makes use of the magnetic field generated when an electric current passes through a magnetic coil placed over the scalp. It can be applied as a single stimulus at a time, in pairs of stimuli, or repetitively in trains of stimuli (repetitive TMS, rTMS). RTMS can induce changes in brain activity, whose after-effects reflect the processes of long-term potentiation and long-term depression, as certain protocols, namely those using low frequencies (≤1 Hz) seem to suppress cortical excitability, while those using high frequencies (>1 Hz) seem to enhance it. It is a technique with very few and mostly mild side-effects, whose effects can persist for long time periods, and as such, it has been studied as a potential treatment option in a multitude of neurodegenerative diseases, including those affecting movement. Although rTMS has received approval as a treatment strategy of only a few aspects in movement disorders in the latest guidelines, its further use seems to also be promising in their context. In this review, we gathered the available literature on the therapeutic application of rTMS in movement disorders, namely Parkinson's disease, Amyotrophic Lateral Sclerosis, Huntington's disease, Dystonia, Tic disorders and Essential Tremor.
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Affiliation(s)
- Georgia Pateraki
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Anargyros
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Christos Bakirtzis
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Pinelopi Ziogka
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Markos Sgantzos
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasiliki Folia
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Peristeri
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
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26
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Bragdon LB, Eng GK, Belanger A, Collins KA, Stern ER. Interoception and Obsessive-Compulsive Disorder: A Review of Current Evidence and Future Directions. Front Psychiatry 2021; 12:686482. [PMID: 34512412 PMCID: PMC8424053 DOI: 10.3389/fpsyt.2021.686482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023] Open
Abstract
Disrupted interoceptive processes are present in a range of psychiatric conditions, and there is a small but growing body of research on the role of interoception in obsessive-compulsive disorder (OCD). In this review, we outline dimensions of interoception and review current literature on the processing of internal bodily sensations within OCD. Investigations in OCD utilizing objective measures of interoception are limited and results mixed, however, the subjective experience of internal bodily sensations appears to be atypical and relate to specific patterns of symptom dimensions. Further, neuroimaging investigations suggest that interoception is related to core features of OCD, particularly sensory phenomena and disgust. Interoception is discussed in the context of treatment by presenting an overview of existing interventions and suggesting how modifications aimed at better targeting interoceptive processes could serve to optimize outcomes. Interoception represents a promising direction for multi-method research in OCD, which we expect, will prove useful for improving current interventions and identifying new treatment targets.
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Affiliation(s)
- Laura B. Bragdon
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Goi Khia Eng
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Amanda Belanger
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Katherine A. Collins
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily R. Stern
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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27
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Zhang J, Kucyi A, Raya J, Nielsen AN, Nomi JS, Damoiseaux JS, Greene DJ, Horovitz SG, Uddin LQ, Whitfield-Gabrieli S. What have we really learned from functional connectivity in clinical populations? Neuroimage 2021; 242:118466. [PMID: 34389443 DOI: 10.1016/j.neuroimage.2021.118466] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 02/09/2023] Open
Abstract
Functional connectivity (FC), or the statistical interdependence of blood-oxygen dependent level (BOLD) signals between brain regions using fMRI, has emerged as a widely used tool for probing functional abnormalities in clinical populations due to the promise of the approach across conceptual, technical, and practical levels. With an already vast and steadily accumulating neuroimaging literature on neurodevelopmental, psychiatric, and neurological diseases and disorders in which FC is a primary measure, we aim here to provide a high-level synthesis of major concepts that have arisen from FC findings in a manner that cuts across different clinical conditions and sheds light on overarching principles. We highlight that FC has allowed us to discover the ubiquity of intrinsic functional networks across virtually all brains and clarify typical patterns of neurodevelopment over the lifespan. This understanding of typical FC maturation with age has provided important benchmarks against which to evaluate divergent maturation in early life and degeneration in late life. This in turn has led to the important insight that many clinical conditions are associated with complex, distributed, network-level changes in the brain, as opposed to solely focal abnormalities. We further emphasize the important role that FC studies have played in supporting a dimensional approach to studying transdiagnostic clinical symptoms and in enhancing the multimodal characterization and prediction of the trajectory of symptom progression across conditions. We highlight the unprecedented opportunity offered by FC to probe functional abnormalities in clinical conditions where brain function could not be easily studied otherwise, such as in disorders of consciousness. Lastly, we suggest high priority areas for future research and acknowledge critical barriers associated with the use of FC methods, particularly those related to artifact removal, data denoising and feasibility in clinical contexts.
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Affiliation(s)
- Jiahe Zhang
- Department of Psychology, 125 Nightingale Hall, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA.
| | - Aaron Kucyi
- Department of Psychology, 125 Nightingale Hall, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Jovicarole Raya
- Department of Psychology, 125 Nightingale Hall, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Ashley N Nielsen
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Jason S Nomi
- Department of Psychology, University of Miami, Miami, FL 33124, USA
| | - Jessica S Damoiseaux
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, MI 48202, USA
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA 92093, USA
| | | | - Lucina Q Uddin
- Department of Psychology, University of Miami, Miami, FL 33124, USA
| | - Susan Whitfield-Gabrieli
- Department of Psychology, 125 Nightingale Hall, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
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28
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Openneer TJC, van der Meer D, Marsman JBC, Forde NJ, Akkermans SEA, Naaijen J, Buitelaar JK, Hoekstra PJ, Dietrich A. Impaired response inhibition during a stop-signal task in children with Tourette syndrome is related to ADHD symptoms: A functional magnetic resonance imaging study. World J Biol Psychiatry 2021; 22:350-361. [PMID: 32821008 DOI: 10.1080/15622975.2020.1813329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Tourette syndrome (TS) is characterised by the presence of sudden, rapid movements and vocalizations (tics). The nature of tics suggests impairments in inhibitory control. However, findings of impaired inhibitory control have so far been inconsistent, possibly due to small sample sizes, wide age ranges, or not taking medication use or attention-deficit/hyperactivity disorder (ADHD) comorbidity into account. METHODS We investigated group differences in response inhibition using an fMRI-based stop-signal task in 103 8 to 12-year-old children (n = 51 with TS, of whom n = 28 without comorbid ADHD [TS - ADHD] and n = 23 with comorbid ADHD [TS + ADHD]; and n = 52 healthy controls), and related these measures to tic and ADHD severity. RESULTS We observed an impaired response inhibition performance in children with TS + ADHD, but not in those with TS - ADHD, relative to healthy controls, as evidenced by a slower stop-signal reaction time, slower mean reaction times, and larger variability of reaction times. Dimensional analyses implicated ADHD severity as the driving force in these findings. Neural activation during failed inhibition was stronger in the inferior frontal gyrus and temporal and parietal areas in TS + ADHD compared to healthy controls. CONCLUSIONS Impaired inhibitory performance and increased neural activity in TS appear to manifest predominantly in relation to ADHD symptomatology.
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Affiliation(s)
- Thaïra J C Openneer
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dennis van der Meer
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Faculty of Health, Medicine and Life Sciences, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jan-Bernard C Marsman
- Neuroimaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Natalie J Forde
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Sophie E A Akkermans
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jilly Naaijen
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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29
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Jurgiel J, Miyakoshi M, Dillon A, Piacentini J, Makeig S, Loo SK. Inhibitory control in children with tic disorder: aberrant fronto-parietal network activity and connectivity. Brain Commun 2021; 3:fcab067. [PMID: 33977267 PMCID: PMC8093924 DOI: 10.1093/braincomms/fcab067] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/03/2022] Open
Abstract
Chronic tic disorders, including Tourette syndrome, are typically thought to have deficits in cognitive inhibition and top down cognitive control due to the frequent and repetitive occurrence of tics, yet studies reporting task performance results have been equivocal. Despite similar behavioural performance, individuals with chronic tic disorder have exhibited aberrant patterns of neural activation in multiple frontal and parietal regions relative to healthy controls during inhibitory control paradigms. In addition to these top down attentional control regions, widespread alterations in brain activity across multiple neural networks have been reported. There is a dearth, however, of studies examining event-related connectivity during cognitive inhibitory paradigms among affected individuals. The goal of this study was to characterize neural oscillatory activity and effective connectivity, using a case–control design, among children with and without chronic tic disorder during performance of a cognitive inhibition task. Electroencephalogram data were recorded in a cohort of children aged 8–12 years old (60 with chronic tic disorder, 35 typically developing controls) while they performed a flanker task. While task accuracy did not differ by diagnosis, children with chronic tic disorder displayed significant cortical source-level, event-related spectral power differences during incongruent flanker trials, which required inhibitory control. Specifically, attenuated broad band oscillatory power modulation within the anterior cingulate cortex was observed relative to controls. Whole brain effective connectivity analyses indicated that children with chronic tic disorder exhibit greater information flow between the anterior cingulate and other fronto-parietal network hubs (midcingulate cortex and precuneus) relative to controls, who instead showed stronger connectivity between central and posterior nodes. Spectral power within the anterior cingulate was not significantly correlated with any connectivity edges, suggesting lower power and higher connectivity are independent (versus resultant) neural mechanisms. Significant correlations between clinical features, task performance and anterior cingulate spectral power and connectivity suggest this region is associated with tic impairment (r = −0.31, P = 0.03) and flanker task incongruent trial accuracy (r’s = −0.27 to −0.42, P’s = 0.0008–0.04). Attenuated activation of the anterior cingulate along with dysregulated information flow between and among nodes within the fronto-parietal attention network may be neural adaptations that result from frequent engagement of neural pathways needed for inhibitory control in chronic tic disorder.
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Affiliation(s)
- Joseph Jurgiel
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Makoto Miyakoshi
- Swartz Center for Neural Computation, University of California, San Diego, La Jolla, CA 92093, USA
| | - Andrea Dillon
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Scott Makeig
- Swartz Center for Neural Computation, University of California, San Diego, La Jolla, CA 92093, USA
| | - Sandra K Loo
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Johnson KA, Duffley G, Anderson DN, Ostrem JL, Welter ML, Baldermann JC, Kuhn J, Huys D, Visser-Vandewalle V, Foltynie T, Zrinzo L, Hariz M, Leentjens AFG, Mogilner AY, Pourfar MH, Almeida L, Gunduz A, Foote KD, Okun MS, Butson CR. Structural connectivity predicts clinical outcomes of deep brain stimulation for Tourette syndrome. Brain 2020; 143:2607-2623. [PMID: 32653920 DOI: 10.1093/brain/awaa188] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/12/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
Deep brain stimulation may be an effective therapy for select cases of severe, treatment-refractory Tourette syndrome; however, patient responses are variable, and there are no reliable methods to predict clinical outcomes. The objectives of this retrospective study were to identify the stimulation-dependent structural networks associated with improvements in tics and comorbid obsessive-compulsive behaviour, compare the networks across surgical targets, and determine if connectivity could be used to predict clinical outcomes. Volumes of tissue activated for a large multisite cohort of patients (n = 66) implanted bilaterally in globus pallidus internus (n = 34) or centromedial thalamus (n = 32) were used to generate probabilistic tractography to form a normative structural connectome. The tractography maps were used to identify networks that were correlated with improvement in tics or comorbid obsessive-compulsive behaviour and to predict clinical outcomes across the cohort. The correlated networks were then used to generate 'reverse' tractography to parcellate the total volume of stimulation across all patients to identify local regions to target or avoid. The results showed that for globus pallidus internus, connectivity to limbic networks, associative networks, caudate, thalamus, and cerebellum was positively correlated with improvement in tics; the model predicted clinical improvement scores (P = 0.003) and was robust to cross-validation. Regions near the anteromedial pallidum exhibited higher connectivity to the positively correlated networks than posteroventral pallidum, and volume of tissue activated overlap with this map was significantly correlated with tic improvement (P < 0.017). For centromedial thalamus, connectivity to sensorimotor networks, parietal-temporal-occipital networks, putamen, and cerebellum was positively correlated with tic improvement; the model predicted clinical improvement scores (P = 0.012) and was robust to cross-validation. Regions in the anterior/lateral centromedial thalamus exhibited higher connectivity to the positively correlated networks, but volume of tissue activated overlap with this map did not predict improvement (P > 0.23). For obsessive-compulsive behaviour, both targets showed that connectivity to the prefrontal cortex, orbitofrontal cortex, and cingulate cortex was positively correlated with improvement; however, only the centromedial thalamus maps predicted clinical outcomes across the cohort (P = 0.034), but the model was not robust to cross-validation. Collectively, the results demonstrate that the structural connectivity of the site of stimulation are likely important for mediating symptom improvement, and the networks involved in tic improvement may differ across surgical targets. These networks provide important insight on potential mechanisms and could be used to guide lead placement and stimulation parameter selection, as well as refine targets for neuromodulation therapies for Tourette syndrome.
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Affiliation(s)
- Kara A Johnson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Gordon Duffley
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Daria Nesterovich Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA.,Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Jill L Ostrem
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Marie-Laure Welter
- Institut du Cerveau et de la Moelle Epiniere, Sorbonne Universités, University of Pierre and Marie Curie University of Paris, the French National Institute of Health and Medical Research U 1127, the National Center for Scientific Research 7225, Paris, France
| | - Juan Carlos Baldermann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Johanniter Hospital Oberhausen, EVKLN, Oberhausen, Germany
| | - Daniel Huys
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Thomas Foltynie
- Functional Neurosurgery Unit, Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Marwan Hariz
- Functional Neurosurgery Unit, Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK.,Department of Clinical Neuroscience, Umea University, Umea, Sweden
| | - Albert F G Leentjens
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alon Y Mogilner
- Center for Neuromodulation, New York University Langone Medical Center, New York, New York, USA
| | - Michael H Pourfar
- Center for Neuromodulation, New York University Langone Medical Center, New York, New York, USA
| | - Leonardo Almeida
- Norman Fixel Institute for Neurological Diseases , Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases , Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA.,J Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases , Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases , Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Christopher R Butson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA.,Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.,Departments of Neurology and Psychiatry, University of Utah, Salt Lake City, Utah, USA
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31
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Kleimaker M, Kleimaker A, Weissbach A, Colzato LS, Beste C, Bäumer T, Münchau A. Non-invasive Brain Stimulation for the Treatment of Gilles de la Tourette Syndrome. Front Neurol 2020; 11:592258. [PMID: 33244309 PMCID: PMC7683779 DOI: 10.3389/fneur.2020.592258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022] Open
Abstract
Gilles de la Tourette Syndrome is a multifaceted neuropsychiatric disorder typically commencing in childhood and characterized by motor and phonic tics. Its pathophysiology is still incompletely understood. However, there is convincing evidence that structural and functional abnormalities in the basal ganglia, in cortico-striato-thalamo-cortical circuits, and some cortical areas including medial frontal regions and the prefrontal cortex as well as hyperactivity of the dopaminergic system are key findings. Conventional therapeutic approaches in addition to counseling comprise behavioral treatment, particularly habit reversal therapy, oral pharmacotherapy (antipsychotic medication, alpha-2-agonists) and botulinum toxin injections. In treatment-refractory Tourette syndrome, deep brain stimulation, particularly of the internal segment of the globus pallidus, is an option for a small minority of patients. Based on pathophysiological considerations, non-invasive brain stimulation might be a suitable alternative. Repetitive transcranial magnetic stimulation appears particularly attractive. It can lead to longer-lasting alterations of excitability and connectivity in cortical networks and inter-connected regions including the basal ganglia through the induction of neural plasticity. Stimulation of the primary motor and premotor cortex has so far not been shown to be clinically effective. Some studies, though, suggest that the supplementary motor area or the temporo-parietal junction might be more appropriate targets. In this manuscript, we will review the evidence for the usefulness of repetitive transcranial magnetic stimulation and transcranial electric stimulation as treatment options in Tourette syndrome. Based on pathophysiological considerations we will discuss the rational for other approaches of non-invasive brain stimulation including state informed repetitive transcranial magnetic stimulation.
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Affiliation(s)
- Maximilian Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Alexander Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Lorenza S Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
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Bhikram T, Crawley A, Arnold P, Abi-Jaoude E, Sandor P. Neuroimaging the emotional modulation of urge inhibition in Tourette Syndrome. Cortex 2020; 135:341-351. [PMID: 33317808 DOI: 10.1016/j.cortex.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 05/24/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
Tourette Syndrome (TS) is a neuropsychiatric condition characterized by tics that are typically preceded by uncomfortable urges that build until the tic is performed. Both tics and their associated urges are commonly exacerbated during states of heightened emotion. However, the neural substrates that are responsible for the development of urges have not been fully elucidated, particularly with regards to the influence of emotion. In this study, we investigate the brain areas associated with the development of urges and their modulation by emotion in patients with TS. Moreover, we explore the influence of obsessive-compulsive symptoms (OCS) which are commonly comorbid in TS. Forty patients with TS and 20 healthy controls completed an emotional blink suppression paradigm while undergoing functional magnetic resonance imaging. For the paradigm, participants completed alternating blocks of blink inhibition and free blinking while viewing pictures of angry and neutral facial expressions. Compared to controls, patients exhibited greater activity in the superior temporal gyrus and midcingulate during the inhibition of urges. Within the patient group, tic severity was associated with activity in the superior frontal gyrus during the angry inhibition contrast as compared to neutral; greater premonitory urge severity was associated with greater activity in the hippocampus, middle temporal gyrus and in the subcortex; blink inhibition ability was negatively associated with activity in the thalamus and insula. There were no significant associations with OCS severity for the emotion-related contrasts. The observed activated regions may represent a network that produces urges in patients, or alternatively, could represent compensatory cortical activity needed to keep urges and tics under control during emotional situations. Additionally, our findings suggest that OCS in the context of TS is similar to traditional obsessive-compulsive disorder and is neurobiologically dissociable from tics.
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Affiliation(s)
- Tracy Bhikram
- Tourette Syndrome Neurodevelopmental Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - Adrian Crawley
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Program in Genetics and Genomic Biology, University of Calgary, Calgary, Alberta, Canada
| | - Elia Abi-Jaoude
- Tourette Syndrome Neurodevelopmental Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Sandor
- Tourette Syndrome Neurodevelopmental Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Child Psychiatry, Department of Psychiatry, Youthdale Treatment Centers, Toronto, Ontario, Canada.
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Yan J, Yu L, Wen F, Wang F, Liu J, Cui Y, Li Y. The severity of obsessive-compulsive symptoms in Tourette syndrome and its relationship with premonitory urges: a meta-analysis. Expert Rev Neurother 2020; 20:1197-1205. [PMID: 32954857 DOI: 10.1080/14737175.2020.1826932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Nearly half of the patients with Tourette Syndrome (TS) present with comorbid Obsessive-Compulsive Symptoms (OCS) and premonitory urges (PUs). However, inconsistent results have been found in the correlation between PUs and OCS in patients with TS. METHODS A meta-analysis was applied to identify the severity of OCS and its correlation with PUs in TS patients. Subgroup and meta-regression analyses were used to identify potential heterogeneity. RESULTS A total of 13 studies, including 576 patients, were enrolled in this study. The pooled correlation coefficient (r) was 0.29 (95% confidence interval: 0.18, 0.38) and heterogeneity (I2) of pooled r was 40% based on a fixed-effect model. The mean level of OCS based on the assessment of Children's Yale-Brown Obsessive-Compulsive Symptom Scale/Yale-Brown Obsessive-Compulsive Symptom Scale was 14.99 (95% CI: 11.41, 18.57) by a random effect model. Results of meta-regression analysis demonstrated that the severity of tic symptoms based on the assessment of the Yale Global Tic Severity Scale was the predictor of severity of OCS (p = 0.018). CONCLUSION There was a mild positive correlation between the PUs and OCS in patients with TS. The severity of OCS in TS patients was mild to moderate and positively predicted by the severity of tic symptoms.
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Affiliation(s)
- Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Liping Yu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Fang Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Jingran Liu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
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Hsu CJ, Wong LC, Wang HP, Lee WT. The multimodality neuroimage findings in individuals with Tourette syndrome. Pediatr Neonatol 2020; 61:467-474. [PMID: 32284198 DOI: 10.1016/j.pedneo.2020.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/28/2020] [Accepted: 03/06/2020] [Indexed: 01/03/2023] Open
Abstract
Chronic tic disorder and Gilles de la Tourette syndrome are very common childhood-onset diseases. However, the pathophysiology underlying these disorders is not yet clear and most studies focus on the disinhibition of the cortico-striatal-thalamo-cortical circuit. Although dysfunction of this circuit is possible, routine clinical neuroimaging studies such as T1-weighted or T2-weighted MRI usually reveal normal results. Therefore, special neuroimaging techniques may be needed to investigate the possible microstructural or functional changes in the brain. Previous structural studies, such as those using diffusion tensor imaging, and volumetric MRI studies, revealed the main abnormalities to be located in the cortico-striatal-thalamo-cortical circuit and to be related to brain regions such as basal ganglion, thalamus, frontal cortex, and motor cortex. Some other potential regions, such as the amygdala, hippocampus or cerebellum, are also occasionally reported. Perfusion studies, such as those using positron emission tomography or functional MRI, also suggest hemodynamic changes over those brain regions related to the cortico-striatal-thalamo-cortical circuit. However, the results can be different in adult and pediatric groups, and neuroimaging findings are also inconsistent between different studies, which may reflect the high diversity of this disease or differences in enrolled patient groups with different comorbidities. Therefore, in this review article, we will focus on the neuroimaging findings relating to Tourette syndrome in different age groups using different imaging techniques.
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Affiliation(s)
- Chia-Jui Hsu
- Department of Pediatrics, Taipei City Hospital, Yangming Branch, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lee Chin Wong
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Pei Wang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Wang-Tso Lee
- Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan.
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Resting-state functional connectivity in drug-naive pediatric patients with Tourette syndrome and obsessive-compulsive disorder. J Psychiatr Res 2020; 129:129-140. [PMID: 32912593 DOI: 10.1016/j.jpsychires.2020.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
Previous studies in cohorts of Tourette syndrome (TS) or obsessive-compulsive disorder (OCD) patients have not clarified whether these two disorders represent two clinical conditions or they are distinct clinical phenotypes of a common disease spectrum. The study aimed to compare functional connectivity (FC) patterns in a pediatric drug-naive cohort of 16 TS patients without any comorbidity (TS), 14 TS patients with OCD (TS + OCD), and 10 pure OCD patients as well as 11 matched controls that underwent resting state fMRI. Via independent component analysis, we examined FC in the basal ganglia (BGN), sensorimotor (SMN), cerebellum (CBN), frontoparietal (FPN), default-mode (DMN), orbitofrontal (OBFN), and salience (SAN) networks among the above cohorts and their association with clinical measures. Compared to controls, TS and TS + OCD patients showed higher FC in the BGN, SMN, CBN and DMN and lower FC in the FPN and SAN. The TS and TS + OCD groups showed comparable FC in all networks. In contrast to controls, OCD patients exhibited increased FC in the BGN, SMN, CBN, DMN, FPN, and SAN. OCD patients also showed higher FC in CBN and FPN when compared with TS and TS + OCD patients both separately and as one group. Tic severity negatively correlated with FC in CBN and FPN in the TS group, while the compulsiveness scores positively correlated with the same two networks in OCD patients. Our findings suggest common FC changes in TS and TS + OCD patients. In contrast, OCD is characterized by a distinctive pattern of FC changes prominently involving the CBN and FPN.
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Conte G, Valente F, Fioriello F, Cardona F. Rage attacks in Tourette Syndrome and Chronic Tic Disorder: a systematic review. Neurosci Biobehav Rev 2020; 119:21-36. [PMID: 32980398 DOI: 10.1016/j.neubiorev.2020.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 01/10/2023]
Abstract
Tourette syndrome (TS) and chronic motor/vocal tic disorder (CTD) are neurodevelopmental conditions defined by the occurrence of multiple tics. Besides the well-known association with attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), rage attacks (RA) represent common and detrimental symptoms for patients. Inorder to explore prevalence of RA in tic disorders, relation to tic severity/comorbidities and available treatments, we performed a systematic literature review based on PRISMA Guidelines. 32 studies published between January 2008 - December 2019 were deemed suitable for the analysis and provided a prevalence of 20-67 %. Most findings showed a direct correlation with tic severity and a significant impact on psychosocial functioning. Although apparently related to comorbid ADHD, RA also frequently occur as independent manifestations. Association with other comorbidities, such as OCD, impulse control and mood disorders has also been reported, not yet fully established. Behavioral interventions appear to be effective, whereas there is limited evidence concerning the efficacy of medication. In TS/CTD, RA may be regarded as a major comorbidity that requires clinical investigation in order to develop personalized treatments.
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Affiliation(s)
- Giulia Conte
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome - Italy, Via dei Sabelli, 108, 00185 Rome, Italy.
| | - Francesca Valente
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome - Italy, Via dei Sabelli, 108, 00185 Rome, Italy.
| | - Francesca Fioriello
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome - Italy, Via dei Sabelli, 108, 00185 Rome, Italy.
| | - Francesco Cardona
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome - Italy, Via dei Sabelli, 108, 00185 Rome, Italy.
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Sigurdsson HP, Jackson SR, Kim S, Dyke K, Jackson GM. A feasibility study for somatomotor cortical mapping in Tourette syndrome using neuronavigated transcranial magnetic stimulation. Cortex 2020; 129:175-187. [DOI: 10.1016/j.cortex.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/06/2020] [Accepted: 04/21/2020] [Indexed: 01/20/2023]
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38
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Naro A, Billeri L, Colucci VP, Le Cause M, De Domenico C, Ciatto L, Bramanti P, Bramanti A, Calabrò RS. Brain functional connectivity in chronic tic disorders and Gilles de la Tourette syndrome. Prog Neurobiol 2020; 194:101884. [PMID: 32659317 DOI: 10.1016/j.pneurobio.2020.101884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/27/2020] [Accepted: 07/07/2020] [Indexed: 01/23/2023]
Abstract
The pathophysiology of chronic tic disorder (cTD) and Gilles de la Tourette syndrome (GTS) is characterized by the dysfunction of both motor and non - motor cortico - striatal - thalamo - cortical (CSTC) circuitries, which leads to tic release and comorbids. A role of fronto - parietal network (FPN) connectivity breakdown has been postulated for tic pathogenesis, given that the FPN entertain connections with limbic, paralimbic, and CSTC networks. Our study was aimed at characterizing the FPN functional connectivity in cTD and GTS in order to assess the role of its deterioration in tic severity and the degree of comorbids. We recorded scalp EEG during resting state in patients with cTD and GTS. The eLORETA current source densities were analyzed, and the lagged phase synchronization (LPS) was calculated to estimate nonlinear functional connectivity between cortical areas. We found that the FPN functional connectivity in delta band was more detrimental in more severe GTS patients. Also, the sensorimotor functional connectivity in beta2 band was stronger in more severe cTD and GTS patients. FPN functional connectivity deterioration correlated with comorbids presence and severity in patients with GTS. Our data suggest that a FPN disconnection may contribute to the motoric symptomatology and comorbid severity in GTS, whereas sensorimotor disconnection may contribute to tic severity in cTD and GTS. Although preliminary, our study points out a differently disturbed brain connectivity between patients with cTD and GTS. This may serve as diagnostic marker and potentially interesting base to develop pharmacological and noninvasive neuromodulation trials aimed at reducing tic symptomatology.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | | | - Laura Ciatto
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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39
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Jackson SR, Loayza J, Crighton M, Sigurdsson HP, Dyke K, Jackson GM. The role of the insula in the generation of motor tics and the experience of the premonitory urge-to-tic in Tourette syndrome. Cortex 2020; 126:119-133. [DOI: 10.1016/j.cortex.2019.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/08/2019] [Accepted: 12/13/2019] [Indexed: 01/18/2023]
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Mainka T, Di Costa S, Borngräber F, Barow E, Münchau A, Ganos C, Haggard P. Learning volition: A longitudinal study of developing intentional awareness in Tourette syndrome. Cortex 2020; 129:33-40. [PMID: 32422423 DOI: 10.1016/j.cortex.2020.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
Tourette syndrome (TS) is characterized by the presence of involuntary movements (tics) which are, at least partly, generated within 'voluntary' motor pathways. Here we reassess 16 TS patients (age 19 ± 2.3 years) who participated in a mental chronometry study of volition 5.5 years previously (Ganos C et al. Cortex. 2015 Mar.; 64:47-54), and 16 age-matched controls. Participants estimated the time of their own voluntary movements (Libet's M judgement), or of conscious intention to make voluntary movements (Libet's W judgement), in separate blocks. We considered M judgement as a control condition. Therefore, the experience of an intention to move occurring prior to actual movement onset, as measured by the W-M gap, was taken as the cardinal feature of volition. Time estimates of the TS group did not differ significantly from controls, for either M or W judgement. Further, M and W time estimates in the TS group had not changed significantly between the two assessments. However, exploratory analyses revealed a strong relation between disease duration and the development of M- and W-judgements: the longer was the disease duration, the less was the developmental increase in the W-M gap (linear regression, p = .003). In conclusion, our results suggest compromised development of experience of volition in developing TS patients. The developmental difficulty in processing internal premotor signals for voluntary actions could reflect the chronic persistence of tics from adolescence to adulthood.
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Affiliation(s)
- Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Steven Di Costa
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Friederike Borngräber
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Ewgenia Barow
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK.
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Sato F, Kado S, Tsutsumi Y, Tachibana Y, Ikenoue E, Furuta T, Uchino K, Bae YC, Uzawa N, Yoshida A. Ascending projection of jaw-closing muscle-proprioception to the intralaminar thalamic nuclei in rats. Brain Res 2020; 1739:146830. [PMID: 32278724 DOI: 10.1016/j.brainres.2020.146830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
Abstract
An invasive intralaminar thalamic stimulation and a non-invasive application of oral splint are both effective in treating tic symptoms of patients with Tourette syndrome (TS). Therefore, these two treatments may exert some influence on the same brain region in TS patients. We thus hypothesized that the proprioceptive input arising from the muscle spindles of jaw-closing muscles (JCMSs), known to be increased by the application of oral splint, is transmitted to the intralaminar thalamic nuclei. To test this issue, we morphologically and electrophysiologically examined the thalamic projections of proprioceptive input from the JCMSs to the intralaminar thalamic nuclei of rats. We first injected an anterograde tracer, biotinylated dextranamine, into the electrophysiologically identified supratrigeminal nucleus, which is known to receive proprioceptive inputs from the JCMSs via the trigeminal mesencephalic neurons. A moderate number of biotinylated dextranamine-labeled axon terminals were bilaterally distributed in the oval paracentral nucleus (OPC) of the intralaminar thalamic nuclei. We also detected electrophysiological responses to the electrical stimulation of bilateral masseter nerves and to sustained jaw-opening in the OPC. After injection of retrograde tracer (cholera toxin B subunit or Fluorogold) into the OPC, neuronal cell bodies were retrogradely labeled in the rostrodorsal portion of the bilateral supratrigeminal nucleus. Here, we show that proprioceptive inputs from the JCMSs are conveyed to the OPC in the intralaminar nuclei via the supratrigeminal nucleus. This study can help to understand previously unrecognized pathways of proprioception ascending inputs from the brainstem to the thalamus, which may contribute to treatments of TS patients.
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Affiliation(s)
- Fumihiko Sato
- Department of Oral Anatomy and Neurobiology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Seiya Kado
- Department of Oral Anatomy and Neurobiology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan; Department of Oral and Maxillofacial Surgery 2, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Yumi Tsutsumi
- Department of Oral Anatomy and Neurobiology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Yoshihisa Tachibana
- Division of System Neuroscience, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Etsuko Ikenoue
- Department of Oral Anatomy and Neurobiology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Takahiro Furuta
- Department of Oral Anatomy and Neurobiology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Katsuro Uchino
- Department of Oral Anatomy and Neurobiology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan; Department of Acupuncture, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo 666-0162, Japan
| | - Yong Chul Bae
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu 700-412, Republic of Korea
| | - Narikazu Uzawa
- Department of Oral and Maxillofacial Surgery 2, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Atsushi Yoshida
- Department of Oral Anatomy and Neurobiology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan.
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The functional connectivity profile of tics and obsessive-compulsive symptoms in Tourette Syndrome. J Psychiatr Res 2020; 123:128-135. [PMID: 32065948 DOI: 10.1016/j.jpsychires.2020.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 11/24/2022]
Abstract
Tourette Syndrome (TS) is characterized by the presence of tics and sensory phenomena, such as premonitory urges, and is often accompanied by significant obsessive-compulsive symptoms (OCS). The goal of this exploratory study was to determine the association between functional connectivity and the different symptom domains of TS, as little is currently known about how they differ. Resting-state functional magnetic resonance imaging was performed in 39 patients with TS and 20 matched healthy controls. Seed-based functional connectivity of the supplementary motor area (SMA), orbitofrontal cortex (OFC), insula, caudate and putamen were compared between the groups, and correlated with clinical measures within the patient group. When compared to controls, patients with TS exhibited greater connectivity between the temporal gyri, insula and putamen, and between the OFC and cingulate cortex. Tic severity was associated with greater connectivity between the putamen and the sensorimotor cortex; OCS severity was associated with less connectivity between the SMA and thalamus and between the caudate and precuneus; and premonitory urge severity was associated with less connectivity between the OFC and sensorimotor cortex and between the inferior frontal gyrus and the putamen and insula seeds. Functional connectivity within sensorimotor processing regions were associated with all of the investigated symptom domains, including OCS, suggesting dysfunctions in the sensorimotor system may explain most of the observed symptoms in TS, and not just tics.
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Examining the functional activity of different obsessive-compulsive symptom dimensions in Tourette syndrome. NEUROIMAGE-CLINICAL 2020; 26:102198. [PMID: 32062563 PMCID: PMC7025096 DOI: 10.1016/j.nicl.2020.102198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
Patients with Tourette Syndrome completed an obsessive–compulsive provocation task. Patients reported higher anxiety for the provocation conditions than did controls. Group differences found in the insula, sensorimotor cortex and supramarginal gyri. Obsessive–compulsive severity associated with frontal and parietal lobe activity. Tic severity associated with anterior cingulate activity for the symmetry condition.
Objectives Tourette syndrome (TS) is commonly comorbid with obsessive–compulsive disorder (OCD) and many phenomenological similarities exist between tics and obsessive–compulsive symptoms (OCS). Therefore, due to the clinical importance of comorbid OCD, the goal of this study was to investigate the neural substrates of OCS in TS using functional magnetic resonance imaging. Methods Forty patients with TS and 20 healthy controls underwent functional magnetic resonance imaging while viewing blocks of OCS-provoking pictures relating to washing, checking and symmetry symptoms, as well as generally disgusting and neutral scenes. Statistical comparisons were made between patients with moderate/severe OCS, absent/mild OCS and healthy controls. As well, within the entire TS patient group, significant associations with clinical measures were assessed for each of the provocation conditions. Results Group differences in the insula, sensorimotor cortex, supramarginal gyrus and visual processing regions were common among the checking, washing and disgust conditions. In the patient group, negative associations between OCS severity and activity in the supramarginal gyrus, inferior frontal gyrus, sensorimotor cortex, precuneus and visual processing regions were common among the provocation conditions. Tic severity was only associated with activity in the anterior cingulate cortex for the symmetry condition. Conclusion Our findings implicate areas previously reported to be involved in OCD, as well as areas not typically implicated in OCD, suggesting that the neurobiological profile of TS+OCD is intermediate to pure TS and pure OCD.
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Abstract
OBJECTIVE Misophonia is a condition characterized by the dislike or hatred (miso) of specific sounds (phonia) that results in an extreme emotional response. There has been growing interest in misophonia, with emerging evidence from neurodevelopmental populations and ongoing debate regarding the psychiatric classification and the mechanisms underlying this phenomenon. This is the first article to report on misophonic experiences and associated clinical characteristics in young people with tic disorders. METHOD In this article, we present the cases of 12 children and young people with tic disorders who have attended clinics in the United Kingdom and Italy who report misophonia. Misophonia was classified as a selective aversive response in accordance with the criteria proposed by Schröder. RESULTS These cases support the view that a range of auditory stimuli may lead to negative/aversive emotional responses of varying degrees, with misophonia seeming to contribute to behavioral reactions. Among these, the most frequent was anger outbursts, followed by an increase in tics, trigger avoidance, repetition of the sound, and self-injurious behavior. No single treatment approach was effective, with some patients responding to cognitive behavioral therapies and others to pharmacological support. CONCLUSION We postulate that misophonia could be an underestimated causative phenomenon for abrupt emotional dysregulation in individuals with tic disorders and should be considered as part of a comprehensive clinical assessment. This article presents findings of relevance to general discussions regarding the classification of misophonia, as well as the potential relationship between sensory abnormalities and the broader phenotype of tic disorders during development.
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Ramkiran S, Heidemeyer L, Gaebler A, Shah NJ, Neuner I. Alterations in basal ganglia-cerebello-thalamo-cortical connectivity and whole brain functional network topology in Tourette's syndrome. NEUROIMAGE-CLINICAL 2019; 24:101998. [PMID: 31518769 PMCID: PMC6742843 DOI: 10.1016/j.nicl.2019.101998] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/12/2019] [Accepted: 08/30/2019] [Indexed: 01/19/2023]
Abstract
Tourette Syndrome (TS) is a neuropsychiatric disorder characterized by the presence of motor and vocal tics. Major pathophysiological theories posit a dysfunction of the cortico-striato-thalamo-cortical circuits as being a representative hallmark of the disease. Recent evidence suggests a more widespread dysfunction of brain networks in TS including the cerebellum and going even beyond classic motor pathways. In order to characterize brain network dysfunction in TS, in this study we investigated functional and effective-like connectivity as well as topological changes of basal ganglia-thalamo-cortical and cortico-cerebellar brain networks. We collected resting-state fMRI data from 28 TS patients (age: 32 ± 11 years) and 28 age-matched, healthy controls (age: 31 ± 9 years). Region of interest based (ROI-ROI) bivariate correlation and ROI-ROI bivariate regression were employed as measures of functional and effective-like connectivity, respectively. Graph theoretical measures of centrality (degree, cost, betweenness centrality), functional segregation (clustering coefficient, local efficiency) and functional integration (average path length, global efficiency) were used to assess topological brain network changes. In this study, TS patients exhibited increased basal ganglia-cortical and thalamo-cortical connectivity, reduced cortico-cerebellar connectivity, and an increase in parallel communication through the basal ganglia, thalamus and cerebellum (increased global efficiency). Additionally, we observed a reduction in serial information transfer (reduction in average path length) within the default mode and the salience network. In summary, our findings show that TS is characterized by increased connectivity and functional integration of multiple basal ganglia-thalamo-cortical circuits, suggesting a predominance of excitatory neurotransmission and a lack of brain maturation. Moreover, topological changes of cortico-cerebellar and brain networks involved in interoception may be underestimated neural correlates of tics and the crucial premonitory urge feeling.
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Affiliation(s)
- Shukti Ramkiran
- Institute of Neuroscience and Medicine 4 (INM-4), Forschungszentrum Juelich, Juelich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - BRAIN - Translational Medicine, Germany.
| | - Larissa Heidemeyer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Arnim Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine 4 (INM-4), Forschungszentrum Juelich, Juelich, Germany; JARA - BRAIN - Translational Medicine, Germany; Department of Neurology, RWTH Aachen University, Aachen, Germany; Institute of Neuroscience and Medicine 11 (INM-11), JARA, Forschungszentrum Juelich, Juelich, Germany
| | - Irene Neuner
- Institute of Neuroscience and Medicine 4 (INM-4), Forschungszentrum Juelich, Juelich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - BRAIN - Translational Medicine, Germany
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Kyriazi M, Kalyva E, Vargiami E, Krikonis K, Zafeiriou D. Premonitory Urges and Their Link With Tic Severity in Children and Adolescents With Tic Disorders. Front Psychiatry 2019; 10:569. [PMID: 31474885 PMCID: PMC6702331 DOI: 10.3389/fpsyt.2019.00569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022] Open
Abstract
Tics wax and wane regarding their severity, while their expression is affected by non-motor sensory or cognitive elements that are mostly known as "premonitory urges." Since premonitory urges are often used in non-pharmacological interventions to decrease tic severity, it is of interest in the present study to examine whether premonitory urges can actually predict tic severity. Fifty-two children and adolescents diagnosed with tics and Tourette syndrome (29 children with provisional tic disorder, 16 children with chronic motor tic disorder, and 7 children with Tourette syndrome) were included in the study. Their age ranged between 6 and 15.7 years (mean age 9 years and 2 months). All participants completed the YGTSS (Yale Global Tic Severity Scale) in order to assess tic severity and the Premonitory Urge for Tics Scale (PUTS) to measure premonitory urges (PU). Regression analysis revealed that PU were present at a higher rate in older subjects (>12 years of age) than in younger children and with a higher level of tic severity. Although the presence of PU was associated with tic severity across the entire age range, there was a stronger association between PU and tic severity in older children. A better insight into the pathophysiology of premonitory urges could possibly lead to the identification of new therapeutic modalities targeting the sensory initiators of tics in future research.
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Affiliation(s)
- Maria Kyriazi
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
| | - Efrosini Kalyva
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
- Centre of Child and Adolescent Research and Development, Thessaloniki, Greece
| | - Efthymia Vargiami
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Krikonis
- DatAnalysis, Statistical Analysis and Design of Scientific Research, Ioannina, Greece
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
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Li Y, Zhang JS, Wen F, Lu XY, Yan CM, Wang F, Cui YH. Premonitory urges located in the tongue for tic disorder: Two case reports and review of literature. World J Clin Cases 2019; 7:1508-1514. [PMID: 31363480 PMCID: PMC6656667 DOI: 10.12998/wjcc.v7.i12.1508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Premonitory urges (PUs) was defined as the uncomfortable physical sensations of inner tension that can be relieved by producing movement responses. Nearly 70%-90% patients with Tourette syndrome reported experiences of PUs.
CASE SUMMARY In this paper, we present two cases of young patients with PUs located in their tongue, which is very rare and easily misdiagnosed in clinical work. Both two young patients complained of an itchy tongue and cannot help biting their tongue. These two cases were worth reporting because it was rare that PUs was the initial symptom and located in the tongue. The results indicated that PUs seem to play an important role in the generation of tics.
CONCLUSION Thus, PUs may be the first process, and an essential part, of the formation of tics.
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Affiliation(s)
- Ying Li
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Ji-Shui Zhang
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Fang Wen
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Xiao-Yan Lu
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Chun-Mei Yan
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Fang Wang
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Yong-Hua Cui
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
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Rae CL, Critchley HD, Seth AK. A Bayesian Account of the Sensory-Motor Interactions Underlying Symptoms of Tourette Syndrome. Front Psychiatry 2019; 10:29. [PMID: 30890965 PMCID: PMC6412155 DOI: 10.3389/fpsyt.2019.00029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/17/2019] [Indexed: 11/17/2022] Open
Abstract
Tourette syndrome is a hyperkinetic movement disorder. Characteristic features include tics, recurrent movements that are experienced as compulsive and "unwilled"; uncomfortable premonitory sensations that resolve through tic release; and often, the ability to suppress tics temporarily. We demonstrate how these symptoms and features can be understood in terms of aberrant predictive (Bayesian) processing in hierarchical neural systems, explaining specifically: why tics arise, their "unvoluntary" nature, how premonitory sensations emerge, and why tic suppression works-sometimes. In our model, premonitory sensations and tics are generated through over-precise priors for sensation and action within somatomotor regions of the striatum. Abnormally high precision of priors arises through the dysfunctional synaptic integration of cortical inputs. These priors for sensation and action are projected into primary sensory and motor areas, triggering premonitory sensations and tics, which in turn elicit prediction errors for unexpected feelings and movements. We propose experimental paradigms to validate this Bayesian account of tics. Our model integrates behavioural, neuroimaging, and computational approaches to provide mechanistic insight into the pathophysiological basis of Tourette syndrome.
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Affiliation(s)
- Charlotte L. Rae
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Hugo D. Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
| | - Anil K. Seth
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- School of Engineering and Informatics, University of Sussex, Brighton, United Kingdom
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Tics and stereotypies: A comparative clinical review. Parkinsonism Relat Disord 2019; 59:117-124. [DOI: 10.1016/j.parkreldis.2019.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/28/2018] [Accepted: 02/03/2019] [Indexed: 01/07/2023]
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Dimensions of interoception predict premonitory urges and tic severity in Tourette syndrome. Psychiatry Res 2019; 271:469-475. [PMID: 30544073 DOI: 10.1016/j.psychres.2018.12.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/24/2022]
Abstract
Interoceptive processes in Tourette syndrome may foster the premonitory urges that commonly precede tics. Twenty-one adults with TS and 22 controls completed heartbeat tracking and discrimination tasks. Three dimensions of interoception were examined: objective accuracy, metacognitive awareness, and subjective (self-report) sensibility. Trait interoceptive prediction error was calculated as the discrepancy between accuracy and sensibility. Participants with TS had numerically lower interoceptive accuracy on the heartbeat tracking task, and increased self-reported interoceptive sensibility. While these group differences were not significant, the discrepancy between lower interoceptive accuracy and heightened sensibility, i.e. the trait interoceptive prediction error, was significantly greater in TS compared to controls. This suggests a heightened higher-order sensitivity to bodily sensations in TS, relative to a noisier perceptual representation of afferent bodily signals. Moreover, interoceptive sensibility predicted the severity of premonitory sensations and tics. This suggests interventions that work to align dimensions of interoceptive experience in TS hold therapeutic potential.
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