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Morand-Beaulieu S, Crowley MJ, Grantz H, Leckman JF, Sukhodolsky DG. Functional connectivity during tic suppression predicts reductions in vocal tics following behavior therapy in children with Tourette syndrome. Psychol Med 2023; 53:7857-7864. [PMID: 37485677 PMCID: PMC10755221 DOI: 10.1017/s0033291723001940] [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: 01/25/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Comprehensive Behavioral Intervention for Tics (CBIT) is recommended as a first-line treatment for Tourette syndrome in children and adults. While there is strong evidence proving its efficacy, the mechanisms of reduction in tic severity during CBIT are still poorly understood. In a recent study, our group identified a functional brain network involved in tic suppression in children with TS. We reasoned that voluntary tic suppression and CBIT may share some mechanisms and thus we wanted to assess whether functional connectivity during tic suppression was associated with CBIT outcome. METHODS Thirty-two children with TS, aged 8 to 13 years old, participated in a randomized controlled trial of CBIT v. a treatment-as-usual control condition. EEG was recorded during tic suppression in all participants at baseline and endpoint. We used a source-reconstructed EEG connectivity pipeline to assess functional connectivity during tic suppression. RESULTS Functional connectivity during tic suppression did not change from baseline to endpoint. However, baseline tic suppression-related functional connectivity specifically predicted the decrease in vocal tic severity from baseline to endpoint in the CBIT group. Supplementary analyses revealed that the functional connectivity between the right superior frontal gyrus and the right angular gyrus was mainly driving this effect. CONCLUSIONS This study revealed that functional connectivity during tic suppression at baseline predicted reduction in vocal tic severity. These results suggest probable overlap between the mechanisms of voluntary tic suppression and those of behavior therapy for tics.
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Affiliation(s)
- Simon Morand-Beaulieu
- Department of Psychology, McGill University, Montreal, QC, Canada
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Heidi Grantz
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - James F. Leckman
- Department of Psychology, McGill University, Montreal, QC, Canada
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Hartmann A, Andrén P, Atkinson-Clément C, Czernecki V, Delorme C, Monique Debes NM, Müller-Vahl K, Paschou P, Szejko N, Topaloudi A, Ueda K, Black KJ. Tourette syndrome research highlights from 2022. F1000Res 2023; 12:826. [PMID: 37691732 PMCID: PMC10483181 DOI: 10.12688/f1000research.135702.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 07/12/2024] Open
Abstract
This is the ninth yearly article in the Tourette Syndrome Research Highlights series, summarizing selected research reports from 2022 relevant to Tourette syndrome. The authors briefly summarize reports they consider most important or interesting.
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Affiliation(s)
- Andreas Hartmann
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | - Per Andrén
- Department of Psychology, University of Lund, Lund, Sweden, Sweden
| | | | - Virginie Czernecki
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | - Cécile Delorme
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | | | | | | | - Natalia Szejko
- Department of Neurology, University of Calgary, Calgary, Alberta, Canada
| | | | - Keisuke Ueda
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri, 63110-1010, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri, 63110-1010, USA
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Hartmann A, Andrén P, Atkinson-Clément C, Czernecki V, Delorme C, Monique Debes NM, Müller-Vahl K, Paschou P, Szejko N, Topaloudi A, Ueda K, Black KJ. Tourette syndrome research highlights from 2022. F1000Res 2023; 12:826. [PMID: 37691732 PMCID: PMC10483181 DOI: 10.12688/f1000research.135702.1] [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] [Accepted: 10/18/2023] [Indexed: 09/12/2023] Open
Abstract
This is the ninth yearly article in the Tourette Syndrome Research Highlights series, summarizing selected research reports from 2022 relevant to Tourette syndrome. The authors briefly summarize reports they consider most important or interesting.
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Affiliation(s)
- Andreas Hartmann
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | - Per Andrén
- Department of Psychology, University of Lund, Lund, Sweden, Sweden
| | | | - Virginie Czernecki
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | - Cécile Delorme
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | | | | | | | - Natalia Szejko
- Department of Neurology, University of Calgary, Calgary, Alberta, Canada
| | | | - Keisuke Ueda
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri, 63110-1010, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri, 63110-1010, USA
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Friedrich J, Rawish T, Bluschke A, Frings C, Beste C, Münchau A. Cognitive and Neural Mechanisms of Behavior Therapy for Tics: A Perception-Action Integration Approach. Biomedicines 2023; 11:1550. [PMID: 37371645 DOI: 10.3390/biomedicines11061550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
European clinical guidelines recommend the use of Exposure and Response Prevention (ERP) and Comprehensive Behavioral Intervention for Tics (CBIT) as first-line treatments for tic disorders. Although ongoing efforts in research are being made to understand the mechanisms underlying these behavioral approaches, as of yet, the neurophysiological mechanisms behind behavioral interventions are poorly understood. However, this is essential to tailor interventions to individual patients in order to increase compliance and efficacy. The Theory of Event Coding (TEC) and its derivative BRAC (Binding and Retrieval in Action Control) provide a theoretical framework to investigate cognitive and neural processes in the context of tic disorders. In this context, tics are conceptualized as a phenomenon of enhanced perception-action binding, with premonitory urges constituting the perceptual and the motor or vocal expression constituting the action part of an event file. Based on this, CBIT is assumed to strongly affect stimulus-response binding in the context of response selection, whereas the effects of ERP presumably unfold during stimulus-response binding in the response inhibition context. Further studies are needed to clarify the neurophysiological processes underlying behavioral interventions to enable the individualization and further development of therapeutic approaches for tic disorders.
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Affiliation(s)
- Julia Friedrich
- Institute of Systems Motor Science, Center for Brain, Behavior and Metabolism (CBBM), University of Lübeck, 23562 Lübeck, Germany
| | - Tina Rawish
- Institute of Systems Motor Science, Center for Brain, Behavior and Metabolism (CBBM), University of Lübeck, 23562 Lübeck, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Christian Frings
- Department of Cognitive Psychology, Faculty of Psychology, University of Trier, 54296 Trier, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- University Neuropsychology Centre, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan 250014, China
| | - Alexander Münchau
- Institute of Systems Motor Science, Center for Brain, Behavior and Metabolism (CBBM), University of Lübeck, 23562 Lübeck, Germany
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Rothenberger A, Heinrich H. Co-Occurrence of Tic Disorders and Attention-Deficit/Hyperactivity Disorder-Does It Reflect a Common Neurobiological Background? Biomedicines 2022; 10:biomedicines10112950. [PMID: 36428518 PMCID: PMC9687745 DOI: 10.3390/biomedicines10112950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The co-existence of tic disorders and attention-deficit/hyperactivity disorder (TD + ADHD) has proven to be highly important in daily clinical practice. The factor ADHD is not only associated with further comorbidities, but also has a long-term negative psychosocial effect, while the factor TD is usually less disturbing for the major part of the patients. It remains unclear how far this is related to a different neurobiological background of the associated disorders or whether TD + ADHD reflects a common one. OBJECTIVE This review provides an update on the neurobiological background of TD + ADHD in order to better understand and treat this clinical problem, while clarifying whether an additive model of TD + ADHD holds true and should be used as a basis for further clinical recommendations. METHOD A comprehensive research of the literature was conducted and analyzed, including existing clinical guidelines for both TD and ADHD. Besides genetical and environmental risk factors, brain structure and functions, neurophysiological processes and neurotransmitter systems were reviewed. RESULTS Only a limited number of empirical studies on the neurobiological background of TD and ADHD have taken the peculiarity of co-existing TD + ADHD into consideration, and even less studies have used a 2 × 2 factorial design in order to disentangle the impact/effects of the factors of TD versus those of ADHD. Nevertheless, the assumption that TD + ADHD can best be seen as an additive model at all levels of investigation was strengthened, although some overlap of more general, disorder non-specific aspects seem to exist. CONCLUSION Beyond stress-related transdiagnostic aspects, separate specific disturbances in certain neuronal circuits may lead to disorder-related symptoms inducing TD + ADHD in an additive way. Hence, within a classificatory categorical framework, the dimensional aspects of multilevel diagnostic-profiling seem to be a helpful precondition for personalized decisions on counselling and disorder-specific treatment in TD + ADHD.
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Affiliation(s)
- Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
- Correspondence:
| | - Hartmut Heinrich
- Neurocare Group, 80331 Munich, Germany
- Kbo-Heckscher-Klinikum, 81539 Munich, Germany
- Research Institute Brainclinics, Brainclinics Foundation, 6524 AD Nijmegen, The Netherlands
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