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Zapparoli L, Devoto F, Mariano M, Seghezzi S, Servello D, Porta M, Paulesu E. Mapping Gilles de la Tourette syndrome through the distress and relief associated with tic-related behaviors: an fMRI study. Transl Psychiatry 2024; 14:7. [PMID: 38191475 PMCID: PMC10774308 DOI: 10.1038/s41398-023-02711-z] [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: 06/07/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
Personal distress associated with tic urges or inhibition and relief associated with tic production are defining features of the personal experience in Gilles de la Tourette syndrome (GTS). These affective phenomena have not been studied using fMRI, hindering our understanding of GTS pathophysiology and possible treatments. Here, we present a novel cross-sectional fMRI study designed to map tic-related phenomenology using distress and relief as predicting variables. We adopted a mental imagery approach and dissected the brain activity associated with different phases of tic behaviors, premonitory urges, and the ensuing tic execution or inhibition: these were compared with the mental simulation of "relaxed situations" and pre-determined stereotyped motor behaviors. We then explored whether the ensuing brain patterns correlated with the distress or relief perceived for the different phases of the tasks. Patients experienced a higher level of distress during the imagery of tic-triggering scenarios and no relief during tic inhibition. On the other hand, patients experienced significant relief during tic imagery. Distress during tic-triggering scenarios and relief during tic imagery were significantly correlated. The distress perceived during urges correlated with increased activation in cortical sensorimotor areas, suggesting a motor alarm. Conversely, relief during tic execution was positively associated with the activity of a subcortical network. The activity of the putamen was associated with both distress during urges and relief during tic execution. These findings highlight the importance of assessing the affective component of tic-related phenomenology. Subcortical structures may be causally involved in the affective component of tic pathophysiology, with the putamen playing a central role in both tic urge and generation. We believe that our results can be readily translated into clinical practice for the development of personalized treatment plans tailored to each patient's unique needs.
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Affiliation(s)
- Laura Zapparoli
- Psychology Department and NeuroMi - Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy.
- fMRI Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.
| | - Francantonio Devoto
- Psychology Department and NeuroMi - Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Marika Mariano
- Psychology Department and NeuroMi - Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Silvia Seghezzi
- Psychology Department and NeuroMi - Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy
- Institute of Cognitive Neuroscience, University College London, London, UK
| | | | - Mauro Porta
- Tourette Center, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Eraldo Paulesu
- Psychology Department and NeuroMi - Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy.
- fMRI Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.
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2
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Hsu CJ, Wong LC, Wang HP, Chung YC, Kao TW, Weng CH, Wu WC, Peng SF, Tseng WYI, Lee WT. The microstructural change of the brain and its clinical severity association in pediatric Tourette syndrome patients. J Neurodev Disord 2023; 15:34. [PMID: 37880631 PMCID: PMC10598924 DOI: 10.1186/s11689-023-09501-0] [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: 04/01/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Gilles de la Tourette syndrome (GTS) is a prevalent pediatric neurological disorder. Most studies point to abnormalities in the cortico-striato-thalamocortical (CSTC) circuits. Neuroimaging studies have shown GTS's extensive impact on the entire brain. However, due to participant variability and potential drug and comorbidity impact, the results are inconsistent. To mitigate the potential impact of participant heterogeneity, we excluded individuals with comorbidities or those currently undergoing medication treatments. Based on the hypothesis of abnormality within the CSTC circuit, we investigated microstructural changes in white matter using diffusion spectrum imaging (DSI). This study offers the first examination of microstructural changes in treatment-naïve pediatric patients with pure GTS using diffusion spectrum imaging. METHODS This single-center prospective study involved 30 patients and 30 age- and gender-matched healthy volunteers who underwent sagittal T1-weighted MRI and DSI. We analyzed generalized fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. RESULTS No significant differences were observed in mean diffusivity and axial diffusivity values between the two groups. However, the patient group exhibited significantly higher generalized fractional anisotropy values in the right frontostriatal tract of the dorsolateral prefrontal cortex, the right frontostriatal tract of the precentral gyrus, and bilateral thalamic radiation of the dorsolateral prefrontal cortex. Additionally, the generalized fractional anisotropy value of the right frontostriatal tract of the precentral gyrus is inversely correlated with the total tic severity scores at the most severe condition. CONCLUSION Treatment-naïve pediatric GTS patients demonstrated increased connectivity within the CSTC circuit as per diffusion spectrum imaging, indicating possible CSTC circuit dysregulation. This finding could also suggest a compensatory change. It thus underscores the necessity of further investigation into the fundamental pathological changes in GTS. Nevertheless, the observed altered connectivity in GTS patients might serve as a potential target for therapeutic intervention.
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Affiliation(s)
- Chia-Jui Hsu
- Department of Pediatrics, National Taiwan University Hsin-Chu Hospital Hsin-Chu Branch, Hsin-Chu, 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
- Department of Pediatrics, National Taiwan University Children's 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
| | - Yi-Chun Chung
- Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Te-Wei Kao
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Hsiang Weng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chau Wu
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shinn-Forng Peng
- Department of Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Tso Lee
- Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan.
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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3
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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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4
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Zapparoli L, Mariano M, Paulesu E. How the motor system copes with aging: a quantitative meta-analysis of the effect of aging on motor function control. Commun Biol 2022; 5:79. [PMID: 35058549 PMCID: PMC8776875 DOI: 10.1038/s42003-022-03027-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/27/2021] [Indexed: 01/28/2023] Open
Abstract
Motor cognitive functions and their neurophysiology evolve and degrade along the lifespan in a dramatic fashion. Current models of how the brain adapts to aging remain inspired primarily by studies on memory or language processes. Yet, aging is strongly associated with reduced motor independence and the associated degraded interaction with the environment: accordingly, any neurocognitive model of aging not considering the motor system is, ipso facto, incomplete. Here we present a meta-analysis of forty functional brain-imaging studies to address aging effects on motor control. Our results indicate that motor control is associated with aging-related changes in brain activity, involving not only motoric brain regions but also posterior areas such as the occipito-temporal cortex. Notably, some of these differences depend on the specific nature of the motor task and the level of performance achieved by the participants. These findings support neurocognitive models of aging that make fewer anatomical assumptions while also considering tasks-dependent and performance-dependent manifestations. Besides the theoretical implications, the present data also provide additional information for the motor rehabilitation domain, indicating that motor control is a more complex phenomenon than previously understood, to which separate cognitive operations can contribute and decrease in different ways with aging. Many aspects of neuronal control degrade with ageing, including motor control. Using a meta-analysis of functional MRI images, it is made apparent that the ageing brain relies more on visual strategies than sensory stimuli to maintain motor function.
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5
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Eddy CM. The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains. Front Psychiatry 2022; 13:797952. [PMID: 35360118 PMCID: PMC8960177 DOI: 10.3389/fpsyt.2022.797952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/14/2022] [Indexed: 01/18/2023] Open
Abstract
Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.
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Affiliation(s)
- Clare M Eddy
- Birmingham and Solihull Mental Health NHS Foundation Trust, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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6
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Quadrelli E, Bartoli B, Bolognini N, Cavanna AE, Zibordi F, Nardocci N, Turati C, Termine C. Automatic imitation in youngsters with Gilles de la Tourette syndrome: A behavioral study. Child Neuropsychol 2021; 27:782-798. [PMID: 33641606 DOI: 10.1080/09297049.2021.1892050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
It is widely known that humans have a tendency to imitate each other and that appropriate modulation of automatic imitative behaviors has a crucial function in social interactions. Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterized by motor and phonic tics. Apart from tics, patients with GTS are often reported to show an abnormal tendency to automatically imitate others' behaviors (i.e., echophenomena), which may be related to a failure in top-down inhibition of imitative response tendencies. The aim of the current study is to explore the top-down inhibitory mechanisms on automatic imitative behaviors in youngsters with GTS. Error rates and reaction times from 32 participants with GTS and 32 controls were collected in response to an automatic imitation task assessing the influence of observed movements displayed in the first-person perspective on congruent and incongruent motor responses. Results showed that participants with GTS had higher error rates than controls, and their responses were faster than those of controls in incompatible stimuli. Our findings provide novel evidence of a key difference between youngsters with GTS and typically developing participants in the ability to effectively control the production of own motor responses to sensory inputs deriving from observed actions.
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Affiliation(s)
- E Quadrelli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,NeuroMI, Milan Center for Neuroscience, Milan, Italy
| | - B Bartoli
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - N Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,NeuroMI, Milan Center for Neuroscience, Milan, Italy
| | - A E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust and University of Birmingham, Birmingham, UK.,School of Life and Health Sciences, Aston University, Birmingham, UK.,Institute of Neurology, University College London, London, UK
| | - F Zibordi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - N Nardocci
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - C Turati
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,NeuroMI, Milan Center for Neuroscience, Milan, Italy
| | - C Termine
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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7
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Zapparoli L, Seghezzi S, Devoto F, Mariano M, Banfi G, Porta M, Paulesu E. Altered sense of agency in Gilles de la Tourette syndrome: behavioural, clinical and functional magnetic resonance imaging findings. Brain Commun 2020; 2:fcaa204. [PMID: 33409491 PMCID: PMC7772095 DOI: 10.1093/braincomms/fcaa204] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/18/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
Current neurocognitive models of motor control postulate that accurate action monitoring is crucial for a normal experience of agency-the ability to attribute the authorship of our actions and their consequences to ourselves. Recent studies demonstrated that action monitoring is impaired in Gilles de la Tourette syndrome, a movement disorder characterized by motor and vocal tics. It follows that Tourette syndrome patients may suffer from a perturbed sense of agency, the hypothesis tested in this study. To this end, we recruited 25 Tourette syndrome patients and 25 matched healthy controls in a case-control behavioural and functional magnetic resonance imaging study. As an implicit index of the sense of agency, we measured the intentional binding phenomenon, i.e., the perceived temporal compression between voluntary movements and their external consequences. We found evidence of an impaired sense of agency in Tourette syndrome patients who, as a group, did not show a significant intentional binding. The more reduced was the individual intentional binding, the more severe were the motor symptoms. Specific differences between the two groups were also observed in terms of brain activation patterns. In the healthy controls group, the magnitude of the intentional binding was associated with the activity of a premotor-parietal-cerebellar network. This relationship was not present in the Tourette syndrome group, suggesting an altered activation of the agency brain network for self-generated acts. We conclude that the less accurate action monitoring described in Tourette syndrome also involves the assessment of the consequences of actions in the outside world. We discuss that this may lead to difficulties in distinguishing external consequences produced by their own actions from the ones caused by others in Tourette syndrome patients.
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Affiliation(s)
- Laura Zapparoli
- Psychology Department and Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
| | - Silvia Seghezzi
- Psychology Department and Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy.,Neuroscience of School of Medicine and Surgery, University of Milano-Bicocca, 20126, Milan, Italy
| | - Francantonio Devoto
- Psychology Department and Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy.,Neuroscience of School of Medicine and Surgery, University of Milano-Bicocca, 20126, Milan, Italy
| | - Marika Mariano
- Psychology Department and Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy.,San Raffaele Vita e Salute University, 20132, Milan, Italy
| | - Mauro Porta
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
| | - Eraldo Paulesu
- Psychology Department and Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
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8
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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: 7] [Impact Index Per Article: 1.8] [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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9
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Zapparoli L, Macerollo A, Joyce EM, Martino D, Kilner JM. Voluntary tic suppression and the normalization of motor cortical beta power in Gilles de la Tourette syndrome: an
EEG
study. Eur J Neurosci 2019; 50:3944-3957. [DOI: 10.1111/ejn.14548] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022]
Affiliation(s)
| | - Antonella Macerollo
- School of Psychology Faculty of Health and Life Sciences University of Liverpool Liverpool UK
- The Walton Centre NHS Foundation Trust Fazakerley UK
| | - Eileen M. Joyce
- Department of Clinical and Movement Neurosciences UCL Institute of Neurology London UK
| | - Davide Martino
- Department of Clinical Neurosciences University of Calgary Calgary Canada
- Hotchkiss Brain Institute University of Calgary Calgary Canada
| | - James M. Kilner
- Department of Clinical and Movement Neurosciences UCL Institute of Neurology London UK
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10
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Servello D, Saleh C, Bona AR, Zekaj E, Porta M. After 19 years of deep brain stimulation in Tourette's syndrome: From multiple targets to one single target? Surg Neurol Int 2018; 9:219. [PMID: 30505621 PMCID: PMC6219290 DOI: 10.4103/sni.sni_271_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Domenico Servello
- Departments of Neurosurgery and Neurology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Christian Saleh
- Departments of Neurosurgery and Neurology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alberto R Bona
- Departments of Neurosurgery and Neurology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Edvin Zekaj
- Departments of Neurosurgery and Neurology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Mauro Porta
- Departments of Neurosurgery and Neurology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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11
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Porta M, Servello D, Dell'Osso B, Dina CZ, Bona A, Alleva GC. Critical aspects in the legal defence of patients with Tourette's Syndrome: An Italian case series. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 61:1-5. [PMID: 30454556 DOI: 10.1016/j.ijlp.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 06/09/2023]
Abstract
Tourette's syndrome (TS) is a developmental neurobehavioral disorder with childhood onset and relevant burden in terms of disability and reduced quality of life. In Italy the biological basis of this syndrome is still frequently ignored and TS is often recognised as a psychiatric manifestation, or even it is not recognised as pathology, which may result in inadequate treatment, social isolation and improper hospitalization. Indeed, the organic medical nature of TS needs to be taken into great consideration in evaluating causality of committing crimes in affected patients. In addition, delaying the diagnosis and consequently proper treatment has a devastating impact on social as well as legal aspects in patients with TS. The present report is aimed to present an Italian case series of 4 TS patients who faced legal problems related to their mental condition, in the intent to add further evidence, raise the level of awareness and encourage further investigation in the field, as in most of the cases, patients' illness was not taken into adequate account by the Justice. The relevant law is discussed in detail.
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Affiliation(s)
- Mauro Porta
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
| | - Domenico Servello
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
| | - Bernardo Dell'Osso
- Department of Psychiatry, Ca Granda Clinical and Research Foundation, Maggiore Policlinico Hospital, University of Milan, 8 S. Barnaba Street, 20100 Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| | - Carlotta Zanaboni Dina
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy.
| | - Alberto Bona
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
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12
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Perani D, Lalli S, Iaccarino L, Alongi P, Gambini O, Franzini A, Albanese A. Prefrontal Cortical Stimulation in Tourette Disorder: Proof-of-concept Clinical and Neuroimaging Study. Mov Disord Clin Pract 2018; 5:499-505. [PMID: 30515438 DOI: 10.1002/mdc3.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/04/2018] [Accepted: 04/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background The benefits of neurosurgery in Tourette Syndrome (TS) are still incompletely understood. Prefrontal cortical electrical stimulation offers a less invasive alternative to deep brain stimulation. Objective To perform a pilot assessment on safety and efficacy of prefrontal cortical bilateral electrical stimulation in TS using clinical and brain metabolic assessments. Methods Four adult TS patients underwent tic assessment using the Yale Global Tic Severity Scale and the Rush Video Rating Scale at baseline and 1, 3, 6, and 12-months after implant; whereas FDG-PET scans were acquired at baseline and after 6 and 12 months. Results Tic clinical scores were improved at 6 months after implant, meanwhile they showed a tendency to re-emerge at the 12-month follow-up. There was a correlation between FDG-PET and tics, mainly consisting in a reduction of baseline brain hypermetabolism, which paralleled tic score reduction. Conclusion Epidural stimulation in TS is safe and yields a modulation of tics, paralleled by FDG-PET metabolic modulation.
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Affiliation(s)
- Daniela Perani
- Vita-Salute San Raffaele University Milan Italy.,In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy.,Nuclear Medicine Unit IRCCS San Raffaele Hospital Milan Italy
| | - Stefania Lalli
- Department of Neurology Catholic University of the Sacred Heart Milan Italy.,Department of Neurology Humanitas Research Hospital Rozzano Milan Italy
| | - Leonardo Iaccarino
- Vita-Salute San Raffaele University Milan Italy.,In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
| | | | - Orsola Gambini
- Department of Psychiatry University of Milan Medical School and San Paolo Hospital Milan Italy
| | - Angelo Franzini
- Department of Neurosurgery Istituto Neurologico "C. Besta" Milan Italy
| | - Alberto Albanese
- Department of Neurology Catholic University of the Sacred Heart Milan Italy.,Department of Neurology Humanitas Research Hospital Rozzano Milan Italy
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13
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Martino D, Ganos C, Worbe Y. Neuroimaging Applications in Tourette's Syndrome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 143:65-108. [DOI: 10.1016/bs.irn.2018.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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Premonitory urges and tics in Tourette syndrome: computational mechanisms and neural correlates. Curr Opin Neurobiol 2017; 46:187-199. [PMID: 29017141 DOI: 10.1016/j.conb.2017.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/01/2017] [Accepted: 08/21/2017] [Indexed: 12/22/2022]
Abstract
Tourette syndrome is characterized by open motor behaviors - tics - but another crucial aspect of the disorder is the presence of premonitory urges: uncomfortable sensations that typically precede tics and are temporarily alleviated by tics. We review the evidence implicating the somatosensory cortices and the insula in premonitory urges and the motor cortico-basal ganglia-thalamo-cortical loop in tics. We consider how these regions interact during tic execution, suggesting that the insula plays an important role as a nexus linking the sensory and emotional character of premonitory urges with their translation into tics. We also consider how these regions interact during tic learning, integrating the neural evidence with a computational perspective on how premonitory-urge alleviation reinforces tics.
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Zapparoli L, Tettamanti M, Porta M, Zerbi A, Servello D, Banfi G, Paulesu E. A tug of war: antagonistic effective connectivity patterns over the motor cortex and the severity of motor symptoms in Gilles de la Tourette syndrome. Eur J Neurosci 2017; 46:2203-2213. [DOI: 10.1111/ejn.13658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/31/2017] [Accepted: 08/09/2017] [Indexed: 01/11/2023]
Affiliation(s)
| | - Marco Tettamanti
- Division of Neuroscience; IRCCS San Raffaele Scientific Institute; Milan Italy
| | | | | | | | - Giuseppe Banfi
- IRCCS Galeazzi; Via Galeazzi 4 Milan Italy
- University Vita e Salute San Raffaele; Milan Italy
| | - Eraldo Paulesu
- IRCCS Galeazzi; Via Galeazzi 4 Milan Italy
- Psychology Department; University of Milano-Bicocca and Milan Center for Neuroscience; Milan Italy
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Morand-Beaulieu S, Leclerc JB, Valois P, Lavoie ME, O'Connor KP, Gauthier B. A Review of the Neuropsychological Dimensions of Tourette Syndrome. Brain Sci 2017; 7:E106. [PMID: 28820427 PMCID: PMC5575626 DOI: 10.3390/brainsci7080106] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022] Open
Abstract
Neurocognitive functioning in Tourette syndrome (TS) has been the subject of intensive research in the past 30 years. A variety of impairments, presumably related to frontal and frontostriatal dysfunctions, have been observed. These impairments were found in various domains, such as attention, memory, executive functions, language, motor and visuomotor functions, among others. In line with contemporary research, other neurocognitive domains have recently been explored in TS, bringing evidence of altered social reasoning, for instance. Therefore, the aims of this review are to give an overview of the neuropsychological dimensions of TS, to report how neuropsychological functions evolve from childhood to adulthood, and to explain how various confounding factors can affect TS patients' performance in neuropsychological tasks. Finally, an important contribution of this review is to show how recent research has confirmed or changed our beliefs about neuropsychological functioning in TS.
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Affiliation(s)
- Simon Morand-Beaulieu
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de neurosciences, Université de Montréal, 2960 Chemin de la Tour, Montréal, QC H3T 1J4, Canada.
| | - Julie B Leclerc
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, QC H2X 3P2, Canada.
| | - Philippe Valois
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, QC H2X 3P2, Canada.
| | - Marc E Lavoie
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de neurosciences, Université de Montréal, 2960 Chemin de la Tour, Montréal, QC H3T 1J4, Canada.
- Département de psychiatrie, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada.
| | - Kieron P O'Connor
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, QC H2X 3P2, Canada.
- Département de psychiatrie, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada.
| | - Bruno Gauthier
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de psychologie, Université de Montréal, Campus Laval, 1700 rue Jacques-Tétreault, Laval, QC H7N 0B6, Canada.
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17
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Polyanska L, Critchley HD, Rae CL. Centrality of prefrontal and motor preparation cortices to Tourette Syndrome revealed by meta-analysis of task-based neuroimaging studies. NEUROIMAGE-CLINICAL 2017; 16:257-267. [PMID: 28831377 PMCID: PMC5554925 DOI: 10.1016/j.nicl.2017.08.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 01/31/2023]
Abstract
Tourette Syndrome (TS) is a neurodevelopmental condition characterized by chronic multiple tics, which are experienced as compulsive and 'unwilled'. Patients with TS can differ markedly in the frequency, severity, and bodily distribution of tics. Moreover, there are high comorbidity rates with attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), anxiety disorders, and depression. This complex clinical profile may account for apparent variability of findings across neuroimaging studies that connect neural function to cognitive and motor behavior in TS. Here we crystalized information from neuroimaging regarding the functional circuitry of TS, and furthermore, tested specifically for neural determinants of tic severity, by applying activation likelihood estimation (ALE) meta-analyses to neuroimaging (activation) studies of TS. Fourteen task-based studies (13 fMRI and one H2O-PET) met rigorous inclusion criteria. These studies, encompassing 25 experiments and 651 participants, tested for differences between TS participants and healthy controls across cognitive, motor, perceptual and somatosensory domains. Relative to controls, TS participants showed distributed differences in the activation of prefrontal (inferior, middle, and superior frontal gyri), anterior cingulate, and motor preparation cortices (lateral premotor cortex and supplementary motor area; SMA). Differences also extended into sensory (somatosensory cortex and the lingual gyrus; V4); and temporo-parietal association cortices (posterior superior temporal sulcus, supramarginal gyrus, and retrosplenial cortex). Within TS participants, tic severity (reported using the Yale Global Tic Severity Scale; YGTSS) selectively correlated with engagement of SMA, precentral gyrus, and middle frontal gyrus across tasks. The dispersed involvement of multiple cortical regions with differences in functional reactivity may account for heterogeneity in the symptomatic expression of TS and its comorbidities. More specifically for tics and tic severity, the findings reinforce previously proposed contributions of premotor and lateral prefrontal cortices to tic expression.
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Affiliation(s)
- Liliana Polyanska
- Sackler Centre for Consciousness Science, University of Sussex, Falmer BN1 9RY, UK.,Department of Neuroscience, Brighton & Sussex Medical School, Falmer BN1 9RY, UK.,Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Falmer BN1 9RY, UK.,Department of Neuroscience, Brighton & Sussex Medical School, Falmer BN1 9RY, UK
| | - Charlotte L Rae
- Sackler Centre for Consciousness Science, University of Sussex, Falmer BN1 9RY, UK.,Department of Neuroscience, Brighton & Sussex Medical School, Falmer BN1 9RY, UK
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Abstract
We present selected highlights from research that appeared during 2015 on Tourette syndrome and other tic disorders. Topics include phenomenology, comorbidities, developmental course, genetics, animal models, neuroimaging, electrophysiology, pharmacology, and treatment. We briefly summarize articles whose results we believe may lead to new treatments, additional research or modifications in current models of TS.
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Affiliation(s)
- Cheryl A Richards
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, USA
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Porta M, Saleh C, Zekaj E, Zanaboni Dina C, Bona AR, Servello D. Why so many deep brain stimulation targets in Tourette’s syndrome? Toward a broadening of the definition of the syndrome. J Neural Transm (Vienna) 2016; 123:785-790. [DOI: 10.1007/s00702-015-1494-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/30/2015] [Indexed: 12/01/2022]
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