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Branca C, Bortolato M. The role of neuroactive steroids in tic disorders. Neurosci Biobehav Rev 2024; 160:105637. [PMID: 38519023 PMCID: PMC11121756 DOI: 10.1016/j.neubiorev.2024.105637] [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: 12/24/2023] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
Tics are sudden, repetitive movements or vocalizations. Tic disorders, such as Tourette syndrome (TS), are contributed by the interplay of genetic risk factors and environmental variables, leading to abnormalities in the functioning of the cortico-striatal-thalamo-cortical (CSTC) circuitry. Various neurotransmitter systems, such as gamma-aminobutyric acid (GABA) and dopamine, are implicated in the pathophysiology of these disorders. Building on the evidence that tic disorders are predominant in males and exacerbated by stress, emerging research is focusing on the involvement of neuroactive steroids, including dehydroepiandrosterone sulfate (DHEAS) and allopregnanolone, in the ontogeny of tics and other phenotypes associated with TS. Emerging evidence indicates that DHEAS levels are significantly elevated in the plasma of TS-affected boys, and the clinical onset of this disorder coincides with the period of adrenarche, the developmental stage characterized by a surge in DHEAS synthesis. On the other hand, allopregnanolone has garnered particular attention for its potential to mediate the adverse effects of acute stress on the exacerbation of tic severity and frequency. Notably, both neurosteroids act as key modulators of GABA-A receptors, suggesting a pivotal role of these targets in the pathophysiology of various clinical manifestations of tic disorders. This review explores the potential mechanisms by which these and other neuroactive steroids may influence tic disorders and discusses the emerging therapeutic strategies that target neuroactive steroids for the management of tic disorders.
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Affiliation(s)
- Caterina Branca
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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2
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Quoilin C, Chaise F, Duque J, de Timary P. Relationship between transcranial magnetic stimulation markers of motor control and clinical recovery in obsessive compulsive disorder/Gilles de la Tourette syndrome: a proof of concept case study. Front Psychiatry 2024; 15:1307344. [PMID: 38304284 PMCID: PMC10832049 DOI: 10.3389/fpsyt.2024.1307344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Abstract
Background Obsessive compulsive disorder (OCD) and Gilles de la Tourette syndrome (GTS) are neurodevelopmental disorders characterized by difficulties in controlling intrusive thoughts (obsessions) and undesired actions (tics), respectively. Both conditions have been associated with abnormal inhibition but a tangible deficit of inhibitory control abilities is controversial in GTS. Methods Here, we examined a 25 years-old male patient with severe OCD symptoms and a mild form of GTS, where impairments in motor control were central. Transcranial magnetic stimulation (TMS) was applied over the primary motor cortex (M1) to elicit motor-evoked potentials (MEPs) during four experimental sessions, allowing us to assess the excitability of motor intracortical circuitry at rest as well as the degree of MEP suppression during action preparation, a phenomenon thought to regulate movement initiation. Results When tested for the first time, the patient presented a decent level of MEP suppression during action preparation, but he exhibited a lack of intracortical inhibition at rest, as evidenced by reduced short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI). Interestingly, the patient's symptomatology drastically improved over the course of the sessions (reduced obsessions and tics), coinciding with feedback given on his good motor control abilities. These changes were reflected in the TMS measurements, with a significant strengthening of intracortical inhibition (SICI and LICI more pronounced than previously) and a more selective tuning of MEPs during action preparation; MEPs became even more suppressed, or selectively facilitated depending on the behavioral condition in which they we probed. Conclusion This study highlights the importance of better understanding motor inhibitory mechanisms in neurodevelopmental disorders and suggests a biofeedback approach as a potential novel treatment.
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Affiliation(s)
- Caroline Quoilin
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Fostine Chaise
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Julie Duque
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Philippe de Timary
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Department of Adult Psychiatry, Cliniques universitaires Saint-Luc, Brussels, Belgium
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3
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Morand-Beaulieu S, Wu J, Mayes LC, Grantz H, Leckman JF, Crowley MJ, Sukhodolsky DG. Increased Alpha-Band Connectivity During Tic Suppression in Children With Tourette Syndrome Revealed by Source Electroencephalography Analyses. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:241-250. [PMID: 33991741 PMCID: PMC8589865 DOI: 10.1016/j.bpsc.2021.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental disorder involving chronic motor and phonic tics. Most individuals with TS can suppress their tics for at least a short period of time. Yet, the brain correlates of tic suppression are still poorly understood. METHODS In the current study, high-density electroencephalography was recorded during a resting-state and a tic suppression session in 72 children with TS. Functional connectivity between cortical regions was assessed in the alpha band (8-13 Hz) using an electroencephalography source connectivity method. Graph theory and network-based statistics were used to assess the global network topology and to identify brain regions showing increased connectivity during tic suppression. RESULTS Graph theoretical analyses revealed distinctive global network topology during tic suppression, relative to rest. Using network-based statistics, we found a subnetwork of increased connectivity during tic suppression (p < .001). That subnetwork encompassed many cortical areas, including the right superior frontal gyrus and the left precuneus, which are involved in the default mode network. We also found a condition-by-age interaction, suggesting age-mediated increases in connectivity during tic suppression. CONCLUSIONS These results suggest that children with TS suppress their tics through a brain circuit involving distributed cortical regions, many of which are part of the default mode network. Brain connectivity during tic suppression also increases as youths with TS mature. These results highlight a mechanism by which children with TS may control their tics, which could be relevant for future treatment studies.
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Affiliation(s)
| | - Jia Wu
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Linda C Mayes
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Heidi Grantz
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Michael J Crowley
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut.
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Zea Vera A, Pedapati EV, Larsh TR, Kohmescher K, Miyakoshi M, Huddleston DA, Jackson HS, Gilbert DL, Horn PS, Wu SW. EEG Correlates of Active Stopping and Preparation for Stopping in Chronic Tic Disorder. Brain Sci 2022; 12:brainsci12020151. [PMID: 35203916 PMCID: PMC8870153 DOI: 10.3390/brainsci12020151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 01/11/2023] Open
Abstract
Motor inhibition is an important cognitive process involved in tic suppression. As the right frontal lobe contains important inhibitory network nodes, we characterized right superior, middle, and inferior frontal gyral (RSFG, RMFG, RIFG) event-related oscillations during motor inhibition in youth with chronic tic disorders (CTD) versus controls. Fourteen children with CTD and 13 controls (10–17 years old) completed an anticipated-response stop signal task while dense-array electroencephalography was recorded. Between-group differences in spectral power changes (3–50 Hz) were explored after source localization and multiple comparisons correction. Two epochs within the stop signal task were studied: (1) preparatory phase early in the trial before motor execution/inhibition and (2) active inhibition phase after stop signal presentation. Correlation analyses between electrophysiologic data and clinical rating scales for tic, obsessive-compulsive symptoms, and inattention/hyperactivity were performed. There were no behavioral or electrophysiological differences during active stopping. During stop preparation, CTD participants showed greater event-related desynchronization (ERD) in the RSFG (γ-band), RMFG (β, γ-bands), and RIFG (θ, α, β, γ-bands). Higher RSFG γ-ERD correlated with lower tic severity (r = 0.66, p = 0.04). Our findings suggest RSFG γ-ERD may represent a mechanism that allows CTD patients to keep tics under control and achieve behavioral performance similar to peers.
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Affiliation(s)
- Alonso Zea Vera
- Department of Neurology, Children’s National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC 20052, USA
- Correspondence: ; Tel.: +1-(202)-476-5000
| | - Ernest V. Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Travis R. Larsh
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
| | - Kevin Kohmescher
- College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Makoto Miyakoshi
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA 92093, USA;
| | - David A. Huddleston
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
| | - Hannah S. Jackson
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
| | - Donald L. Gilbert
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Paul S. Horn
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Steve W. Wu
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Lee I, Lee J, Lim MH, Kim KM. Comparison of Quantitative Electroencephalography between Tic Disorder and Attention-Deficit/Hyperactivity Disorder in Children. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:739-750. [PMID: 34690129 PMCID: PMC8553536 DOI: 10.9758/cpn.2021.19.4.739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/31/2022]
Abstract
Objective Attention-deficit/hyperactivity disorder (ADHD) and tic disorder (TD) are among the most common comorbid psychopathologies and have a shared genetic basis. The psychopathological and neurophysiological aspects of the mechanism underlying the comorbidity of both disorders have been investigated, but the pathophysiological aspects remain unclear. Therefore, this study aimed to compare the neurophysiological characteristics of ADHD with those of TD using resting-state electroencephalography and exact low-resolution brain electromagnetic tomography (eLORETA) analysis. Methods We performed eLORETA analysis based on the resting-state scalp-recorded electrical potential distribution in 34 children with ADHD and 21 age-matched children with TD. Between-group differences in electroencephalography (EEG) current source density in delta, theta, alpha, beta, and gamma bands were investigated in each cortical region. Results Compared with the TD group, the ADHD group showed significantly increased theta activity in the frontal region (superior frontal gyrus, t = 3.37, p < 0.05; medial frontal gyrus, t = 3.35, p < 0.05). In contrast, children with TD showed decreased posterior alpha activity than those with ADHD (precuneus, t = −3.40, p < 0.05; posterior cingulate gyrus, t = −3.38, p < 0.05). These findings were only significant when the eyes were closed. Conclusion Increased theta activity in the frontal region is a neurophysiological marker that can distinguish ADHD from TD. Also, reduced posterior alpha activity might represent aberrant inhibitory control. Further research needs to confirm these characteristics by simultaneously measuring EEG-functional magnetic resonance imaging.
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Affiliation(s)
- Ilju Lee
- Department of Psychology, College of Health Science, Dankook University, Cheonan, Korea
| | - Jiryun Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Myung Ho Lim
- Department of Psychology, College of Health Science, Dankook University, Cheonan, Korea
| | - Kyoung Min Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea.,Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Korea
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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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7
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Ueda K, Kim S, Greene DJ, Black KJ. Correlates and clinical implications of tic suppressibility. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021; 8:112-120. [PMID: 34178574 DOI: 10.1007/s40474-021-00230-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review Tic disorders are common in the pediatric population and are differentiated from other movement disorders by tic suppressibility. Understanding the mechanism of tic suppression may provide new insights to the pathophysiology of tic disorders. This article highlights clinical phenomenology and neuronal correlates of tic suppressibility. Recent findings Recent studies suggest that tic suppressibility exists in children shortly after onset of their tics. Moreover, those who are better able to suppress their tics have better tic outcomes. Interoceptive awareness and automatic action inhibition may be involved in tic suppression. Summary We illustrate a possible underlying mechanism of tic suppressibility and its clinical correlations and implications. New concepts such as interoceptive awareness and action inhibition may help explain tic disorders. Further study will be useful to fill remaining knowledge gaps.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Kevin J Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.,Department of Radiology, Washington University School of Medicine, St Louis, MO, USA.,Department of Neuroscience, Washington University School of Medicine, St Louis, MO, USA
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8
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Rothenberger A, Heinrich H. Electrophysiology Echoes Brain Dynamics in Children and Adolescents With Tourette Syndrome-A Developmental Perspective. Front Neurol 2021; 12:587097. [PMID: 33658971 PMCID: PMC7917116 DOI: 10.3389/fneur.2021.587097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/19/2021] [Indexed: 11/28/2022] Open
Abstract
The development of the complex clinical picture of motor and vocal tics in children and adolescents with Tourette syndrome (TS) must be paralleled by changes in the underlying pathophysiology. Electrophysiological methods such as EEG and event-related potentials (ERPs) are non-invasive, safe and easy to apply and thus seem to provide an adequate means to investigate brain dynamics during this brain maturational period. Also, electrophysiology is characterized by a high time resolution and can reflect motor, sensory and cognitive aspects as well as sleep behavior. Hence, this narrative review focuses on how electrophysiology echoes brain dynamics during development of youngsters with TS and might be useful for the treatment of tics. A comprehensive picture of developmental brain dynamics could be revealed showing that electrophysiological parameters evolve concurrently with clinical characteristics of TS. Specifically, evidence for a maturational delay of motor inhibition related to cortico-spinal hyper-excitability and brain mechanisms for its cognitive compensation could be shown. Moreover, deviant sleep parameters and probably a stronger perception-action binding were reported. For neuromodulatory treatments (e.g., neurofeedback; repetitive transcranial magnetic stimulation, rTMS/transcranial direct current stimulation, tDCS) targeting neuronal deficits and/or strengthening compensatory brain mechanisms, pilot studies support the possibility of positive effects regarding tic reduction. Finally, attention-deficit/hyperactivity disorder (ADHD), as a highly frequent co-existing disorder with TS, has to be considered when using and interpreting electrophysiological measures in TS. In conclusion, application of electrophysiology seems to be promising regarding clinical and research aspects in youngsters with TS.
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Affiliation(s)
- Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Hartmut Heinrich
- neuroCare Group, Munich, Germany.,kbo-Heckscher-Klinikum, Munich, Germany.,Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, Netherlands
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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: 36] [Impact Index Per Article: 9.0] [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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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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11
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Kalsi N, Tambelli R, Altavilla D, Trentini C, Panunzi S, Stanca M, Aceto P, Cardona F, Lai C. Neurophysiological correlate of emotional regulation in cognitive and motor deficits in Tourette's syndrome. World J Biol Psychiatry 2019; 20:647-661. [PMID: 29364039 DOI: 10.1080/15622975.2018.1430375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives: The present study investigated the role of different emotions in the expression of cognitive and motor control abilities of children having Tourette's syndrome (TS) compared to healthy controls.Methods: The electroencephalography activity of 33 children (mean age in final sample: TS (n = 10) = 10.5 ± 2.3; control (n = 10) = 10.1 ± 2.9) was recorded during a visual task consisting of four emotional face cues (anger, happiness, neutral and sadness) followed by a target in congruent or incongruent position with emotional cue. The participants were asked to indicate the target location.Results: The TS patients showed a shorter latency of the P1 and N170 only for anger cues compared to controls. In addition, sLORETA results showed an increased activation in the left occipital area and a decreased activation in the left amygdala, temporal and cingulate for anger cues in TS patients. Coherently, TS patients showed a lower accuracy of response only with anger cue and severity of tics resulted correlated with the event-related potentials data and behavioural responses linked to anger cue.Conclusions: These results suggest that children with TS process emotions (in particular the anger) differently from the controls, and that its regulation seems to have an important role in the cognitive and motor deficits in TS.
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Affiliation(s)
- Navkiran Kalsi
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Daniela Altavilla
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Cristina Trentini
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Sara Panunzi
- Department of Paediatrics and Child Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Mariella Stanca
- Department of Paediatrics and Child Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Paola Aceto
- Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Cardona
- Department of Paediatrics and Child Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
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12
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Kim S, Greene DJ, Robichaux-Viehoever A, Bihun EC, Koller JM, Acevedo H, Schlaggar BL, Black KJ. Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome. J Child Neurol 2019; 34:757-764. [PMID: 31241402 PMCID: PMC6733613 DOI: 10.1177/0883073819855531] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Successful voluntary tic suppression is a key component of the behavioral interventions that are used to treat tic disorders. This study aimed to examine tic suppression in children with recent-onset tics and determine whether the capacity to suppress tics predicts future tic severity. We tested 45 children (30 male, mean age 7.74 years) with recent-onset tics (mean 3.47 months prior to the first study visit; baseline) and re-examined each child at the 12-month anniversary of the first recognized tic (follow-up). At the baseline visit, children performed a tic suppression task with several conditions: tic freely, inhibit tics given a verbal request, and inhibit tics in the presence of a reward. At the baseline visit, children with tics for only a few months could suppress their tics, and tic suppression was especially successful when they received an immediate and contingent reward. Additionally, the ability to suppress tics in the presence of a reward predicted tic severity at follow-up. These findings suggest that better inhibitory control of tics within months of tic onset may be an important predictor of future tic symptom outcome.
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Affiliation(s)
- Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Deanna J. Greene
- Department of Psychiatry, Washington University School of Medicine, United States
- Department of Radiology, Washington University School of Medicine, United States
| | | | - Emily C. Bihun
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Haley Acevedo
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, United States
- Department of Radiology, Washington University School of Medicine, United States
- Department of Neurology, Washington University School of Medicine, United States
- Department of Neuroscience, Washington University School of Medicine, United States
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13
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Ganos C, Rothwell J, Haggard P. Voluntary inhibitory motor control over involuntary tic movements. Mov Disord 2018; 33:937-946. [DOI: 10.1002/mds.27346] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Christos Ganos
- Department of Neurology, Charité; University Medicine; Berlin Germany
- Institute of Cognitive Neuroscience; University College London; London UK
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology; University College London; London UK
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology; University College London; London UK
| | - Patrick Haggard
- Institute of Cognitive Neuroscience; University College London; London UK
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14
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Rats overexpressing the dopamine transporter display behavioral and neurobiological abnormalities with relevance to repetitive disorders. Sci Rep 2016; 6:39145. [PMID: 27974817 PMCID: PMC5156927 DOI: 10.1038/srep39145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 11/18/2016] [Indexed: 01/13/2023] Open
Abstract
The dopamine transporter (DAT) plays a pivotal role in maintaining optimal dopamine signaling. DAT-overactivity has been linked to various neuropsychiatric disorders yet so far the direct pathological consequences of it has not been fully assessed. We here generated a transgenic rat model that via pronuclear microinjection overexpresses the DAT gene. Our results demonstrate that DAT-overexpression induces multiple neurobiological effects that exceeded the expected alterations in the corticostriatal dopamine system. Furthermore, transgenic rats specifically exhibited behavioral and pharmaco-therapeutic profiles phenotypic of repetitive disorders. Together our findings suggest that the DAT rat model will constitute a valuable tool for further investigations into the pathological influence of DAT overexpression on neural systems relevant to neuropsychiatric disorders.
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15
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Niccolai V, van Dijk H, Franzkowiak S, Finis J, Südmeyer M, Jonas M, Thomalla G, Siebner HR, Müller-Vahl K, Münchau A, Schnitzler A, Biermann-Ruben K. Increased beta rhythm as an indicator of inhibitory mechanisms in tourette syndrome. Mov Disord 2015; 31:384-92. [DOI: 10.1002/mds.26454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Affiliation(s)
- Valentina Niccolai
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty; Düsseldorf University; Düsseldorf Germany
| | - Hanneke van Dijk
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty; Düsseldorf University; Düsseldorf Germany
| | - Stephanie Franzkowiak
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty; Düsseldorf University; Düsseldorf Germany
| | - Jennifer Finis
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty; Düsseldorf University; Düsseldorf Germany
| | - Martin Südmeyer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty; Düsseldorf University; Düsseldorf Germany
| | - Melanie Jonas
- Department of Psychology; Hamburg University; Hamburg Germany
| | - Götz Thomalla
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Hartwig Roman Siebner
- Danish Research Center for Magnetic Resonance; Copenhagen University Hospital; Copenhagen Denmark
- Department of Neurology; Copenhagen University Hospital Bispebjerg
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School; Hannover Germany
| | - Alexander Münchau
- Department of Pediatric and Adult Movement Disorders and Neuropsychiatry; University of Lübeck
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty; Düsseldorf University; Düsseldorf Germany
| | - Katja Biermann-Ruben
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty; Düsseldorf University; Düsseldorf Germany
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16
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Farkas A, Bluschke A, Roessner V, Beste C. Neurofeedback and its possible relevance for the treatment of Tourette syndrome. Neurosci Biobehav Rev 2015; 51:87-99. [PMID: 25616186 DOI: 10.1016/j.neubiorev.2015.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
Neurofeedback is an increasingly recognized therapeutic option in various neuropsychiatric disorders to treat dysfunctions in cognitive control as well as disorder-specific symptoms. In this review we propose that neurofeedback may also reflect a valuable therapeutic option to treat executive control functions in Gilles-de-la-Tourette syndrome (GTS). Deficits in executive control functions when ADHD symptoms appear in GTS likely reflect pathophysiological processes in cortico-thalamic-striatal circuits and may also underlie the motor symptoms in GTS. Such executive control deficits evident in comorbid GTS/ADHD depend on neurophysiological processes well-known to be modifiable by neurofeedback. However, so far efforts to use neurofeedback to treat cognitive dysfunctions are scarce. We outline why neurofeedback should be considered a promising treatment option, what forms of neurofeedback may prove to be most effective and how neurofeedback may be implemented in existing intervention strategies to treat comorbid GTS/ADHD and associated dysfunctions in cognitive control. As cognitive control deficits in GTS mostly appear in comorbid GTS/ADHD, neurofeedback may be most useful in this frequent combination of disorders.
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Affiliation(s)
- Aniko Farkas
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Germany.
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17
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Greene DJ, Koller JM, Robichaux-Viehoever A, Bihun EC, Schlaggar BL, Black KJ. Reward enhances tic suppression in children within months of tic disorder onset. Dev Cogn Neurosci 2014; 11:65-74. [PMID: 25220075 PMCID: PMC4323948 DOI: 10.1016/j.dcn.2014.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 11/12/2022] Open
Abstract
We examine a common, yet rarely studied, population: children with recent-onset tics. The ability to suppress tics is present within months of tic onset. Immediate, contingent reward enhances these children's ability to suppress tics.
Tic disorders are childhood onset neuropsychiatric disorders characterized by motor and/or vocal tics. Research has demonstrated that children with chronic tics (including Tourette syndrome and Chronic Tic Disorder: TS/CTD) can suppress tics, particularly when an immediate, contingent reward is given for successful tic suppression. As a diagnosis of TS/CTD requires tics to be present for at least one year, children in these tic suppression studies had been living with tics for quite some time. Thus, it is unclear whether the ability to inhibit tics is learned over time or present at tic onset. Resolving that issue would inform theories of how tics develop and how behavior therapy for tics works. We investigated tic suppression in school-age children as close to the time of tic onset as possible, and no later than six months after onset. Children were asked to suppress their tics both in the presence and absence of a contingent reward. Results demonstrated that these children, like children with TS/CTD, have some capacity to suppress tics, and that immediate reward enhances that capacity. These findings demonstrate that the modulating effect of reward on inhibitory control of tics is present within months of tic onset, before tics have become chronic.
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Affiliation(s)
- Deanna J Greene
- Department of Radiology, Washington University School of Medicine, United States; Department of Psychiatry, Washington University School of Medicine, United States.
| | - Jonathan M Koller
- Department of Psychiatry, Washington University School of Medicine, United States
| | | | - Emily C Bihun
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Bradley L Schlaggar
- Department of Radiology, Washington University School of Medicine, United States; Department of Neurology, Washington University School of Medicine, United States; Department of Anatomy & Neurobiology, Washington University School of Medicine, United States; Department of Pediatrics, Washington University School of Medicine, United States
| | - Kevin J Black
- Department of Radiology, Washington University School of Medicine, United States; Department of Psychiatry, Washington University School of Medicine, United States; Department of Neurology, Washington University School of Medicine, United States; Department of Anatomy & Neurobiology, Washington University School of Medicine, United States
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