1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Moccia L, di Luzio M, Conte E, Modica M, Ambrosecchia M, Ardizzi M, Lanzotti P, Kotzalidis GD, Janiri D, Di Nicola M, Janiri L, Gallese V, Sani G. Sense of agency and its disturbances: A systematic review targeting the intentional binding effect in neuropsychiatric disorders. Psychiatry Clin Neurosci 2024; 78:3-18. [PMID: 37755315 DOI: 10.1111/pcn.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
Sense of agency (SoA) indicates a person's ability to perceive her/his own motor acts as actually being her/his and, through them, to exert control over the course of external events. Disruptions in SoA may profoundly affect the individual's functioning, as observed in several neuropsychiatric disorders. This is the first article to systematically review studies that investigated intentional binding (IB), a quantitative proxy for SoA measurement, in neurological and psychiatric patients. Eligible were studies of IB involving patients with neurological and/or psychiatric disorders. We included 15 studies involving 692 individuals. Risk of bias was low throughout studies. Abnormally increased action-outcome binding was found in schizophrenia and in patients with Parkinson's disease taking dopaminergic medications or reporting impulsive-compulsive behaviors. A decreased IB effect was observed in Tourette's disorder and functional movement disorders, whereas increased action-outcome binding was found in patients with the cortico-basal syndrome. The extent of IB deviation from healthy control values correlated with the severity of symptoms in several disorders. Inconsistent effects were found for autism spectrum disorders, anorexia nervosa, and borderline personality disorder. Findings pave the way for treatments specifically targeting SoA in neuropsychiatric disorders where IB is altered.
Collapse
Affiliation(s)
- Lorenzo Moccia
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michelangelo di Luzio
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Eliana Conte
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Modica
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marianna Ambrosecchia
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Martina Ardizzi
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Pierluigi Lanzotti
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- NESMOS Department, University of Rome La Sapienza, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Delfina Janiri
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Janiri
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vittorio Gallese
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
- Italian Academy for Advanced Studies in America at Columbia University, New York, New York, USA
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| |
Collapse
|
3
|
Fagerland SM, Berntsen HR, Fredriksen M, Endestad T, Skouras S, Rootwelt-Revheim ME, Undseth RM. Exploring protocol development: Implementing systematic contextual memory to enhance real-time fMRI neurofeedback. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2024; 15:41-62. [PMID: 38827812 PMCID: PMC11141335 DOI: 10.2478/joeb-2024-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Indexed: 06/05/2024]
Abstract
Objective The goal of this study was to explore the development and implementation of a protocol for real-time fMRI neurofeedback (rtfMRI-nf) and to assess the potential for enhancing the selective brain activation using stimuli from Virtual Reality (VR). In this study we focused on two specific brain regions, supplementary motor area (SMA) and right inferior frontal gyrus (rIFG). Publications by other study groups have suggested impaired function in these specific brain regions in patients with the diagnoses Attention Deficit Hyperactivity Disorder (ADHD) and Tourette's Syndrome (TS). This study explored the development of a protocol to investigate if attention and contextual memory may be used to systematically strengthen the procedure of rtfMRI-nf. Methods We used open-science software and platforms for rtfMRI-nf and for developing a simulated repetition of the rtfMRI-nf brain training in VR. We conducted seven exploratory tests in which we updated the protocol at each step. During rtfMRI-nf, MRI images are analyzed live while a person is undergoing an MRI scan, and the results are simultaneously shown to the person in the MRI-scanner. By focusing the analysis on specific regions of the brain, this procedure can be used to help the person strengthen conscious control of these regions. The VR simulation of the same experience involved a walk through the hospital toward the MRI scanner where the training sessions were conducted, as well as a subsequent simulated repetition of the MRI training. The VR simulation was a 2D projection of the experience.The seven exploratory tests involved 19 volunteers. Through this exploration, methods for aiming within the brain (e.g. masks/algorithms for coordinate-system control) and calculations for the analyses (e.g. calculations based on connectivity versus activity) were updated by the project team throughout the project. The final procedure involved three initial rounds of rtfMRI-nf for learning brain strategies. Then, the volunteers were provided with VR headsets and given instructions for one week of use. Afterward, a new session with three rounds of rtfMRI-nf was conducted. Results Through our exploration of the indirect effect parameters - brain region activity (directed oxygenated blood flow), connectivity (degree of correlated activity in different regions), and neurofeedback score - the volunteers tended to increase activity in the reinforced brain regions through our seven tests. Updates of procedures and analyses were always conducted between pilots, and never within. The VR simulated repetition was tested in pilot 7, but the role of the VR contribution in this setting is unclear due to underpowered testing. Conclusion This proof-of-concept protocol implies how rtfMRI-nf may be used to selectively train two brain regions (SMA and rIFG). The method may likely be adapted to train any given region in the brain, but readers are advised to update and adapt the procedure to experimental needs.
Collapse
Affiliation(s)
- Steffen Maude Fagerland
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Cognitive and Neuropsychology, Department of Psychology, University of Oslo, Oslo, Norway
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, Department of Psychology, University of Oslo, Norway
| | - Henrik Røsholm Berntsen
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
| | - Mats Fredriksen
- Neuropsychatric Outpatient Clinic, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tor Endestad
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, Department of Psychology, University of Oslo, Norway
- Department of Neuropsychology, Helgeland Hospital, Norway
| | - Stavros Skouras
- Department of Fundamental Neurosciences, Faculty of Medicine, University of Geneva, Geneva, CH-1202, Switzerland
- Department of Biological and Medical Psychology, University of Bergen, Bergen, NO-5020, Norway
- Department of Neurology, Inselspital University Hospital Bern, Bern, CH-3010, Switzerland
| | - Mona Elisabeth Rootwelt-Revheim
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Marie Undseth
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Cognitive and Neuropsychology, Department of Psychology, University of Oslo, Oslo, Norway
- Division of Radiology Research, The Intervention Centre, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
4
|
Tics: neurological disorders determined by a deficit in sensorimotor gating processes. Neurol Sci 2022; 43:5839-5850. [PMID: 35781754 PMCID: PMC9474467 DOI: 10.1007/s10072-022-06235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022]
Abstract
Tic related disorders affect 4–20% of the population, mostly idiopathic, can be grouped in a wide spectrum of severity, where the most severe end is Tourette Syndrome (TS). Tics are arrhythmic hyperkinesias to whom execution the subject is forced by a “premonitory urge” that can be classified as sensory tic, just-right experience or urge without obsession. If an intact volitional inhibition allows patients to temporarily suppress tics, a lack or deficit in automatic inhibition is involved in the genesis of the disorder. Studies have assessed the presence of intrinsic microscopic and macroscopic anomalies in striatal circuits and relative cortical areas in association with a hyperdopaminergic state in the basal forebrain. Prepulse inhibition (PPI) of the startle reflex is a measure of inhibitory functions by which a weak sensory stimulus inhibits the elicitation of a startle response determined by a sudden intense stimulus. It is considered an operation measure of sensorimotor gating, a neural process by which unnecessary stimuli are eliminated from awareness. Evidence points out that the limbic domain of the CSTC loops, dopamine and GABA receptors within the striatum play an important role in PPI modulation. It is conceivable that a sensorimotor gating deficit may be involved in the genesis of premonitory urge and symptoms. Therefore, correcting the sensorimotor gating deficit may be considered a target for tic-related disorders therapies; in such case PPI (as well as other indirect estimators of sensorimotor gating) could represent therapeutic impact predictors.
Collapse
|
5
|
Pacella V, Moro V. Motor awareness: a model based on neurological syndromes. Brain Struct Funct 2022; 227:3145-3160. [PMID: 36064864 DOI: 10.1007/s00429-022-02558-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/24/2022] [Indexed: 12/20/2022]
Abstract
Motor awareness is a complex, multifaceted construct involving the awareness of both (i) one's motor state while executing a movement or remaining still and (ii) one's motor abilities. The analysis of neurological syndromes associated with motor disorders suggests the existence of various different components which are, however, integrated into a model of motor awareness. These components are: (i) motor intention, namely, a conscious desire to perform an action; (ii) motor monitoring and error recognition, that is, the capacity to check the execution of the action and identify motor errors; and (iii) a general awareness of one's own motor abilities and deficits, that is, the capacity to recognize the general state of one's motor abilities about the performance of specific actions and the potential consequences of motor impairment. Neuroanatomical correlates involving the parietal and insular cortices, the medial and lateral frontal regions, and subcortical structures (basal ganglia and limbic system) support this multi-component model. Specific damage (or disconnections) to these structures results in a number of different disorders in motor awareness, such as anosognosia for hemiplegia and apraxia, and a number of symptoms which are specific to motor intention disorders (e.g., the Anarchic Hand Syndrome and Tourette's Syndrome) or motor monitoring (e.g., Parkinson's and Huntington's diseases). All of these clinical conditions are discussed in the light of a motor awareness model.
Collapse
Affiliation(s)
- Valentina Pacella
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, 33076, Bordeaux, CS, France. .,Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France.
| | - Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| |
Collapse
|
6
|
Tikoo S, Suppa A, Tommasin S, Giannì C, Conte G, Mirabella G, Cardona F, Pantano P. The Cerebellum in Drug-naive Children with Tourette Syndrome and Obsessive–Compulsive Disorder. THE CEREBELLUM 2021; 21:867-878. [PMID: 34595609 PMCID: PMC9596574 DOI: 10.1007/s12311-021-01327-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/24/2022]
Abstract
Tourette syndrome (TS) and obsessive–compulsive disorder (OCD) are two neurodevelopmental disorders characterized by repetitive behaviors. Our recent study in drug-naive children with TS and OCD provided evidence of cerebellar involvement in both disorders. In addition, cerebellar functional connectivity (FC) was similar in TS patients without comorbidities (TSpure) and TS patients with OCD comorbidity (TS + OCD), but differed in pure OCD patients. To investigate in detail the cerebellar involvement in the pathophysiology of TS and OCD, we explored cerebellar structural and functional abnormalities in drug-naive children with TSpure, TS + OCD, and OCD and assessed possible correlations with severity scores. We examined 53 drug-naive children, classified as TSpure (n = 16), TS + OCD (n = 14), OCD (n = 11), or controls (n = 12). All subjects underwent a multimodal 3T magnetic resonance imaging examination. Cerebellar lobular volumes and quantitative diffusion tensor imaging parameters of cerebellar peduncles were used as measures of structural integrity. The dentate nucleus was selected as a region of interest to examine cerebello-cerebral functional connectivity alterations. Structural analysis revealed that both TSpure and TS + OCD patients had higher fractional anisotropy in cerebellar peduncles than controls. Conversely, OCD patients were characterized by lower fractional anisotropy than both controls and TSpure and TS + OCD patients. Lastly, cerebellar functional connectivity analysis revealed significant alterations in the cerebello-thalamo-cortical circuit in TSpure, TS + OCD, and OCD patients. Early cerebellar structural and functional changes in drug-naive pediatric TSpure, TS + OCD, and OCD patients support a primary role of the cerebellum in the pathophysiology of these disorders.
Collapse
Affiliation(s)
- Sankalp Tikoo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
- Department of Neuroimmunology, IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Giulia Conte
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Giovanni Mirabella
- Department of Clinical and Experimental Sciences Section, Brescia University, Brescia, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Francesco Cardona
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
| |
Collapse
|
7
|
Robey KL, Balboni DC. Wanted: A vocabulary for talking about involuntary behaviors associated with Lesch-Nyhan disease. JIMD Rep 2021; 59:26-31. [PMID: 33977027 PMCID: PMC8100390 DOI: 10.1002/jmd2.12210] [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: 12/16/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 01/18/2023] Open
Abstract
Lesch-Nyhan disease (LND) is a rare genetic disorder with an unusual behavioral phenotype that includes severe and involuntary self-injury requiring the near constant use of protective devices and, for some individuals, dental extraction. Often, the person with LND also engages in emotional self-injury in the form of both self-sabotage and behaviors directed toward others that will have a negative social consequence. When these self-destructive behaviors present themselves, it is sometimes challenging for caregivers, professionals, or other observers to fully recognize their lack of volition. It is an even greater challenge to accurately and convincingly convey their involuntary nature to medical students, colleagues, school staff, or even family members who might be unfamiliar with the disorder. It is difficult to find words to clearly and adequately convey the essence of behaviors like those that we find in LND without, in some way, implying intent.
Collapse
Affiliation(s)
- Kenneth L. Robey
- Quality Improvement and Patient SafetyMatheny Medical and Educational CenterPeapackNew JerseyUSA
| | - Daniel C. Balboni
- Psychological ServicesMatheny Medical and Educational CenterPeapackNew JerseyUSA
| |
Collapse
|
8
|
Rae CL, Parkinson J, Betka S, Gouldvan Praag CD, Bouyagoub S, Polyanska L, Larsson DEO, Harrison NA, Garfinkel SN, Critchley HD. Amplified engagement of prefrontal cortex during control of voluntary action in Tourette syndrome. Brain Commun 2021; 2:fcaa199. [PMID: 33409490 PMCID: PMC7772099 DOI: 10.1093/braincomms/fcaa199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Tourette syndrome is characterized by ‘unvoluntary’ tics, which are compulsive, yet often temporarily suppressible. The inferior frontal gyrus is implicated in motor control, including inhibition of pre-potent actions through influences on downstream subcortical and motor regions. Although tic suppression in Tourette syndrome also engages the inferior frontal gyrus, it is unclear whether such prefrontal control of action is also dysfunctional: Tic suppression studies do not permit comparison with control groups, and neuroimaging studies of motor inhibition can be confounded by the concurrent expression or suppression of tics. Here, patients with Tourette syndrome were directly compared to control participants when performing an intentional inhibition task during functional MRI. Tic expression was recorded throughout for removal from statistical models. Participants were instructed to make a button press in response to Go cues, withhold responses to NoGo cues, and decide whether to press or withhold to ‘Choose’ cues. Overall performance was similar between groups, for both intentional inhibition rates (% Choose-Go) and reactive NoGo inhibition commission errors. A subliminal face prime elicited no additional effects on intentional or reactive inhibition. Across participants, the task activated prefrontal and motor cortices and subcortical nuclei, including pre-supplementary motor area, inferior frontal gyrus, insula, caudate nucleus, thalamus and primary motor cortex. In Tourette syndrome, activity was elevated in the inferior frontal gyrus, insula and basal ganglia, most notably within the right inferior frontal gyrus during voluntary action and inhibition (Choose-Go and Choose-NoGo), and reactive inhibition (NoGo-correct). Anatomically, the locus of this inferior frontal gyrus hyperactivation during control of voluntary action matched that previously reported for tic suppression. In Tourette syndrome, activity within the caudate nucleus was also enhanced during both intentional (Choose-NoGo) and reactive (NoGo-correct) inhibition. Strikingly, despite the absence of overt motor behaviour, primary motor cortex activity increased in patients with Tourette syndrome but decreased in controls during both reactive and intentional inhibition. Additionally, severity of premonitory sensations scaled with functional connectivity of the pre-supplementary motor area to the caudate nucleus, globus pallidus and thalamus when choosing to respond (Choose-Go). Together, these results suggest that patients with Tourette syndrome use equivalent prefrontal mechanisms to suppress tics and withhold non-tic actions, but require greater inferior frontal gyrus engagement than controls to overcome motor drive from hyperactive downstream regions, notably primary motor cortex. Moreover, premonitory sensations may cue midline motor regions to generate tics through interactions with the basal ganglia.
Collapse
Affiliation(s)
- Charlotte L Rae
- School of Psychology, University of Sussex, Sussex BN1 9QH, UK
| | - Jim Parkinson
- School of Psychology, University of Sussex, Sussex BN1 9QH, UK
| | - Sophie Betka
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | | | - Samira Bouyagoub
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | - Liliana Polyanska
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | | | - Neil A Harrison
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, Sussex, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Sussex, UK
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Stults-Kolehmainen MA, Blacutt M, Bartholomew JB, Gilson TA, Ash GI, McKee PC, Sinha R. Motivation States for Physical Activity and Sedentary Behavior: Desire, Urge, Wanting, and Craving. Front Psychol 2020; 11:568390. [PMID: 33240154 PMCID: PMC7677192 DOI: 10.3389/fpsyg.2020.568390] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/16/2020] [Indexed: 12/24/2022] Open
Abstract
To better explain daily fluctuations in physical activity and sedentary behavior, investigations of motivation are turning from social cognitive frameworks to those centered on affect, emotion and automaticity, such as the Affect and Health Behavior Framework (AHBF), Integrated Framework and Affective-Reflective Theory (ART). This shift has necessitated: (a) re-examination of older theories and their constructs, such as drives, needs and tensions and (b) an inspection of competing theories from other fields that also attempt to explain dynamic changes in health behaviors. The Dynamical Model of Desire, Elaborated Intrusion Theory and others commonly share with AHBF the idea that human behavior is driven strongly by desires and/or the similar concepts of wants, urges, and cravings. These affectively-charged motivation states (ACMS) change quickly and may better explain physical activity behavior from one moment to the next. Desires for movement predominantly derive from negative but also positive reinforcement. Data from clinical populations with movement dysfunction or psychiatric disorders provides further evidence of these drivers of movement. Those with Restless Legs Syndrome, akathisia, tic disorders and exercise dependence all report strong urges to move and relief when it is accomplished. Motor control research has identified centers of the brain responsible for wants and urges for muscular movement. Models elaborated herein differentiate between wants, desires, urges and cravings. The WANT model (Wants and Aversions for Neuromuscular Tasks) conceptualizes desires for movement and rest as varying by magnitude, approach or avoidance-orientation (wants versus aversions) and as occupying independent dimensions instead of opposite ends of the same axis. For instance, one hypothetically might be in a state of both high desire for movement and rest simultaneously. Variations in motivation states to move and rest may also be associated with various stress states, like freezing or fight and flight. The first validated instrument to measure feelings of desire/want for movement and rest, the CRAVE Scale (Cravings for Rest and Volitional Energy Expenditure) is already shedding light on the nature of these states. With these advances in theory, conceptual modeling and instrumentation, future investigations may explore the effects of desires and urges for movement and sedentary behavior in earnest.
Collapse
Affiliation(s)
- Matthew A. Stults-Kolehmainen
- Bariatric and Minimally Invasive Surgery Program, Yale-New Haven Hospital, New Haven, CT, United States
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Miguel Blacutt
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - John B. Bartholomew
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Todd A. Gilson
- Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb, IL, United States
| | - Garrett I. Ash
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME), VA Connecticut Healthcare System, West Haven, CT, United States
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
| | - Paul C. McKee
- Department of Psychology, Southern Connecticut State University, New Haven, CT, United States
| | - Rajita Sinha
- Yale Stress Center, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
11
|
McGurrin P, Attaripour S, Vial F, Hallett M. Purposely Induced Tics: Electrophysiology. Tremor Other Hyperkinet Mov (N Y) 2020; 10:tre-10-744. [PMID: 32195038 PMCID: PMC7070698 DOI: 10.7916/tohm.v0.744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/06/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Patrick McGurrin
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Sanaz Attaripour
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA,Department of Neurology, University of California, Irvine, Irvine, CA, USA
| | - Felipe Vial
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA,Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Vitacura, Región Metropolitana, CL
| | - Mark Hallett
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA,To whom correspondence should be addressed. E-mail:
| |
Collapse
|
12
|
Rae CL, Critchley HD, Seth AK. A Bayesian Account of the Sensory-Motor Interactions Underlying Symptoms of Tourette Syndrome. Front Psychiatry 2019; 10:29. [PMID: 30890965 PMCID: PMC6412155 DOI: 10.3389/fpsyt.2019.00029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/17/2019] [Indexed: 11/17/2022] Open
Abstract
Tourette syndrome is a hyperkinetic movement disorder. Characteristic features include tics, recurrent movements that are experienced as compulsive and "unwilled"; uncomfortable premonitory sensations that resolve through tic release; and often, the ability to suppress tics temporarily. We demonstrate how these symptoms and features can be understood in terms of aberrant predictive (Bayesian) processing in hierarchical neural systems, explaining specifically: why tics arise, their "unvoluntary" nature, how premonitory sensations emerge, and why tic suppression works-sometimes. In our model, premonitory sensations and tics are generated through over-precise priors for sensation and action within somatomotor regions of the striatum. Abnormally high precision of priors arises through the dysfunctional synaptic integration of cortical inputs. These priors for sensation and action are projected into primary sensory and motor areas, triggering premonitory sensations and tics, which in turn elicit prediction errors for unexpected feelings and movements. We propose experimental paradigms to validate this Bayesian account of tics. Our model integrates behavioural, neuroimaging, and computational approaches to provide mechanistic insight into the pathophysiological basis of Tourette syndrome.
Collapse
Affiliation(s)
- Charlotte L. Rae
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Hugo D. Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
| | - Anil K. Seth
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- School of Engineering and Informatics, University of Sussex, Brighton, United Kingdom
| |
Collapse
|
13
|
Rae CL, Polyanska L, Gould van Praag CD, Parkinson J, Bouyagoub S, Nagai Y, Seth AK, Harrison NA, Garfinkel SN, Critchley HD. Face perception enhances insula and motor network reactivity in Tourette syndrome. Brain 2018; 141:3249-3261. [PMID: 30346484 PMCID: PMC6202569 DOI: 10.1093/brain/awy254] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/24/2018] [Accepted: 08/15/2018] [Indexed: 11/25/2022] Open
Abstract
Tourette syndrome is a neurodevelopmental disorder, characterized by motor and phonic tics. Tics are typically experienced as avolitional, compulsive, and associated with premonitory urges. They are exacerbated by stress and can be triggered by external stimuli, including social cues like the actions and facial expressions of others. Importantly, emotional social stimuli, with angry facial stimuli potentially the most potent social threat cue, also trigger behavioural reactions in healthy individuals, suggesting that such mechanisms may be particularly sensitive in people with Tourette syndrome. Twenty-one participants with Tourette syndrome and 21 healthy controls underwent functional MRI while viewing faces wearing either neutral or angry expressions to quantify group differences in neural activity associated with processing social information. Simultaneous video recordings of participants during neuroimaging enabled us to model confounding effects of tics on task-related responses to the processing of faces. In both Tourette syndrome and control participants, face stimuli evoked enhanced activation within canonical face perception regions, including the occipital face area and fusiform face area. However, the Tourette syndrome group showed additional responses within the anterior insula to both neutral and angry faces. Functional connectivity during face viewing was then examined in a series of psychophysiological interactions. In participants with Tourette syndrome, the insula showed functional connectivity with a set of cortical regions previously implicated in tic generation: the presupplementary motor area, premotor cortex, primary motor cortex, and the putamen. Furthermore, insula functional connectivity with the globus pallidus and thalamus varied in proportion to tic severity, while supplementary motor area connectivity varied in proportion to premonitory sensations, with insula connectivity to these regions increasing to a greater extent in patients with worse symptom severity. In addition, the occipital face area showed increased functional connectivity in Tourette syndrome participants with posterior cortical regions, including primary somatosensory cortex, and occipital face area connectivity with primary somatosensory and primary motor cortices varied in proportion to tic severity. There were no significant psychophysiological interactions in controls. These findings highlight a potential mechanism in Tourette syndrome through which heightened representation within insular cortex of embodied affective social information may impact the reactivity of subcortical motor pathways, supporting programmed motor actions that are causally implicated in tic generation. Medicinal and psychological therapies that focus on reducing insular hyper-reactivity to social stimuli may have potential benefit for tic reduction in people with Tourette syndrome.
Collapse
Affiliation(s)
- Charlotte L Rae
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
| | - Liliana Polyanska
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
- Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Cassandra D Gould van Praag
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
- Department of Psychiatry, University of Oxford, UK
| | - Jim Parkinson
- Sackler Centre for Consciousness Science, University of Sussex, UK
- School of Psychology, University of Sussex, UK
| | - Samira Bouyagoub
- Department of Neuroscience, Brighton and Sussex Medical School, UK
| | - Yoko Nagai
- Department of Neuroscience, Brighton and Sussex Medical School, UK
| | - Anil K Seth
- Sackler Centre for Consciousness Science, University of Sussex, UK
- School of Engineering and Informatics, University of Sussex, UK
| | - Neil A Harrison
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
- Sussex Partnership NHS Foundation Trust, UK
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
- Sussex Partnership NHS Foundation Trust, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Abstract
Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental disorder that is characterized by several motor and phonic tics. Tics usually develop before 10 years of age, exhibit a waxing and waning course and typically improve with increasing age. A prevalence of approximately 1% is estimated in children and adolescents. The condition can result in considerable social stigma and poor quality of life, especially when tics are severe (for example, with coprolalia (swearing tics) and self-injurious behaviours) or when GTS is accompanied by attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or another neuropsychiatric disorder. The aetiology is complex and multifactorial. GTS is considered to be polygenic, involving multiple common risk variants combined with rare, inherited or de novo mutations. These as well as non-genetic factors (such as perinatal events and immunological factors) are likely to contribute to the heterogeneity of the clinical phenotype, the structural and functional brain anomalies and the neural circuitry involvement. Management usually includes psychoeducation and reassurance, behavioural methods, pharmacotherapy and, rarely, functional neurosurgery. Future research that integrates clinical and neurobiological data, including neuroimaging and genetics, is expected to reveal the pathogenesis of GTS at the neural circuit level, which may lead to targeted interventions.
Collapse
|
16
|
Cavanna AE, Black KJ, Hallett M, Voon V. Neurobiology of the Premonitory Urge in Tourette's Syndrome: Pathophysiology and Treatment Implications. J Neuropsychiatry Clin Neurosci 2017; 29:95-104. [PMID: 28121259 PMCID: PMC5409107 DOI: 10.1176/appi.neuropsych.16070141] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Motor and vocal tics are relatively common motor manifestations identified as the core features of Tourette's syndrome (TS). Although traditional descriptions have focused on objective phenomenological observations, such as anatomical location, number and frequency of tics, patients' first-person accounts have consistently reported characteristic subjective correlates. These sensory phenomena are often described as a feeling of mounting inner tension or urge to move ("premonitory urge"), which is transiently relieved by tic expression. This article reviews the existing literature on the clinical and neurobiological aspects of the premonitory urge in patients with TS, with focus on its pathophysiology and possible treatment implications.
Collapse
Affiliation(s)
- Andrea E. Cavanna
- Department of Neuropsychiatry Research Group, BSMHFT and University of Birmingham, Birmingham, UK,School of Life and Health Sciences, Aston University, Birmingham, UK,University College London and Institute of Neurology, London, UK,Corresponding author: Andrea E. Cavanna, MD PhD FRCP, Department of Neuropsychiatry, The Barberry National Centre for Mental Health, 25 Vincent Drive, Birmingham B152FG, United Kingdom, , Tel: +44 121 3012280
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Anatomy & Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neurosciences Institute, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
17
|
Misirlisoy E, Brandt V, Ganos C, Tübing J, Münchau A, Haggard P. The relation between attention and tic generation in Tourette syndrome. Neuropsychology 2014; 29:658-65. [PMID: 25486384 PMCID: PMC4484548 DOI: 10.1037/neu0000161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Many neuropsychiatric disorders involve abnormal attentional processing. Systematic investigations of how attention may affect tic frequency in Tourette syndrome are lacking. Method: Patients performed rhythmic finger movements, approximately once every 2 s. Each movement triggered a unique visual color stimulus. Patients were asked to monitor and remember their finger actions, the external colors caused by their actions, or their tics. Sixteen adult Tourette syndrome patients performed each task twice: once while inhibiting tics, and once without inhibiting tics. Results: During the “freely tic” condition, patients had significantly fewer tics when attending to finger movements, or to the ensuing colors, compared with when attending to their tics. Attention to fingers produced the fewest tics overall. During tic suppression, tic frequency was reduced to an equal level in all conditions. Conclusions: Focusing attention away from tics significantly reduces tic frequency. This attentional process may operate by regulating motor noise.
Collapse
Affiliation(s)
| | - Valerie Brandt
- Department for Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck
| | | | - Jennifer Tübing
- Department for Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck
| | - Alexander Münchau
- Department for Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck
| | | |
Collapse
|