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Malaty IA, Anderson S, Bennett SM, Budman CL, Coffey BJ, Coffman KA, Greenberg E, McGuire JF, Müller-Vahl KR, Okun MS, Quezada J, Robichaux-Viehoever A, Black KJ. Diagnosis and Management of Functional Tic-Like Phenomena. J Clin Med 2022; 11:6470. [PMID: 36362696 PMCID: PMC9656241 DOI: 10.3390/jcm11216470] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
Over the past 3 years, a global phenomenon has emerged characterized by the sudden onset and frequently rapid escalation of tics and tic-like movements and phonations. These symptoms have occurred not only in youth known to have tics or Tourette syndrome (TS), but also, and more notably, in youth with no prior history of tics. The Tourette Association of America (TAA) convened an international, multidisciplinary working group to better understand this apparent presentation of functional neurological disorder (FND) and its relationship to TS. Here, we review and summarize the literature relevant to distinguish the two, with recommendations to clinicians for diagnosis and management. Finally, we highlight areas for future emphasis and research.
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Affiliation(s)
- Irene A. Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | | | - Shannon M. Bennett
- Department of Psychiatry, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY 10065, USA
| | - Cathy L. Budman
- Department of Psychiatry, Northwell Health, Zucker School of Medicine, Hofstra/Northwell, Uniondale, NY 11549, USA
| | - Barbara J. Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Keith A. Coffman
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kirsten R. Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), 30625 Hannover, Germany
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Julio Quezada
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | | | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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2
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Beeler P, Jensen NO, Kim S, Robichaux-Viehoever A, Schlaggar BL, Greene DJ, Black KJ, Chakrabarty RK. Fractality of tics as a quantitative assessment tool for Tourette syndrome. J R Soc Interface 2022; 19:20210742. [PMID: 35193387 PMCID: PMC8864347 DOI: 10.1098/rsif.2021.0742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tics manifest as brief, purposeless and unintentional movements or noises that, for many individuals, can be suppressed temporarily with effort. Previous work has hypothesized that the chaotic temporal nature of tics could possess an inherent fractality, that is, have neighbour-to-neighbour correlation at all levels of timescale. However, demonstrating this phenomenon has eluded researchers for more than two decades, primarily because of the challenges associated with estimating the scale-invariant, power law exponent—called the fractal dimension Df—from fractional Brownian noise. Here, we confirm this hypothesis and establish the fractality of tics by examining two tic time series datasets collected 6–12 months apart in children with tics, using random walk models and directional statistics. We find that Df is correlated with tic severity as measured by the YGTTS total tic score, and that Df is a sensitive parameter in examining the effect of several tic suppression conditions on the tic time series. Our findings pave the way for using the fractal nature of tics as a robust quantitative tool for estimating tic severity and treatment effectiveness, as well as a possible marker for differentiating typical from functional tics.
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Affiliation(s)
- Payton Beeler
- Center for Aerosol Science and Engineering, Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, MO 63110, USA
| | - Nicholas O Jensen
- Computational and Systems Biology Program, Division of Biology and Biomedical Sciences, Washington University in St Louis, St Louis, MO 63110, USA
| | - Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, USA
| | | | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD 21205, USA.,Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA 92093, USA
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, USA.,Department of Neurology, Washington University School of Medicine, St Louis, MO 63130, USA.,Department of Radiology, Washington University School of Medicine, St Louis, MO 63130, USA.,Department of Neuroscience, Washington University School of Medicine, St Louis, MO 63130, USA
| | - Rajan K Chakrabarty
- Center for Aerosol Science and Engineering, Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, MO 63110, USA.,Institute for Public Health, Washington University in St Louis, St Louis, MO 63110, USA
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3
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Luciano MS, Robichaux-Viehoever A, Dodenhoff KA, Gittings M, Viser AC, Racine CA, Bledsoe IO, Pereira C, Wang S, Starr PA, Ostrem JL. Thalamic deep brain stimulation for acquired dystonia in children and young adults: a phase 1 clinical trial. J Neurosurg Pediatr 2020; 27:203-212. [PMID: 33254134 PMCID: PMC8155109 DOI: 10.3171/2020.7.peds20348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility and preliminary efficacy and safety of combined bilateral ventralis oralis posterior/ventralis intermedius (Vop/Vim) deep brain stimulation (DBS) for the treatment of acquired dystonia in children and young adults. Pallidal DBS is efficacious for severe, medication-refractory isolated dystonia, providing 50%-60% long-term improvement. Unfortunately, pallidal stimulation response rates in acquired dystonia are modest and unpredictable, with frequent nonresponders. Acquired dystonia, most commonly caused by cerebral palsy, is more common than isolated dystonia in pediatric populations and is more recalcitrant to standard treatments. Given the limitations of pallidal DBS in acquired dystonia, there is a need to explore alternative brain targets. Preliminary evidence has suggested that thalamic stimulation may be efficacious for acquired dystonia. METHODS Four participants, 3 with perinatal brain injuries and 1 with postencephalitic symptomatic dystonia, underwent bilateral Vop/Vim DBS and bimonthly evaluations for 12 months. The primary efficacy outcome was the change in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Barry-Albright Dystonia Scale (BADS) scores between the baseline and 12-month assessments. Video documentation was used for blinded ratings. Secondary outcomes included evaluation of spasticity (Modified Ashworth Scale score), quality of life (Pediatric Quality of Life Inventory [PedsQL] and modified Unified Parkinson's Disease Rating Scale Part II [UPDRS-II] scores), and neuropsychological assessments. Adverse events were monitored for safety. RESULTS All participants tolerated the procedure well, and there were no safety concerns or serious adverse events. There was an average improvement of 21.5% in the BFMDRS motor subscale score, but the improvement was only 1.6% according to the BADS score. Following blinded video review, dystonia severity ratings were even more modest. Secondary outcomes, however, were more encouraging, with the BFMDRS disability subscale score improving by 15.7%, the PedsQL total score by 27%, and the modified UPDRS-II score by 19.3%. Neuropsychological assessment findings were unchanged 1 year after surgery. CONCLUSIONS Bilateral thalamic neuromodulation by DBS for severe, medication-refractory acquired dystonia was well tolerated. Primary and secondary outcomes showed highly variable treatment effect sizes comparable to those of pallidal stimulation in this population. As previously described, improvements in quality of life and disability were not reflected in dystonia severity scales, suggesting a need for the development of scales specifically for acquired dystonia.Clinical trial registration no.: NCT03078816 (clinicaltrials.gov).
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Affiliation(s)
- Marta San Luciano
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Amy Robichaux-Viehoever
- Department of Neurology, Division of Child Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Kristen A Dodenhoff
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Melissa Gittings
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Aaron C Viser
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Caroline A Racine
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ian O Bledsoe
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Christa Pereira
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Sarah Wang
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jill L Ostrem
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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4
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Sherafati A, Snyder AZ, Eggebrecht AT, Bergonzi KM, Burns-Yocum TM, Lugar HM, Ferradal SL, Robichaux-Viehoever A, Smyser CD, Palanca BJ, Hershey T, Culver JP. Global motion detection and censoring in high-density diffuse optical tomography. Hum Brain Mapp 2020; 41:4093-4112. [PMID: 32648643 PMCID: PMC8022277 DOI: 10.1002/hbm.25111] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 12/30/2022] Open
Abstract
Motion‐induced artifacts can significantly corrupt optical neuroimaging, as in most neuroimaging modalities. For high‐density diffuse optical tomography (HD‐DOT) with hundreds to thousands of source‐detector pair measurements, motion detection methods are underdeveloped relative to both functional magnetic resonance imaging (fMRI) and standard functional near‐infrared spectroscopy (fNIRS). This limitation restricts the application of HD‐DOT in many challenging imaging situations and subject populations (e.g., bedside monitoring and children). Here, we evaluated a new motion detection method for multi‐channel optical imaging systems that leverages spatial patterns across measurement channels. Specifically, we introduced a global variance of temporal derivatives (GVTD) metric as a motion detection index. We showed that GVTD strongly correlates with external measures of motion and has high sensitivity and specificity to instructed motion—with an area under the receiver operator characteristic curve of 0.88, calculated based on five different types of instructed motion. Additionally, we showed that applying GVTD‐based motion censoring on both hearing words task and resting state HD‐DOT data with natural head motion results in an improved spatial similarity to fMRI mapping. We then compared the GVTD similarity scores with several commonly used motion correction methods described in the fNIRS literature, including correlation‐based signal improvement (CBSI), temporal derivative distribution repair (TDDR), wavelet filtering, and targeted principal component analysis (tPCA). We find that GVTD motion censoring on HD‐DOT data outperforms other methods and results in spatial maps more similar to those of matched fMRI data.
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Affiliation(s)
- Arefeh Sherafati
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Abraham Z Snyder
- Department of Radiology, Washington University School of Medicine in St, St. Louis, Missouri, USA.,Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Adam T Eggebrecht
- Department of Radiology, Washington University School of Medicine in St, St. Louis, Missouri, USA.,Department of Biomedical Engineering, Washington University School in St. Louis, St. Louis, Missouri, USA.,Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | | | - Tracy M Burns-Yocum
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - Heather M Lugar
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Silvina L Ferradal
- Department Of Intelligent Systems Engineering, Indiana University, Bloomington, Indiana, USA
| | | | - Christopher D Smyser
- Department of Radiology, Washington University School of Medicine in St, St. Louis, Missouri, USA.,Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ben J Palanca
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Tamara Hershey
- Department of Radiology, Washington University School of Medicine in St, St. Louis, Missouri, USA.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - Joseph P Culver
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Radiology, Washington University School of Medicine in St, St. Louis, Missouri, USA.,Department of Biomedical Engineering, Washington University School in St. Louis, St. Louis, Missouri, USA.,Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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5
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Marshall RD, Collins A, Escolar ML, Jinnah HA, Klopstock T, Kruer MC, Videnovic A, Robichaux-Viehoever A, Swett L, Revicki DA, Bender RH, Lenderking WR. A Scale to Assess Activities of Daily Living in Pantothenate Kinase-Associated Neurodegeneration. Mov Disord Clin Pract 2019; 6:139-149. [PMID: 30838313 PMCID: PMC6384181 DOI: 10.1002/mdc3.12716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022] Open
Abstract
Objective Pantothenate kinase‐associated neurodegeneration (PKAN) is an autosomal‐recessive, neurodegenerative disorder with a mixed‐motor phenotype caused by a defective PanK2 enzyme, for which there are few adequate treatment options. Clinimetrically sound measures of patient‐reported outcomes are necessary to facilitate therapeutic development for this debilitating disease. This study's objective was to develop such a scale and assess its clinimetric properties. Methods A conceptually driven, iterative, content development process incorporating input from experts, caregivers, and patients was used. Scale items were initially adapted from the Unified Parkinson's Disease Rating Scale (UPDRS) Part II resulting in the 12‐item Pantothenate Kinase‐Associated Neurodegeneration Activities of Daily Living (PKAN‐ADL). The PKAN‐ADL scale was administered to caregivers (n = 37) and patients (n = 2) twice over 2 weeks, along with selected Quality of Life in Neurological Disorders (Neuro‐QoL) measures, selected attributes of the Health Utilities Index (HUI)‐2/3, and the Stroke Aphasia Depression Questionnaire (SADQ‐10) to assess construct validity. Results Internal consistency was 0.93, with excellent test‐retest reliability (intraclass correlation coefficient = 0.99). Of the 12 items, 25% (n = 3) showed a ceiling effect >30% (range, 31–54) and 42% (n = 5) showed a floor effect >30% (range, 31–46), reflecting disease heterogeneity. Convergent validity was shown with Neuro‐QoL measures (rs > 0.90) and HUI‐2/3 attributes (rs ≥ 0.48); divergent validity was demonstrated with the SADQ‐10 (r = 0.11). Participants reported a high level of comprehension (98%), and average item relevance ratings (0–10 scale) ranged from 7.0 to 9.9. Conclusion The PKAN‐ADL scale demonstrated acceptable content validity, with evidence of construct validity and excellent reliability. Overall results support the use of the PKAN‐ADL scale in clinical trials.
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Affiliation(s)
| | - Abigail Collins
- Departments of Pediatrics and Neurology University of Colorado School of Medicine Denver Colorado USA
| | - Maria L Escolar
- Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - H A Jinnah
- Departments of Neurology and Human Genetics Emory University School of Medicine Atlanta Georgia USA
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur-Institute University of Munich, Munich, Germany and German Center for Neurodegenerative Diseases (DZNE) Munich Germany
| | - Michael C Kruer
- Barrow Neurological Institute Phoenix Children's Hospital, University of Arizona College of Medicine Phoenix Arizona USA
| | - Aleksandar Videnovic
- Department of Neurology Massachusetts General Hospital/Harvard Medical School Boston Massachusetts USA
| | - Amy Robichaux-Viehoever
- Departments of Neurology and Pediatrics University of California-San Francisco San Francisco California USA
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7
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Abstract
Management of movement disorders in children is an evolving field. This article outlines the major categories of treatment options for pediatric movement disorders and general guidelines for their use. We review the evidence for existing therapies, which continue to lack large-scale controlled trials to guide treatment decisions. The field continues to rely on extrapolations from adult studies and lower quality evidence such as case reports and case series to guide treatment guidelines and consensus statements. Developments in new pharmaceuticals for rare diseases have begun to provide hope for those cases in which a genetic diagnosis can be made. Advances in surgical therapies such as deep brain stimulation as well as new modes of treatment such as gene therapy, epigenetic modulation, and stem cell therapy hold promise for improving outcomes in both primary and secondary causes of movement disorders. There is a critical need for larger, multicenter, controlled clinical trials to fully evaluate treatments for pediatric movement disorders.
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Affiliation(s)
- Jeffrey B Russ
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Akila M Nallappan
- Undergraduate Program, Case Western Reserve University, Cleveland, OH
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Eggebrecht AT, Ferradal SL, Robichaux-Viehoever A, Hassanpour MS, Dehghani H, Snyder AZ, Hershey T, Culver JP. Mapping distributed brain function and networks with diffuse optical tomography. Nat Photonics 2014; 8:448-454. [PMID: 25083161 PMCID: PMC4114252 DOI: 10.1038/nphoton.2014.107] [Citation(s) in RCA: 291] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 04/10/2014] [Indexed: 05/18/2023]
Abstract
Mapping of human brain function has revolutionized systems neuroscience. However, traditional functional neuroimaging by positron emission tomography or functional magnetic resonance imaging cannot be used when applications require portability, or are contraindicated because of ionizing radiation (positron emission tomography) or implanted metal (functional magnetic resonance imaging). Optical neuroimaging offers a non-invasive alternative that is radiation free and compatible with implanted metal and electronic devices (for example, pacemakers). However, optical imaging technology has heretofore lacked the combination of spatial resolution and wide field of view sufficient to map distributed brain functions. Here, we present a high-density diffuse optical tomography imaging array that can map higher-order, distributed brain function. The system was tested by imaging four hierarchical language tasks and multiple resting-state networks including the dorsal attention and default mode networks. Finally, we imaged brain function in patients with Parkinson's disease and implanted deep brain stimulators that preclude functional magnetic resonance imaging.
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Affiliation(s)
- Adam T. Eggebrecht
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Silvina L. Ferradal
- Department of Biomedical Engineering, Washington University, St Louis, Missouri 63130, USA
| | - Amy Robichaux-Viehoever
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Mahlega S. Hassanpour
- Department of Physics, Washington University School of Medicine, St Louis, Missouri 63130, USA
| | - Hamid Dehghani
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Abraham Z. Snyder
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, USA
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Joseph P. Culver
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, USA
- Department of Biomedical Engineering, Washington University, St Louis, Missouri 63130, USA
- Department of Physics, Washington University School of Medicine, St Louis, Missouri 63130, USA
- Correspondence and requests for materials should be addressed to J.P.C.
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10
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Filges I, Sparagana S, Sargent M, Selby K, Schlade-Bartusiak K, Lueder GT, Robichaux-Viehoever A, Schlaggar BL, Shimony JS, Shinawi M. Brain MRI abnormalities and spectrum of neurological and clinical findings in three patients with proximal 16p11.2 microduplication. Am J Med Genet A 2014; 164A:2003-12. [PMID: 24891046 DOI: 10.1002/ajmg.a.36605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 04/16/2014] [Indexed: 11/06/2022]
Abstract
The phenotype of recurrent ∼600 kb microdeletion and microduplication on proximal 16p11.2 is characterized by a spectrum of neurodevelopmental impairments including developmental delay and intellectual disability, epilepsy, autism and psychiatric disorders which are all subject to incomplete penetrance and variable expressivity. A variety of brain MRI abnormalities were reported in patients with 16p11.2 rearrangements, but no systematic correlation has been studied among patients with similar brain anomalies, their neurodevelopmental and clinical phenotypes. We present three patients with the proximal 16p11.2 microduplication exhibiting significant developmental delay, anxiety disorder and other variable clinical features. Our patients have abnormal brain MRI findings of cerebral T2 hyperintense foci (3/3) and ventriculomegaly (2/3). The neuroradiological or neurological findings in two cases prompted an extensive diagnostic work-up. One patient has exhibited neurological regression and progressive vision impairment and was diagnosed with juvenile neuronal ceroid-lipofuscinosis. We compare the clinical course and phenotype of these patients in regard to the clinical significance of the cerebral lesions and the need for MRI surveillance. We conclude that in all three patients the lesions were not progressive, did not show any sign of malignant transformation and could not be correlated to specific clinical features. We discuss potential etiologic mechanisms that may include overexpression of genes within the duplicated region involved in control of cell proliferation and complex molecular mechanisms such as the MAPK/ERK pathway. Systematic studies in larger cohorts are needed to confirm our observation and to establish the prevalence and clinical significance of these neuroanatomical abnormalities in patients with 16p11.2 duplications.
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Affiliation(s)
- Isabel Filges
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute, University of British Columbia, Vancouver, Canada; Division of Medical Genetics, Department of Biomedicine, University Hospitals Basel, Basel, Switzerland
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Kanter EM, Majumder S, Vargis E, Robichaux-Viehoever A, Kanter GJ, Shappell H, Jones HW, Mahadevan-Jansen A. Multiclass discrimination of cervical precancers using Raman spectroscopy. J Raman Spectrosc 2009; 40:205-211. [PMID: 21691450 PMCID: PMC3117583 DOI: 10.1002/jrs.2108] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Raman spectroscopy has the potential to differentiate among the various stages leading to high-grade cervical cancer such as normal, squamous metaplasia, and low-grade cancer. For Raman spectroscopy to successfully differentiate among the stages, an applicable statistical method must be developed. Algorithms like linear discriminant analysis (LDA) are incapable of differentiating among three or more types of tissues. We developed a novel statistical method combining the method of maximum representation and discrimination feature (MRDF) to extract diagnostic information with sparse multinomial logistic regression (SMLR) to classify spectra based on nonlinear features for multiclass analysis of Raman spectra. We found that high-grade spectra classified correctly 95% of the time; low-grade data classified correctly 74% of the time, improving sensitivity from 92 to 98% and specificity from 81 to 96% suggesting that MRDF with SMLR is a more appropriate technique for categorizing Raman spectra. SMLR also outputs a posterior probability to evaluate the algorithm's accuracy. This combined method holds promise to diagnose subtle changes leading to cervical cancer.
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Affiliation(s)
- Elizabeth M. Kanter
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37235, USA
| | - Shovan Majumder
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37235, USA
| | - Elizabeth Vargis
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37235, USA
| | | | | | | | - Howard W. Jones
- Vanderbilt University, Department of Obstetrics and Gynecology, Nanville, TN, USA
| | - Anita Mahadevan-Jansen
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37235, USA
- Correspondence to: Anita Mahadevan-Jansen, Vanderbilt University, Department of Biomedical Engineering, Station B, Box 351631 Nashville, TN 37235, USA.
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Robichaux-Viehoever A, Kanter E, Shappell H, Billheimer D, Jones H, Mahadevan-Jansen A. Characterization of Raman spectra measured in vivo for the detection of cervical dysplasia. Appl Spectrosc 2007; 61:986-93. [PMID: 17910796 DOI: 10.1366/000370207781746053] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Raman spectroscopy has been shown to have the potential for providing differential diagnosis in the cervix with high sensitivity and specificity in previous studies. The research presented here further evaluates the potential of near-infrared Raman spectroscopy to detect cervical dysplasia in a clinical setting. Using a portable system, Raman spectra were collected from the cervix of 79 patients using clinically feasible integration times (5 seconds on most patients). Multiple Raman measurements were taken from colposcopically normal and abnormal areas prior to the excision of tissue. Data were processed to extract Raman spectra from measured signal, which includes fluorescence and noise. The resulting spectra were correlated with the corresponding histopathologic diagnosis to determine empirical differences between different diagnostic categories. Using histology as the gold standard, logistic regression discrimination algorithms were developed to distinguish between normal ectocervix, squamous metaplasia, and high-grade dysplasia using independent training and validation sets of data. An unbiased estimate of the accuracy of the model indicates that Raman spectroscopy can distinguish between high-grade dysplasia and benign tissue with sensitivity of 89% and specificity of 81%, while colposcopy in expert hands was able to discriminate with a sensitivity and specificity of 87% and 72%.
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Affiliation(s)
- Amy Robichaux-Viehoever
- Department of Biomedical Engineering, Station B, Vanderbilt University, Nashville, TN 37235, USA
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