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Naysmith LF, Kumari V, Williams SCR. Neural mapping of prepulse-induced startle reflex modulation as indices of sensory information processing in healthy and clinical populations: A systematic review. Hum Brain Mapp 2021; 42:5495-5518. [PMID: 34414633 PMCID: PMC8519869 DOI: 10.1002/hbm.25631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 12/18/2022] Open
Abstract
Startle reflex is modulated when a weaker sensory stimulus ("prepulse") precedes a startling stimulus ("pulse"). Prepulse Inhibition (PPI) is the attenuation of the startle reflex (prepulse precedes pulse by 30-500 ms), whereas Prepulse Facilitation (PPF) is the enhancement of the startle reflex (prepulse precedes pulse by 500-6000 ms). Here, we critically appraise human studies using functional neuroimaging to establish brain regions associated with PPI and PPF. Of 10 studies, nine studies revealed thalamic, striatal and frontal lobe activation during PPI in healthy groups, and activation deficits in the cortico-striato-pallido-thalamic circuitry in schizophrenia (three studies) and Tourette Syndrome (two studies). One study revealed a shared network for PPI and PPF in frontal regions and cerebellum, with PPF networks recruiting superior medial gyrus and cingulate cortex. The main gaps in the literature are (i) limited PPF research and whether PPI and PPF operate on separate/shared networks, (ii) no data on sex differences in neural underpinnings of PPI and PPF, and (iii) no data on neural underpinnings of PPI and PPF in other clinical disorders.
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Affiliation(s)
- Laura F. Naysmith
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Centre for Cognitive Neuroscience, College of HealthMedicine and Life Sciences, Brunel University LondonUK
| | - Steven C. R. Williams
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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Benítez-Burraco A, Progovac L. Language evolution: examining the link between cross-modality and aggression through the lens of disorders. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200188. [PMID: 33745319 PMCID: PMC8059641 DOI: 10.1098/rstb.2020.0188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
We demonstrate how two linguistic phenomena, figurative language (implicating cross-modality) and derogatory language (implicating aggression), both demand a precise degree of (dis)inhibition in the same cortico-subcortical brain circuits, in particular cortico-striatal networks, whose connectivity has been significantly enhanced in recent evolution. We examine four cognitive disorders/conditions that exhibit abnormal patterns of (dis)inhibition in these networks: schizophrenia (SZ), autism spectrum disorder (ASD), synaesthesia and Tourette's syndrome (TS), with the goal of understanding why the two phenomena altered reactive aggression and altered cross-modality cluster together in these disorders. Our proposal is that enhanced cross-modality (necessary to support language, in particular metaphoricity) was a result, partly a side-effect, of self-domestication (SD). SD targeted the taming of reactive aggression, but reactive impulses are controlled by the same cortico-subcortical networks that are implicated in cross-modality. We further add that this biological process of SD did not act alone, but was engaged in an intense feedback loop with the cultural emergence of early forms of language/grammar, whose high degree of raw metaphoricity and verbal aggression also contributed to increased brain connectivity and cortical control. Consequently, in conjunction with linguistic expressions serving as approximations/'fossils' of the earliest stages of language, these cognitive disorders/conditions serve as confident proxies of brain changes in language evolution, helping us reconstruct certain crucial aspects of early prehistoric languages and cognition, as well as shed new light on the nature of the disorders. This article is part of the theme issue 'Reconstructing prehistoric languages'.
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Affiliation(s)
- Antonio Benítez-Burraco
- Department of Spanish, Linguistics and Theory of Literature (Linguistics), Faculty of Philology, University of Seville, Seville, Spain
| | - Ljiljana Progovac
- Linguistics Program, Department of English, Wayne State University, Detroit, MI, USA
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Jalenques I, Cyrille D, Derost P, Hartmann A, Lauron S, Jameux C, Tauveron-Jalenques U, Guiguet-Auclair C, Rondepierre F. Cross-cultural adaptation and psychometric evaluation of the French version of the Gilles de la Tourette Syndrome Quality of Life Scale (GTS-QOL). PLoS One 2020; 15:e0243912. [PMID: 33351837 PMCID: PMC7755204 DOI: 10.1371/journal.pone.0243912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL) is a self-rated disease-specific questionnaire to assess health-related quality of life of subjects with GTS. Our aim was to perform the cross-cultural adaptation of the GTS-QOL into French and to assess its psychometric properties. METHODS The GTS-QOL was cross-culturally adapted by conducting forward and backward translations, following international guidelines. The psychometric properties of the GTS-QOL-French were assessed in 109 participants aged 16 years and above with regard to factor structure, internal consistency, reliability and convergent validity with the MOVES (Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey) and the WHOQOL-BREF (World Health Organization Quality of Life Brief). RESULTS Exploratory factor analysis of the GTS-QOL-French resulted in a 6-factor solution and did not replicate the original structure in four subscales. The results showed good acceptability (missing values per subscale ranging from 0% to 0.9%), good internal consistency (Cronbach's alpha ranging from 0.68 to 0.94) and good test-retest reliability (intraclass correlation coefficients ranging from 0.70 to 0.81). Convergent validity with the MOVES and WHOQOL-BREF scales showed high correlations. DISCUSSION Our study provides evidence of the good psychometric properties of the GTS-QOL-French. The cross-cultural adaptation and validation of this specific instrument will make it possible to assess health-related quality of life in French-speaking subjects with GTS. The GTS-QOL-French could be recommended for use in future research.
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Affiliation(s)
- Isabelle Jalenques
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Diane Cyrille
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Andreas Hartmann
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, National Reference Center for Tourette Syndrome, Paris, France
| | - Sophie Lauron
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Clara Jameux
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Urbain Tauveron-Jalenques
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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Wang D, Tian HL, Cui X, Wang Q, Guo F, Zhang W, Tang QS. Effects of Jian-Pi-Zhi-Dong Decoction on the Expression of 5-HT and Its Receptor in a Rat Model of Tourette Syndrome and Comorbid Anxiety. Med Sci Monit 2020; 26:e924658. [PMID: 32738135 PMCID: PMC7416613 DOI: 10.12659/msm.924658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/13/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Anxiety is one of the common comorbidities of Tourette syndrome (TS). The serotonin (5-HT) system is involved in both TS and anxiety. Jian-pi-zhi-dong decoction (JPZDD) is widely used. However, the mechanism remains unknown. In this study, a rat model of TS and comorbid anxiety was used to evaluate the effect of JPZDD on 5-HT and its receptor. MATERIAL AND METHODS 48 rats were divided into 4 groups randomly (n=12). The model was established by empty water bottle stimulation plus iminodipropionitrile injection for 3 weeks. Then the control and model groups were gavaged with saline, while the treatment groups were gavaged with fluoxetine hydrochloride (Flx) or JPZDD. Body weights were measured, and behavioral tests were evaluated with stereotypy and elevated plus maze. The morphologic characters were observed by hematoxylin and eosin staining. The content of 5-HT was detected by enzyme-linked immunosorbent assay and high-performance liquid chromatography. The expression of 5-HT2C receptor was detected by western blot and quantitative polymerase chain reaction. RESULTS The stereotypy score was lower and the time spent in the open arm was longer in the JPZDD group compared with the model group. After the treatment of Flx or JPZDD, the structure of neurons became gradually normal and the cells were arranged neatly. The contents of 5-HT in the treatment groups were higher compared with the model group in the striatum. The expression of 5-HT2C mRNA in the striatum of JPZDD and Flx groups decreased compared with the model group, and the JPZDD group was lower than the Flx group. CONCLUSIONS JPZDD alleviated both tic and anxiety symptoms and the mechanism may be via reducing the expression of 5-HT2C mRNA in the striatum, increasing the concentration of 5-HT, and enhancing the activity of the 5-HT system, which in turn exerts neuro-inhibition.
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Affiliation(s)
- Dan Wang
- Department of Encephalopathy, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Hui-ling Tian
- Acupuncture-Moxibustion and Tuina Institute, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Xia Cui
- Department of Pediatrics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Qian Wang
- Department of Pediatrics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Fan Guo
- Department of Pediatrics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Wen Zhang
- Department of Pediatrics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Qi-sheng Tang
- Department of Encephalopathy, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
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Xia X, Lin Y, Lang B, Yuan J, Sheng L, Yang D, Shen J. Characteristics of diffusion tensor imaging of central nervous system in children with tourette's disease. Medicine (Baltimore) 2020; 99:e20492. [PMID: 32481462 DOI: 10.1097/md.0000000000020492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the characteristics of diffusion tensor imaging (DTI) of the central nervous system in children with Tourette syndrome (TS).Fifteen children with TS (TS group) and 15 normal children (control group) were studied, and all of them underwent DTI. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) parameters were calculated using the DTIStudio software. The region of interest was delineated manually. The ADC and FA values of the bilateral caudate nucleus, bilateral globus pallidus, bilateral putamen, bilateral thalamus, and bilateral frontal lobe white matter were measured using the region of interest editor software. The differences of FA values and ADC values between the same brain areas were compared. The associations between ADC, FA values and Yale Global Tic Severity Scale (YGTSS) scores were evaluated by Pearson correlation analyses.The FA values of left globus pallidus and left thalamus were significantly lower in the TS group than in the control group (P < .05), while the ADC values of the right caudate nucleus and bilateral thalamus were significantly higher in the TS group than in the control group (P < .05). The decrease in FA in the left thalamus significantly correlated with the YGTSS score (r = 0.692; P < .05). No correlation was found between FA and ADC values in other brain regions and the YGTSS score (P > .05).After the DTI analyses, abnormalities were found in the left globus pallidus, right caudate nucleus, and bilateral thalamus in children with TS. Especially the changes in the left thalamus structure was crucial in the pathophysiological clock of TS.
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Affiliation(s)
| | | | - Boxu Lang
- Department of Acupuncture and Massage Rehabilitation, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, China
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Abstract
Tourette syndrome is a multifaceted disorder characterized by multiple motor and at least one vocal tics that start in childhood, persist for at least 1 year, and cannot be attributed to another medical condition or exposure to medications/drugs. Clinical diagnostic criteria are available, and identification of tics is typically straightforward based on characteristic appearance and features. Diagnostic uncertainty can rarely arise in cases of mild tics, atypical features, certain psychiatric comorbidities, and other non-tic movement disorders. Comorbid psychopathology, including attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive behaviors/obsessive-compulsive disorder, affects the majority of patients and is correlated with disease severity and the presence of additional psychiatric behaviors. The severity of tics often improves after adolescence, whereas psychiatric symptoms typically persist. The subset of patients in whom tics persist into adulthood experience higher rates of anxiety, and lower self-esteem, socioeconomic status, and quality of life; the relative contribution of motor tics and psychopathology is not fully understood. This article summarizes the clinical features of Tourette syndrome, including major diagnostic criteria, unique features of tics, and key aspects that differentiate tics from common mimics and chameleons. Comorbid psychiatric conditions and their impact on phenotype and quality of life are described. Finally, current understanding of the natural history is summarized, including limited research in adults with Tourette syndrome.
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Affiliation(s)
- Chandler E Gill
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Katie Kompoliti
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, Chicago, IL, USA
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Abstract
PURPOSE OF REVIEW The purpose of this article is to present current information on the phenomenology, epidemiology, comorbidities, and pathophysiology of tic disorders and discuss therapy options. It is hoped that a greater understanding of each of these components will provide clinicians with the necessary information to deliver thoughtful and optimal care to affected individuals. RECENT FINDINGS Recent advances include the finding that Tourette syndrome is likely due to a combination of several different genes, both low-effect and larger-effect variants, plus environmental factors. Pathophysiologically, increasing evidence supports involvement of the cortical-basal ganglia-thalamocortical circuit; however, the primary location and neurotransmitter remain controversial. Behavioral therapy is first-line treatment, and pharmacotherapy is based on tic severity. Several newer therapeutic agents are under investigation (eg, valbenazine, deutetrabenazine, cannabinoids), and deep brain stimulation is a promising therapy. SUMMARY Tics, defined as sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations, are essential components of Tourette syndrome. Although some tics may be mild, others can cause significant psychosocial, physical, and functional difficulties that affect daily activities. In addition to tics, most affected individuals have coexisting neuropsychological difficulties (attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, mood disorder, disruptive behaviors, schizotypal traits, suicidal behavior, personality disorder, antisocial activities, and sleep disorders) that can further impact social and academic activities or employment.
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Nagy P, Bognár E, Farkas L, Kenézlöi E, Vida P, Gádoros J, Tárnok Z. [Clinical characteristics of children with Tourette's Syndrome]. Psychiatr Hung 2020; 35:37-45. [PMID: 31854321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Tourette Syndrome (TS) is a neurodevelopmental disorder presenting with motor and vocal tics. Although TS influences the everyday life of children, we only have fragmented knowledge on the topic of the developmental and comorbidity profile, symptom severity and genetical/environmental background. The aim of this article is to present the demographical characteristics, comorbidity profile and the tic symptom types and severity of patients from the Tourette Syndrome Outpatient Clinic of Vadaskert Child and Adolescent Psychiatry Hospital, Budapest. METHODS Our sample consists of all the patients (N=137), who visited the Tourette Syndrome Outpatient Clinic between February, 2012, and July, 2013. Patients were in the age range of 3 to 18 years. We recorded demographical and tic-specific data (age, symptom onset, TS in the family, comorbidity, adverse pre-/peri-/postnatal events) of the participants, and administered the Yale Global Tic Severity Scale (YGTSS). RESULTS The average age at symptom onset was 5.9 years. Average symptom severity (measured by the YGTSS) was 22.4 points. Comorbid Attention Deficit and Hyperactivity Disorder (ADHD) was reported in 31%, Obsessive-Compulsive Disorder (OCD) in 10%, and Autism Spectrum Disorders (ASD) in 10% of the sample. The most common tic types were simple head tics (blinking, shaking of head). Symptom severity correlated positively with age (p <0.05), but not with gender, age at symptom onset, positive family history for TS, or adverse pre-, peri-, and postnatal events. CONCLUSION The characteristics of our sample does not show any major differences from international reports of similar samples. Comorbidity is an exception: our sample shows lower rates of comorbidities than usually reported.
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Affiliation(s)
- Péter Nagy
- Vadaskert Gyermekpszichiatriai Korhaz es Szakambulancia, Budapest, Hungary, E-mail:
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9
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Abstract
Background Anatomically, cortical-basal ganglia-thalamo-cortical (CBGTC) circuits have an essential role in the expression of tics. At the biochemical level, the proper conveyance of messages through these circuits requires several functionally integrated neurotransmitter systems. In this manuscript, evidence supporting proposed pathophysiological abnormalities, both anatomical and chemical is reviewed. In addition, the results of standard and emerging tic-suppressing therapies affecting nine separate neurotransmitter systems are discussed. The goal of this review is to integrate our current understanding of the pathophysiology of Tourette syndrome (TS) with present and proposed pharmacotherapies for tic suppression. Methods For this manuscript, literature searches were conducted for both current basic science and clinical information in PubMed, Google-Scholar, and other scholarly journals to September 2018. Results The precise primary site of abnormality for tics remains undetermined. Although many pathophysiologic hypotheses favor a specific abnormality of the cortex, striatum, or globus pallidus, others recognize essential influences from regions such as the thalamus, cerebellum, brainstem, and ventral striatum. Some prefer an alteration within direct and indirect pathways, whereas others believe this fails to recognize the multiple interactions within and between CBGTC circuits. Although research and clinical evidence supports involvement of the dopaminergic system, additional data emphasizes the potential roles for several other neurotransmitter systems. Discussion A greater understanding of the primary neurochemical defect in TS would be extremely valuable for the development of new tic-suppressing therapies. Nevertheless, recognizing the varied and complex interactions that exist in a multi-neurotransmitter system, successful therapy may not require direct targeting of the primary abnormality.
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Affiliation(s)
- Farhan Augustine
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harvey S. Singer
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Neumann WJ, Huebl J, Brücke C, Lofredi R, Horn A, Saryyeva A, Müller-Vahl K, Krauss JK, Kühn AA. Pallidal and thalamic neural oscillatory patterns in tourette's syndrome. Ann Neurol 2018; 84:505-514. [PMID: 30112767 DOI: 10.1002/ana.25311] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/08/2018] [Accepted: 07/08/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Aberrant oscillatory activity has been hypothesized to play a role in the pathophysiology of Tourette's syndrome (TS). Deep brain stimulation (DBS) has recently been established as an effective treatment for severe TS. Modulation of symptom-specific oscillations may underlie the mechanism of action of DBS and could be used for adaptive neuromodulation to improve therapeutic efficacy. The objective of this study was to demonstrate a pathophysiological association of pallidal and thalamic local field potentials (LFPs) with TS. METHODS Nine medication-refractory TS patients were included in the study. Intracerebral LFPs were recorded simultaneously from bilateral pallidal and thalamic DBS electrodes. Spectral and temporal dynamics of pallidal and thalamic oscillations were characterized and correlated with preoperative Yale Global Tic Severity Scale (YGTSS) scores. RESULTS Peaks of activity in the theta (3-12Hz) and beta (13-35Hz) were present in pallidal and thalamic recordings from all patients (3 women/6 men; mean age, 29.8 years) and coupled through coherence across targets. Presence of prolonged theta bursts in both targets was associated with preoperative motor tic severity. Total preoperative YGTSS scores (mean, 38.1) were correlated with pallidal and thalamic LFP activity using multivariable linear regression (R² = 0.96; p = 0.02). INTERPRETATION Our findings suggest that pallidothalamic oscillations may be implicated in the pathophysiology of TS. Furthermore, our results highlight the utility of multisite and -spectral oscillatory features in severely affected patients for future identification and clinical use of oscillatory physiomarkers for adaptive stimulation in TS. Ann Neurol 2018;84:505-514.
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Affiliation(s)
- Wolf-Julian Neumann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Julius Huebl
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christof Brücke
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roxanne Lofredi
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Kirsten Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Charité-Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Kronenbuerger M, Belenghi P, Ilgner J, Freiherr J, Hummel T, Neuner I. Olfactory functioning in adults with Tourette syndrome. PLoS One 2018; 13:e0197598. [PMID: 29874283 PMCID: PMC5991349 DOI: 10.1371/journal.pone.0197598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/04/2018] [Indexed: 01/19/2023] Open
Abstract
Tourette syndrome is a chronic tic disorder characterized by motor and vocal tics. Comorbidities such as attention deficit hyperactivity disorder and obsessive compulsive disorder can be found. The overlap between neuroanatomical regions and neurotransmitter systems in the olfactory system and the pathophysiology of Tourette syndrome let us hypothesize altered olfactory performance in Tourette syndrome. The main objective of this study was to systematically assess olfactory functioning in subjects with Tourette syndrome and to compare it to healthy controls. We assessed 28 adults with Tourette syndrome (age 33.1±9.4 years, disease duration 23.7±9.7 years) and 28 healthy controls (age 32.9±9.0 years) matched in regard to age, sex, education and smoking habits. The “Sniffin Sticks” test battery was applied to assess odor threshold, discrimination, and identification. Additionally, the combined score of the odor threshold test, the odor discrimination test and the odor identification test of the “Sniffin Sticks” test battery was calculated. Although it was not the primary aim of this study, we assessed whether tics and comorbidity could contribute to olfactory alterations in adults with Tourette syndrome. Therefore, clinical scores were used to assess severity of tics and co-morbidity such as attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety and depression in subjects with Tourette syndrome. Pathology of the nasal cavities was excluded with rhinoendoscopy. Independent sample t-tests were applied to compare performance in olfactory tests. In the case of statistically significant differences (critical p-value: 0.05), multiple linear regression analysis was carried out to explore whether tic severity, social impairment, co-morbidity or medical treatment had an impact on the differences found. Descriptive values are reported as mean ± standard deviation. Tourette syndrome subjects showed lower combined scores (Tourette syndrome subjects 31.9 ± 5.1 versus healthy controls 35.0 ± 3.1; p = 0.007), odor identification scores (Tourette syndrome subjects 12.4 ± 2.0 versus healthy controls 13.7 ± 1.4; p = 0.008) and odor discrimination scores (Tourette syndrome subjects 12.1 ± 2.1 versus healthy controls 13.2 ± 1.6; p = 0.041) in comparison to healthy subjects, while there was no difference in odor threshold (Tourette syndrome subjects 7.3 ± 2.7 versus healthy controls 8.1 ± 2.2; p = 0.22). Seven out of 28 Tourette syndrome subjects (25%) scored in the range of the age- and sex-dependent combined score for hyposmia, while two of 28 healthy controls (7%) had a similar low combined score. None of the participants were found to have functional anosmia. Multiple linear regression analyses suggest that social impairment may a predictor for low combined score and odor identification score in Tourette syndrome subjects (p = 0.003). Compared to healthy controls, altered olfaction in adults with Tourette syndrome was found in this study. Normal odor threshold level but lower scores at tasks involving supra-threshold odor concentrations point towards a central-nervous alteration in the processing of olfactory information in Tourette syndrome.
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Affiliation(s)
- Martin Kronenbuerger
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Department of Neurology, University of Greifswald, Greifswald, Germany
- * E-mail:
| | - Patrizia Belenghi
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Justus Ilgner
- Department of Otorhinolaryngology and Plastic Head and Neck Surgery, RWTH Aachen University, Aachen, Germany
| | - Jessica Freiherr
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- JARA—Translational Brain Medicine, Aachen, Germany
- Institute of Neuroscience and Medicine 4, Forschungszentrum, Jülich, Germany
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Nespoli E, Rizzo F, Boeckers T, Schulze U, Hengerer B. Altered dopaminergic regulation of the dorsal striatum is able to induce tic-like movements in juvenile rats. PLoS One 2018; 13:e0196515. [PMID: 29698507 PMCID: PMC5919623 DOI: 10.1371/journal.pone.0196515] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/13/2018] [Indexed: 01/01/2023] Open
Abstract
Motor tics are sudden, repetitive, involuntary movements representing the hallmark behaviors of the neurodevelopmental disease Tourette’s syndrome (TS). The primary cause of TS remains unclear. The initial observation that dopaminergic antagonists alleviate tics led to the development of a dopaminergic theory of TS etiology which is supported by post mortem and in vivo studies indicating that non-physiological activation of the striatum could generate tics. The striatum controls movement execution through the balanced activity of dopamine receptor D1 and D2-expressing medium spiny neurons of the direct and indirect pathway, respectively. Different neurotransmitters can activate or repress striatal activity and among them, dopamine plays a major role. In this study we introduced a chronic dopaminergic alteration in juvenile rats, in order to modify the delicate balance between direct and indirect pathway. This manipulation was done in the dorsal striatum, that had been associated with tic-like movements generation in animal models. The results were movements resembling tics, which were categorized and scored according to a newly developed rating scale and were reduced by clonidine and riluzole treatment. Finally, post mortem analyses revealed altered RNA expression of dopaminergic receptors D1 and D2, suggesting an imbalanced dopaminergic regulation of medium spiny neuron activity as being causally related to the observed phenotype.
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Affiliation(s)
- Ester Nespoli
- CNS Department, Boehringer Ingelheim Pharma GmbH& Co. KG, Biberach an der Riss, Germany
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
- * E-mail: (BH); (EN)
| | - Francesca Rizzo
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
- Institute of Anatomy and Cell Biology, University of Ulm, Ulm, Germany
| | - Tobias Boeckers
- Institute of Anatomy and Cell Biology, University of Ulm, Ulm, Germany
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Bastian Hengerer
- CNS Department, Boehringer Ingelheim Pharma GmbH& Co. KG, Biberach an der Riss, Germany
- * E-mail: (BH); (EN)
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Hirschtritt ME, Darrow SM, Illmann C, Osiecki L, Grados M, Sandor P, Dion Y, King RA, Pauls D, Budman CL, Cath DC, Greenberg E, Lyon GJ, Yu D, McGrath LM, McMahon WM, Lee PC, Delucchi KL, Scharf JM, Mathews CA. Genetic and phenotypic overlap of specific obsessive-compulsive and attention-deficit/hyperactive subtypes with Tourette syndrome. Psychol Med 2018; 48:279-293. [PMID: 28651666 PMCID: PMC7909616 DOI: 10.1017/s0033291717001672] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 12/15/2022]
Abstract
BACKGROUND The unique phenotypic and genetic aspects of obsessive-compulsive (OCD) and attention-deficit/hyperactivity disorder (ADHD) among individuals with Tourette syndrome (TS) are not well characterized. Here, we examine symptom patterns and heritability of OCD and ADHD in TS families. METHOD OCD and ADHD symptom patterns were examined in TS patients and their family members (N = 3494) using exploratory factor analyses (EFA) for OCD and ADHD symptoms separately, followed by latent class analyses (LCA) of the resulting OCD and ADHD factor sum scores jointly; heritability and clinical relevance of the resulting factors and classes were assessed. RESULTS EFA yielded a 2-factor model for ADHD and an 8-factor model for OCD. Both ADHD factors (inattentive and hyperactive/impulsive symptoms) were genetically related to TS, ADHD, and OCD. The doubts, contamination, need for sameness, and superstitions factors were genetically related to OCD, but not ADHD or TS; symmetry/exactness and fear-of-harm were associated with TS and OCD while hoarding was associated with ADHD and OCD. In contrast, aggressive urges were genetically associated with TS, OCD, and ADHD. LCA revealed a three-class solution: few OCD/ADHD symptoms (LC1), OCD & ADHD symptoms (LC2), and symmetry/exactness, hoarding, and ADHD symptoms (LC3). LC2 had the highest psychiatric comorbidity rates (⩾50% for all disorders). CONCLUSIONS Symmetry/exactness, aggressive urges, fear-of-harm, and hoarding show complex genetic relationships with TS, OCD, and ADHD, and, rather than being specific subtypes of OCD, transcend traditional diagnostic boundaries, perhaps representing an underlying vulnerability (e.g. failure of top-down cognitive control) common to all three disorders.
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Affiliation(s)
| | - Sabrina M. Darrow
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Sandor
- Department of Psychiatry, University of Toronto and University Health Network, Youthdale Treatment Centers, Toronto, Ontario, Canada
| | - Yves Dion
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
| | - Robert A. King
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - David Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cathy L. Budman
- Department of Psychiatry, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA
| | - Danielle C. Cath
- Faculty of Social and Behavioural Sciences, Utrecht University and Altrecht Academic Anxiety Center, Utrecht, GGz Drenthe and department of psychiatry, University Medical Center Groningen, The Netherlands
| | - Erica Greenberg
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gholson J. Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Paul C. Lee
- Department of Behavioral Health, Tripler Army Medical Center, Honolulu, HI, USA
| | - Kevin L. Delucchi
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Jeremiah M. Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Cognitive and Behavioral Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Carol A. Mathews
- Department of Psychiatry, and University of Florida Genetics Institute, University of Florida, Gainesville, FL, USA
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Brandt VC, Stock AK, Münchau A, Beste C. Evidence for enhanced multi-component behaviour in Tourette syndrome - an EEG study. Sci Rep 2017; 7:7722. [PMID: 28798371 PMCID: PMC5552788 DOI: 10.1038/s41598-017-08158-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/07/2017] [Indexed: 12/30/2022] Open
Abstract
Evidence suggests that Tourette syndrome is characterized by an increase in dopamine transmission and structural as well as functional changes in fronto-striatal circuits that might lead to enhanced multi-component behaviour integration. Behavioural and neurophysiological data regarding multi-component behaviour was collected from 15 patients with Tourette syndrome (mean age = 30.40 ± 11.10) and 15 healthy controls (27.07 ± 5.44), using the stop-change task. In this task, participants are asked to sometimes withhold responses to a Go stimulus (stop cue) and change hands to respond to an alternative Go stimulus (change cue). Different onset asynchronies between stop and change cues were implemented (0 and 300 ms) in order to vary task difficulty. Tourette patients responded more accurately than healthy controls when there was no delay between stop and change stimulus, while there was no difference in the 300 ms delay condition. This performance advantage was reflected in a smaller P3 event related potential. Enhanced multi-component behaviour in Tourette syndrome is likely based on an enhanced ability to integrate information from multiple sources and translate it into an appropriate response sequence. This may be a consequence of chronic tic control in these patients, or a known fronto-striatal networks hyperconnectivity in Tourette syndrome.
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Affiliation(s)
- Valerie C Brandt
- Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK.
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, Center for Brain, Behaviour and Metabolism, University of Lübeck, Lübeck, Germany.
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Dresden, Germany
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, Center for Brain, Behaviour and Metabolism, University of Lübeck, Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Dresden, Germany
- Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic
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Martino D, Delorme C, Pelosin E, Hartmann A, Worbe Y, Avanzino L. Abnormal lateralization of fine motor actions in Tourette syndrome persists into adulthood. PLoS One 2017; 12:e0180812. [PMID: 28708864 PMCID: PMC5510833 DOI: 10.1371/journal.pone.0180812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/21/2017] [Indexed: 12/14/2022] Open
Abstract
Youth with Tourette syndrome (TS) exhibit, compared to healthy, abnormal ability to lateralize digital sequential tasks. It is unknown whether this trait is related to inter-hemispheric connections, and whether it is preserved or lost in patients with TS persisting through adult life. We studied 13 adult TS patients and 15 age-matched healthy volunteers. All participants undertook: 1) a finger opposition task, performed with the right hand (RH) only or with both hands, using a sensor-engineered glove in synchrony with a metronome at 2 Hz; we calculated a lateralization index [(single RH-bimanual RH)/single RH X 100) for percentage of correct movements (%CORR); 2) MRI-based diffusion tensor imaging and probabilistic tractography of inter-hemispheric corpus callosum (CC) connections between supplementary motor areas (SMA) and primary motor cortices (M1). We confirmed a significant increase in the %CORR in RH in the bimanual vs. single task in TS patients (p<0.001), coupled to an abnormal ability to lateralize finger movements (significantly lower lateralization index for %CORR in TS patients, p = 0.04). The %CORR lateralization index correlated positively with tic severity measured with the Yale Global Tic Severity Scale (R = 0.55;p = 0.04). We detected a significantly higher fractional anisotropy (FA) in both the M1-M1 (p = 0.036) and the SMA-SMA (p = 0.018) callosal fibre tracts in TS patients. In healthy subjects, the %CORR lateralization index correlated positively with fractional anisotropy of SMA-SMA fibre tracts (R = 0.63, p = 0.02); this correlation was not significant in TS patients. TS patients exhibited an abnormal ability to lateralize finger movements in sequential tasks, which increased in accuracy when the task was performed bimanually. This abnormality persists throughout different age periods and appears dissociated from the transcallosal connectivity of motor cortical regions. The altered interhemispheric transfer of motor abilities in TS may be the result of compensatory processes linked to self-regulation of motor control.
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Affiliation(s)
- D. Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - C. Delorme
- UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC University Paris 06, Paris, France
- Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47–83 boulevard de l'Hôpital, Paris, France, and French National Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - E. Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa Genoa, Italy
| | - A. Hartmann
- UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC University Paris 06, Paris, France
- Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47–83 boulevard de l'Hôpital, Paris, France, and French National Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Y. Worbe
- UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC University Paris 06, Paris, France
- Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47–83 boulevard de l'Hôpital, Paris, France, and French National Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Department of Neurophysiology, Saint-Antoine Hospital, Paris, France
| | - L. Avanzino
- Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Experimental Medicine, University of Genoa Genoa, Italy
- * E-mail:
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Rapanelli M, Frick LR, Pittenger C. The Role of Interneurons in Autism and Tourette Syndrome. Trends Neurosci 2017; 40:397-407. [PMID: 28578790 PMCID: PMC5528854 DOI: 10.1016/j.tins.2017.05.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/17/2017] [Accepted: 05/02/2017] [Indexed: 01/08/2023]
Abstract
The brain includes multiple types of interconnected excitatory and inhibitory neurons that together allow us to move, think, feel, and interact with the environment. Inhibitory interneurons (INs) comprise a small, heterogeneous fraction, but they exert a powerful and tight control over neuronal activity and consequently modulate the magnitude of neuronal output and, ultimately, information processing. IN abnormalities are linked to two pediatric psychiatric disorders with high comorbidity: autism spectrum disorder (ASD) and Tourette syndrome (TS). Studies probing the basis of this link have been contradictory regarding whether the causative mechanism is a reduction in number, dysfunction, or gene aberrant expression (or a combination thereof). Here, we integrate different theories into a more comprehensive view of INs as responsible for the symptomatology observed in these disorders.
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Affiliation(s)
- Maximiliano Rapanelli
- Yale School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, USA; Present address: Department of Physiology & Biophysics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, State University of New York at Buffalo, NY 14214, USA.
| | - Luciana Romina Frick
- Yale School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, USA; Present address: Hunter James Kelly Research Institute, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, NY 14203, USA
| | - Christopher Pittenger
- Yale School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, USA
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Caligiore D, Mannella F, Arbib MA, Baldassarre G. Dysfunctions of the basal ganglia-cerebellar-thalamo-cortical system produce motor tics in Tourette syndrome. PLoS Comput Biol 2017; 13:e1005395. [PMID: 28358814 PMCID: PMC5373520 DOI: 10.1371/journal.pcbi.1005395] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 02/01/2017] [Indexed: 12/24/2022] Open
Abstract
Motor tics are a cardinal feature of Tourette syndrome and are traditionally associated with an excess of striatal dopamine in the basal ganglia. Recent evidence increasingly supports a more articulated view where cerebellum and cortex, working closely in concert with basal ganglia, are also involved in tic production. Building on such evidence, this article proposes a computational model of the basal ganglia-cerebellar-thalamo-cortical system to study how motor tics are generated in Tourette syndrome. In particular, the model: (i) reproduces the main results of recent experiments about the involvement of the basal ganglia-cerebellar-thalamo-cortical system in tic generation; (ii) suggests an explanation of the system-level mechanisms underlying motor tic production: in this respect, the model predicts that the interplay between dopaminergic signal and cortical activity contributes to triggering the tic event and that the recently discovered basal ganglia-cerebellar anatomical pathway may support the involvement of the cerebellum in tic production; (iii) furnishes predictions on the amount of tics generated when striatal dopamine increases and when the cortex is externally stimulated. These predictions could be important in identifying new brain target areas for future therapies. Finally, the model represents the first computational attempt to study the role of the recently discovered basal ganglia-cerebellar anatomical links. Studying this non-cortex-mediated basal ganglia-cerebellar interaction could radically change our perspective about how these areas interact with each other and with the cortex. Overall, the model also shows the utility of casting Tourette syndrome within a system-level perspective rather than viewing it as related to the dysfunction of a single brain area. Tourette syndrome is a neuropsychiatric disorder characterized by vocal and motor tics. Tics represent a cardinal symptom traditionally associated with a dysfunction of the basal ganglia leading to an excess of the dopamine neurotransmitter. This view gives a restricted clinical picture and limits therapeutic approaches because it ignores the influence of altered interactions between the basal ganglia and other brain areas. In this respect, recent evidence supports a more articulated framework where cerebellum and cortex are also involved in tic production. Building on these data, we propose a computational model of the basal ganglia-cerebellar-thalamo-cortical network to investigate the specific mechanisms underlying motor tic production. The model reproduces the results of recent experiments and suggests an explanation of the system-level processes underlying tic production. Moreover, it furnishes predictions related to the amount of tics generated when there are dysfunctions in the basal ganglia-cerebellar-thalamo-cortical circuits. These predictions could be important in identifying new brain target areas for future therapies based on a system-level view of Tourette syndrome.
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Affiliation(s)
- Daniele Caligiore
- Laboratory of Computational Embodied Neuroscience, Institute of Cognitive Sciences and Technologies, National Research Council (CNR-ISTC-LOCEN), Roma, Italy
- * E-mail:
| | - Francesco Mannella
- Laboratory of Computational Embodied Neuroscience, Institute of Cognitive Sciences and Technologies, National Research Council (CNR-ISTC-LOCEN), Roma, Italy
| | - Michael A. Arbib
- Neuroscience Program, USC Brain Project, Computer Science Department, University of Southern California, Los Angeles, California, United States of America
| | - Gianluca Baldassarre
- Laboratory of Computational Embodied Neuroscience, Institute of Cognitive Sciences and Technologies, National Research Council (CNR-ISTC-LOCEN), Roma, Italy
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Abstract
BACKGROUND Previous studies suggest that adults with Tourette syndrome (TS) can respond unconventionally on tasks involving social cognition. We therefore hypothesized that these patients would exhibit different neural responses to healthy controls in response to emotionally salient expressions of human eyes. METHOD Twenty-five adults with TS and 25 matched healthy controls were scanned using fMRI during the standard version of the Reading the Mind in the Eyes Task which requires mental state judgements, and a novel comparison version requiring judgements about age. RESULTS During prompted mental state recognition, greater activity was apparent in TS within left orbitofrontal cortex, posterior cingulate, right amygdala and right temporo-parietal junction (TPJ), while reduced activity was apparent in regions including left inferior parietal cortex. Age judgement elicited greater activity in TS within precuneus, medial prefrontal and temporal regions involved in mentalizing. The interaction between group and task revealed differential activity in areas including right inferior frontal gyrus. Task-related activity in the TPJ covaried with global ratings of the urge to tic. CONCLUSIONS While recognizing mental states, adults with TS exhibit greater activity than controls in brain areas involved in the processing of negative emotion, in addition to reduced activity in regions associated with the attribution of agency. In addition, increased recruitment of areas involved in mental state reasoning is apparent in these patients when mentalizing is not a task requirement. Our findings highlight differential neural reactivity in response to emotive social cues in TS, which may interact with tic expression.
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Affiliation(s)
- C M Eddy
- BSMHFT National Centre for Mental Health,Birmingham,UK
| | - A E Cavanna
- BSMHFT National Centre for Mental Health,Birmingham,UK
| | - P C Hansen
- Birmingham University Imaging Centre and School of Psychology,College of Life and Environmental Sciences,University of Birmingham,UK
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Yaniv A, Benaroya-Milshtein N, Steinberg T, Ruhrrman D, Apter A, Lavidor M. Specific executive control impairments in Tourette syndrome: The role of response inhibition. Res Dev Disabil 2017; 61:1-10. [PMID: 28039814 DOI: 10.1016/j.ridd.2016.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/28/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is a childhood-onset disorder characterized by motor and vocal tics. While cognitive features of common comorbid conditions such as attention deficit hyperactive disorder and obsessive compulsive disorder have been widely investigated, the cognitive profile of TS patients remains to be precisely defined. In this regard, the executive functions system (EF) is of especial interest. AIMS The aim of the study was to delineate the various components of executive processes in adult TS patients. METHODS A sample of 19 adults diagnosed with TS and 19 age-matched control subjects underwent computerized battery of executive tasks, as well as block design and memory tests. All patients received a thorough clinical assessment with an emphasis on illness severity. RESULTS There was a marked impairment in response inhibition ability regardless of comorbid conditions, In addition, there was decreased accuracy in set shifting, but not in response time. These results imply that impaired response inhibition in the EF system is the primary cognitive impairment in TS and that many of the previously reported impaired executive functions in TS are secondary to this impairment. CONCLUSIONS This finding of impaired response inhibition in TS may imply that rehabilitation of this inhibition component could prove to be an important therapeutic strategy in adults with TS.
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Affiliation(s)
- Asaf Yaniv
- Department of Psychology, Bar Ilan University, Israel
| | - Noa Benaroya-Milshtein
- The Matta and Harry Freund Neuropsychiatric Tourette Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Steinberg
- The Matta and Harry Freund Neuropsychiatric Tourette Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Ruhrrman
- The Matta and Harry Freund Neuropsychiatric Tourette Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alan Apter
- The Matta and Harry Freund Neuropsychiatric Tourette Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Lavidor
- Department of Psychology, Bar Ilan University, Israel; The Gonda Brain Research center, Bar Ilan University, Israel.
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Larsen SB, Sørensen CB, Skov L, Debes NM. [Neuroradiological changes by suppression of tics]. Ugeskr Laeger 2017; 179:V06160424. [PMID: 28074769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Tourette's syndrome is characterized by involuntary tics. First choice of treatment has been pharmacological, but recently, behavioural therapy teaching patients to suppress their tics has been introduced. Neuroimaging studies have shown an increased activity in the prefrontal cortex, temporal lobes and caudate nucleus, and a decreased activity in globus pallidus and putamen during inhibition of tics. The activity in the frontal lobes changes with age, probably caused by a lack of compensatory hypertrophy. In order to fully understand the mechanism behind behavioural therapy further studies are needed.
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Robbins TW, Dalley JW. Dissecting Impulsivity: Brain Mechanisms and Neuropsychiatric Implications. Nebr Symp Motiv 2017; 64:201-226. [PMID: 30351564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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24
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Dye CD, Walenski M, Mostofsky SH, Ullman MT. A verbal strength in children with Tourette syndrome? Evidence from a non-word repetition task. Brain Lang 2016; 160:61-70. [PMID: 27479738 DOI: 10.1016/j.bandl.2016.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 06/06/2016] [Accepted: 07/17/2016] [Indexed: 06/06/2023]
Abstract
Tourette syndrome (TS) is characterized by motor and vocal tics, and frontal/basal-ganglia abnormalities. Whereas cognitive strengths have been found in other neurodevelopmental disorders, less attention has been paid to strengths in TS, or to verbal strengths in any neurodevelopmental disorder. We examined whether the finding of speeded TS production of rule-governed morphological forms (e.g., "slipped") that involve composition (Walenski, Mostofsky, & Ullman, 2007) might extend to another language domain, phonology. Thirteen children with TS and 14 typically-developing (TD) children performed a non-word repetition task: they repeated legal phonological strings (e.g.,"naichovabe"), a task that taps rule-governed (de)composition. Parallel to the morphology findings, the children with TS showed speeded production, while the two groups had similar accuracy. The results were not explained by potentially confounding factors, including IQ. Overall, the findings suggest that rule-governed grammatical composition may be speeded in TS, perhaps due to frontal/basal-ganglia abnormalities.
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Affiliation(s)
- Cristina D Dye
- Centre for Research in Linguistics and Language Sciences, Newcastle University, United Kingdom.
| | - Matthew Walenski
- The Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, United States
| | | | - Michael T Ullman
- Brain and Language Lab, Department of Neuroscience, Georgetown University, United States.
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Ludlow AK, Wilkins AJ. Atypical Sensory behaviours in children with Tourette's Syndrome and in children with Autism Spectrum Disorders. Res Dev Disabil 2016; 56:108-116. [PMID: 27286465 DOI: 10.1016/j.ridd.2016.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 05/12/2016] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
Certain visual disturbances make it difficult to read text and have been attributed to visual stress, also called "pattern-related visual stress". 12 Children with ASD, 12 children with Tourette's syndrome and without ASD and 12 controls, all matched on age and non verbal ability, participated in an experiment exploring sensory behaviours and visual stress. Reading rate and accuracy were assessed with the Wilkins Rate of Reading test with and without the Intuitive Overlays. Both the children with Tourette's and the children with ASD showed a higher prevalence of atypical sensory behaviours and symptoms of visual stress than the typically developing control children. Six out of twelve children with Tourette's syndrome (50%) read more accurately and over 15% more quickly with a coloured overlay. Four of the 12 children with ASD and none of the control children read over 15% more quickly with an overlay. The findings are discussed in relation to problems in sensory modulation.
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Affiliation(s)
- Amanda K Ludlow
- University of Hertfordshire, College Lane, Hatfield, AL10 9AB, United Kingdom; University of Birmingham, Edgbaston, B15 2TT, United Kingdom.
| | - Arnold J Wilkins
- University of Essex, Wivenhoe Park, Colchester CO4 3SQ, United Kingdom.
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Abstract
The effects of heat on tic symptoms were studied in a sample of 78 adults with Tourette syndrome. 62 men and 16 women completed a survey concerning the type, onset, and course of their tics. 10 adult male subjects also participated in a thermal challenge during which ambient temperature was raised from 22°C to 35°C following a control period. Of the 78, 24% or 19 reported increased tics upon exposure to heat. Compared to the remaining 59 subjects, there were no differences in sex distribution, current age, or overall course of illness. In the thermal challenge, there was general increase in tics that was correlated with sweat rate ( r = .55, p=.001). This effect was prominent in 5 of 10 subjects ( rs = .29 to .63). There were no mean differences in current age, age of onset, or current severity of symptoms between the five subjects of each group. Tic symptoms in a subgroup of patients with Tourette syndrome may be sensitive to heat. Abnormal heat regulation is not a likely explanation for the observed increase in tics. The increase may be due to normal heat-loss mechanisms through dopaminergic pathways.
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Affiliation(s)
- L Scahill
- Child Study Center, Yale School of Nursing, New Haven, CT 06520-7900, USA
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Meidinger AL, Miltenberger RG, Himle M, Omvig M, Trainor C, Crosby R. An Investigation of Tic Suppression and the Rebound Effect in Tourette’s Disorder. Behav Modif 2016; 29:716-45. [PMID: 16046662 DOI: 10.1177/0145445505279262] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many patients, parents of children with Tourette’s disorder, and professionals have suggested that following a period of suppression, tics will rebound to a rate that will exceed the average rate of occurrence. At present, there are no empirical data to support or refute such an effect. This experiment utilized an A-B-A design with replication to test this hypothesized effect. Following baseline observation, participants were instructed to refrain from exhibiting tics while watching videotapes, engaging in conversation, or while alone in a room with no activity. Observation continued following the suppression phase. Results of this experiment showed suppression of tics in almost one half of all sessions, with adults demonstrating suppression more frequently. Furthermore, results of this experiment failed to support a commonly held perception that following a period of voluntary suppression tics will rebound to a rate that will exceed the average rate of occurrence.
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Affiliation(s)
- Amy L Meidinger
- Department of Psychology, University of Alabama, Birmingham, AL, USA
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Shute JB, Okun MS, Opri E, Molina R, Rossi PJ, Martinez-Ramirez D, Foote KD, Gunduz A. Thalamocortical network activity enables chronic tic detection in humans with Tourette syndrome. Neuroimage Clin 2016; 12:165-72. [PMID: 27419067 PMCID: PMC4936504 DOI: 10.1016/j.nicl.2016.06.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/17/2016] [Accepted: 06/20/2016] [Indexed: 01/15/2023]
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder characterized by multiple motor and vocal tics. Deep brain stimulation (DBS) is an emerging therapy for severe cases of TS. We studied two patients with TS implanted with bilateral Medtronic Activa PC + S DBS devices, capable of chronic recordings, with depth leads in the thalamic centromedian-parafascicular complex (CM-PF) and subdural strips over the precentral gyrus. Low-frequency (1-10 Hz) CM-PF activity was observed during tics, as well as modulations in beta rhythms over the motor cortex. Tics were divided into three categories: long complex, complex, and simple. Long complex tics, tics involving multiple body regions and lasting longer than 5 s, were concurrent with a highly detectable thalamocortical signature (average recall [sensitivity] 88.6%, average precision 96.3%). Complex tics were detected with an average recall of 63.9% and precision of 36.6% and simple tics an average recall of 39.3% and precision of 37.9%. The detections were determined using data from both patients.
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Affiliation(s)
- Jonathan B. Shute
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32611, USA
| | - Michael S. Okun
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32611, USA
- Department of Neurology, University of Florida, Gainesville, FL 32611, USA
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
| | - Enrico Opri
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32611, USA
| | - Rene Molina
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL 32611, USA
| | - P. Justin Rossi
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32611, USA
| | - Daniel Martinez-Ramirez
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32611, USA
- Department of Neurology, University of Florida, Gainesville, FL 32611, USA
| | - Kelly D. Foote
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32611, USA
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
| | - Aysegul Gunduz
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32611, USA
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL 32611, USA
- Corresponding author at: University of Florida J. Crayton Pruitt Department of Biomedical Engineering, 1275 Center Drive, BMS J283, Gainesville, FL 32611, USA.University of Florida J. Crayton Pruitt Department of Biomedical Engineering1275 Center Drive, BMS J283GainesvilleFL32611USA
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Pépés SE, Draper A, Jackson GM, Jackson SR. Effects of age on motor excitability measures from children and adolescents with Tourette syndrome. Dev Cogn Neurosci 2016; 19:78-86. [PMID: 26934638 PMCID: PMC6988104 DOI: 10.1016/j.dcn.2016.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/01/2016] [Accepted: 02/12/2016] [Indexed: 12/27/2022] Open
Abstract
Tourette syndrome (TS) is a neurological disorder characterised by vocal and motor tics. It is associated with cortical-striatal-thalamic-cortical circuit [CSTC] dysfunction and hyper-excitability of cortical motor regions. TS follows a developmental time course, in which tics often become increasingly more controlled during adolescence. Importantly, however, a substantial minority of patients continue to have debilitating tics into adulthood. This indicates that there may be important differences between adult TS patients and children and adolescents with the disorder. We use TMS to examine cortical motor excitability in a sample of children, adolescents and young adults with TS. We demonstrate that, in contrast to studies of adult patients, resting motor threshold and the variability of MEP responses are increased in children with TS, while the gain of motor excitability in reduced. Importantly, we demonstrate that these differences normalise with age over adolescence. We conclude that these effects are likely due to a developmental delay in the maturation of key brain networks in TS, consistent with recent brain imaging studies of structural and functional brain connectivity. Importantly, these findings suggest that the alterations in brain network structure and function associated with TS may be quite different in children and adult patients with the condition.
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Affiliation(s)
| | | | - Georgina M Jackson
- Institute of Mental Health, School of Medicine, University of Nottingham, UK
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Testini P, Zhao CZ, Stead M, Duffy PS, Klassen BT, Lee KH. Centromedian-Parafascicular Complex Deep Brain Stimulation for Tourette Syndrome: A Retrospective Study. Mayo Clin Proc 2016; 91:218-25. [PMID: 26848003 PMCID: PMC4765735 DOI: 10.1016/j.mayocp.2015.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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] [Received: 09/24/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 12/24/2022]
Abstract
Deep brain stimulation (DBS) of the thalamic centromedian/parafascicular (CM-Pf) complex has been reported as a promising treatment for patients with severe, treatment-resistant Tourette syndrome (TS). In this study, safety and clinical outcomes of bilateral thalamic CM-Pf DBS were reviewed in a series of 12 consecutive patients with medically refractory TS, 11 of whom met the criteria of postsurgical follow-up at our institution for at least 2 months. Five patients were followed for a year or longer. Consistent with many patients with TS, all patients had psychiatric comorbidities. Tic severity and frequency were measured by using the Yale Global Tic Severity Scale (YGTSS) over time (average, 26 months) in 10 subjects. One patient was tested at 2-week follow-up only and thus was excluded from group YGTSS analysis. Final YGTSS scores differed significantly from the preoperative baseline score. The average (n=10) improvement relative to baseline in the total score was 54% (95% CI, 37-70); average improvement relative to baseline in the YGTSS Motor tic, Phonic tic, and Impairment subtests was 46% (95% CI, 34-64), 52% (95% CI, 34-72), and 59% (95% CI, 39-78), respectively. There were no intraoperative complications. After surgery, 1 subject underwent wound revision because of a scalp erosion and wound infection; the implanted DBS system was successfully salvaged with surgical revision and combined antibiotic therapy. Stimulation-induced adverse effects did not prevent the use of the DBS system, although 1 subject is undergoing a trial period with the stimulator off. This surgical series adds to the literature on CM-Pf DBS and supports its use as an effective and safe therapeutic option for severe refractory TS.
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Affiliation(s)
- Paola Testini
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Cong Z Zhao
- Department of Medicine, University of California San Francisco, Fresno, CA
| | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.
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31
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Ünal D, Akdemir D. [Neurobiology of Tourette Syndrome]. Turk Psikiyatri Derg 2016; 27:275-285. [PMID: 28046197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by chronic motor and vocal tics. Although it is a common disorder in childhood, the etiology of Tourette Syndrome has not been fully elucidated yet. Studies, -conducted so far- have revealed differences in neurobiological structures of individuals who suffer from Tourette Syndrome. The objective of this review is to assess etiological and pathophysiological studies in the Tourette Syndrome literature. An electronical search was conducted in PubMed database using the keywords tic disorders, Tourette Syndrome, neurobiology, genetics, neuroimaging and animal models. Research and review studies published between 1985 and 2015, with a selection preference towards recent publications, were reviewed. According to the studies, genetic predisposition hypothesis is considered as a priority. However, a precise genetic disorder associated with Tourette Syndrome has not been found. The evidence from postmortem and neuroimaging studies in heterogenous patient groups and animal studies supports the pathological involvement of cortico-striato-thalamo-cortical (CSTC) circuits in Tourette Syndrome. Consequently, the most emphasized hypothesis in the pathophysiology is the dopaminergic dysfunction in these circuits. Furthermore, these findings of the animal, postmortem and neuroimaging studies have confirmed the neurodevelopmental hypothesis of Tourette Syndrome. In conclusion, more studies are needed to understand the etiology of the disorder. The data obtained from neurobiological studies of the disorder will not only shed light on the way of Tourette Syndrome, but also guide studies on its treatment options.
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32
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Baldermann JC, Schüller T, Huys D, Becker I, Timmermann L, Jessen F, Visser-Vandewalle V, Kuhn J. Deep Brain Stimulation for Tourette-Syndrome: A Systematic Review and Meta-Analysis. Brain Stimul 2015; 9:296-304. [PMID: 26827109 DOI: 10.1016/j.brs.2015.11.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/15/2015] [Accepted: 11/13/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A significant proportion of patients with Tourette syndrome (TS) continue to experience symptoms across adulthood that in severe cases fail to respond to standard therapies. For these cases, deep brain stimulation (DBS) is emerging as a promising treatment option. OBJECTIVE We conducted a systematic literature review to evaluate the efficacy of DBS for GTS. METHODS Individual data of case reports and series were pooled; the Yale Global Tic Severity Scale (YGTSS) was chosen as primary outcome parameter. RESULTS In total, 57 studies were eligible, including 156 cases. Overall, DBS resulted in a significant improvement of 52.68% (IQR = 40.74, p < 0.001) in the YGTSS. Analysis of controlled studies significantly favored stimulation versus off stimulation with a standardized mean difference of 0.96 (95% CI: 0.36-1.56). Disentangling different target points revealed significant YGTSS reductions after stimulation of the thalamus, the posteroventrolateral part and the anteromedial part of the globus pallidus internus, the anterior limb of the internal capsule and nucleus accumbens with no significant difference between these targets. A significant negative correlation of preoperative tic scores with the outcome of thalamic stimulation was found. CONCLUSIONS Despite small patient numbers, we conclude that DBS for GTS is a valid option for medically intractable patients. Different brain targets resulted in comparable improvement rates, indicating a modulation of a common network. Future studies might focus on a better characterization of the clinical effects of distinct regions, rather than searching for a unique target.
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Affiliation(s)
- Juan Carlos Baldermann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Thomas Schüller
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Daniel Huys
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
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Israelashvili M, Bar-Gad I. Corticostriatal Divergent Function in Determining the Temporal and Spatial Properties of Motor Tics. J Neurosci 2015; 35:16340-51. [PMID: 26674861 PMCID: PMC4679818 DOI: 10.1523/jneurosci.2770-15.2015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/11/2015] [Accepted: 10/18/2015] [Indexed: 12/21/2022] Open
Abstract
Striatal disinhibition leads to the formation of motor tics resembling those expressed during Tourette syndrome and other tic disorders. The spatial properties of these tics are dependent on the location of the focal disinhibition within the striatum; however, the factors affecting the temporal properties of tic expression are still unknown. Here, we used microstimulation within the motor cortex of freely behaving rats before and after striatal disinhibition to explore the factors underlying the timing of individual tics. Cortical activation determined the timing of individual tics via an accumulation process of inputs that was dependent on the frequency and amplitude of the inputs. The resulting tics and their neuronal representation within the striatum were highly stereotypic and independent of the cortical activity properties. The generation of tics was limited by absolute and relative tic refractory periods that were derived from an internal striatal state. Thus, the precise time of the tic expression depends on the interaction between the summation of incoming excitatory inputs to the striatum and the timing of the previous tic. A data-driven computational model of corticostriatal function closely replicated the temporal properties of tic generation and enabled the prediction of tic timing based on incoming cortical activity and tic history. These converging experimental and computational findings suggest a clear functional dichotomy within the corticostriatal network, pointing to disparate temporal (cortical) versus spatial (striatal) encoding. Thus, the abnormal striatal inhibition typical of Tourette syndrome and other tic disorders results in tics due to cortical activation of the abnormal striatal network. SIGNIFICANCE STATEMENT The factors underlying the temporal properties of tics expressed in Tourette syndrome and other tic disorders have eluded clinicians and scientists for decades. In this study, we highlight the key role of corticostriatal activity in determining the timing of individual tics. We found that cortical activation determined the timing of tics but did not determine their form. A data-driven computational model of the corticostriatal network closely replicated the temporal properties of tic generation and enabled the prediction of tic timing based on incoming cortical activity and tic history. This study thus shows that, although tics originate in the striatum, their timing depends on the interplay between incoming excitatory corticostriatal inputs and the internal striatal state.
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Affiliation(s)
- Michal Israelashvili
- The Leslie and Susan Goldschmied (Gonda) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan 52900, Israel
| | - Izhar Bar-Gad
- The Leslie and Susan Goldschmied (Gonda) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan 52900, Israel
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34
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Shprecher DR, Kious BM, Himle MH. Advances in mechanistic understanding and treatment approaches to Tourette syndrome. Discov Med 2015; 20:295-301. [PMID: 26645901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tourette syndrome (TS) is a childhood onset neurodevelopmental disorder characterized by semi-involuntary, repetitive movements and sounds (motor and phonic tics). Transient tics in childhood are common, and their persistence in TS may be due to failure of maturation of frontal-subcortical circuits mediated by genetic predisposition and environmental factors. Tic improvement by young adult years is common, but its mechanism and predictive factors are unclear. Though tics can often be managed with nonmedical therapies, pharmacotherapy is often used for refractory, severe, or injurious tics but is complicated by side effects and incomplete benefit. This review summarizes the current understanding of TS pathophysiology, current and future treatment options, and recommendations for future research.
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Affiliation(s)
- David R Shprecher
- Department of Neurology, University of Utah, Salt Lake City, UT 84108, USA
| | - Brent M Kious
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA
| | - Michael H Himle
- Department of Psychology, University of Utah, Salt Lake City, UT 84108, USA
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35
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Jackson GM, Draper A, Dyke K, Pépés SE, Jackson SR. Inhibition, Disinhibition, and the Control of Action in Tourette Syndrome. Trends Cogn Sci 2015; 19:655-665. [PMID: 26440120 DOI: 10.1016/j.tics.2015.08.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 01/06/2023]
Abstract
Tourette syndrome (TS) is a neurological disorder characterized by vocal and motor tics. TS is associated with impairments in behavioral inhibition, dysfunctional signaling of the inhibitory neurotransmitter GABA, and alterations in the balance of excitatory and inhibitory influences within brain networks implicated in motor learning and the selection of actions. We review evidence that increased control over motor outputs, including the suppression of tics, may develop during adolescence in TS and be accompanied by compensatory, neuromodulatory, alterations in brain structure and function. In particular, we argue that increased control over motor outputs in TS is brought about by local increases in 'tonic' inhibition that lead to a reduction in the 'gain' of motor excitability.
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Affiliation(s)
- Georgina M Jackson
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Amelia Draper
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Katherine Dyke
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Sophia E Pépés
- School of Psychology, University of Nottingham, Nottingham, UK
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36
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Puts NAJ, Harris AD, Crocetti D, Nettles C, Singer HS, Tommerdahl M, Edden RAE, Mostofsky SH. Reduced GABAergic inhibition and abnormal sensory symptoms in children with Tourette syndrome. J Neurophysiol 2015; 114:808-17. [PMID: 26041822 PMCID: PMC4533064 DOI: 10.1152/jn.00060.2015] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/28/2015] [Indexed: 11/22/2022] Open
Abstract
Tourette Syndrome (TS) is characterized by the presence of chronic tics. Individuals with TS often report difficulty with ignoring (habituating to) tactile sensations, and some patients perceive that this contributes to a "premonitory urge" to tic. While common, the physiological basis of impaired tactile processing in TS, and indeed tics themselves, remain poorly understood. It has been well established that GABAergic processing plays an important role in shaping the neurophysiological response to tactile stimulation. Furthermore, there are multiple lines of evidence suggesting that a deficit in GABAergic transmission may contribute to symptoms found in TS. In this study, GABA-edited magnetic resonance spectroscopy (MRS) was combined with a battery of vibrotactile tasks to investigate the role of GABA and atypical sensory processing in children with TS. Our results show reduced primary sensorimotor cortex (SM1) GABA concentration in children with TS compared with healthy control subjects (HC), as well as patterns of impaired performance on tactile detection and adaptation tasks, consistent with altered GABAergic function. Moreover, in children with TS SM1 GABA concentration correlated with motor tic severity, linking the core feature of TS directly to in vivo brain neurochemistry. There was an absence of the typical correlation between GABA and frequency discrimination performance in TS as was seen in HC. These data show that reduced GABA concentration in TS may contribute to both motor tics and sensory impairments in children with TS. Understanding the mechanisms of altered sensory processing in TS may provide a foundation for novel interventions to alleviate these symptoms.
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Affiliation(s)
- Nicolaas A J Puts
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland;
| | - Ashley D Harris
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Deana Crocetti
- Center for Neurodevelopment and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland
| | - Carrie Nettles
- Center for Neurodevelopment and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland
| | - Harvey S Singer
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark Tommerdahl
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Stewart H Mostofsky
- Center for Neurodevelopment and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Israelashvili M, Loewenstern Y, Bar-Gad I. Abnormal neuronal activity in Tourette syndrome and its modulation using deep brain stimulation. J Neurophysiol 2015; 114:6-20. [PMID: 25925326 PMCID: PMC4493664 DOI: 10.1152/jn.00277.2015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/29/2015] [Indexed: 12/26/2022] Open
Abstract
Tourette syndrome (TS) is a common childhood-onset disorder characterized by motor and vocal tics that are typically accompanied by a multitude of comorbid symptoms. Pharmacological treatment options are limited, which has led to the exploration of deep brain stimulation (DBS) as a possible treatment for severe cases. Multiple lines of evidence have linked TS with abnormalities in the motor and limbic cortico-basal ganglia (CBG) pathways. Neurophysiological data have only recently started to slowly accumulate from multiple sources: noninvasive imaging and electrophysiological techniques, invasive electrophysiological recordings in TS patients undergoing DBS implantation surgery, and animal models of the disorder. These converging sources point to system-level physiological changes throughout the CBG pathway, including both general altered baseline neuronal activity patterns and specific tic-related activity. DBS has been applied to different regions along the motor and limbic pathways, primarily to the globus pallidus internus, thalamic nuclei, and nucleus accumbens. In line with the findings that also draw on the more abundant application of DBS to Parkinson's disease, this stimulation is assumed to result in changes in the neuronal firing patterns and the passage of information through the stimulated nuclei. We present an overview of recent experimental findings on abnormal neuronal activity associated with TS and the changes in this activity following DBS. These findings are then discussed in the context of current models of CBG function in the normal state, during TS, and finally in the wider context of DBS in CBG-related disorders.
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Affiliation(s)
- Michal Israelashvili
- The Leslie & Susan Goldschmied (Gonda) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Yocheved Loewenstern
- The Leslie & Susan Goldschmied (Gonda) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Izhar Bar-Gad
- The Leslie & Susan Goldschmied (Gonda) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
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Qiao J, Weng S, Wang P, Long J, Wang Z. Normalization of Intrinsic Neural Circuits Governing Tourette's Syndrome Using Cranial Electrotherapy Stimulation. IEEE Trans Biomed Eng 2014; 62:1272-80. [PMID: 25546850 DOI: 10.1109/tbme.2014.2385151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
GOAL The aim of this study was to investigate the normalization of the intrinsic functional activity and connectivity of TS adolescents before and after the cranial electrotherapy stimulation (CES) with alpha stim device. METHODS We performed resting-state functional magnetic resonance imaging on eight adolescents before and after CES with mean age of about nine-years old who had Tourette's syndrome with moderate to severe tics symptom. Independent component analysis (ICA) with hierarchical partner matching method was used to examine the functional connectivity between regions within cortico-striato-thalamo-cortical (CSTC) circuit. Granger causality was used to investigate effective connectivity among these regions detected by ICA. We then performed pattern classification on independent components with significant group differences that served as endophenotype markers to distinguish the adolescents between TS and the normalized ones after CES. RESULTS Results showed that TS adolescents after CES treatment had stronger functional activity and connectivity in anterior cingulate cortex (ACC), caudate and posterior cingulate cortex while had weaker activity in supplementary motor area within the motor pathway compared with TS before CES. CONCLUSION The results suggest that the functional activity and connectivity in motor pathway was suppressed while activities in the control portions within CSTC loop including ACC and caudate were increased in TS adolescents after CES compared with adolescents before CES. SIGNIFICANCE The normalization of the balance between motor and control portions of the CSTC circuit may result in the recovery of TS adolescents.
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Abstract
Purpose:To describe an association of Tourette's syndrome with rapid eye movement sleep behaviour disorder (RBD) in a prepubescent boy.Methods:A four year longitudinal single-case study.Results:The co-existence of Tourette's syndrome and RBD was confirmed after polysomnographic studies using the standard criteria. The authors propose possible overlap in the pathophysiological mechanisms underlying the two disorders.
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Liu WY, Lin PH, Lien HY, Wang HS, Wong AMK, Tang SFT. Spatio-temporal gait characteristics in children with Tourette syndrome: a preliminary study. Res Dev Disabil 2014; 35:2008-2014. [PMID: 24864054 DOI: 10.1016/j.ridd.2014.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 06/03/2023]
Abstract
Earlier studies had suggested that variability of stride length in gait is a pathological sign of basal ganglia disease. Some evidence implicates the involvement of the basal ganglia and related thalamocortical circuitry in Tourette syndrome (TS). To date, the gait of subjects with TS has only discussed in case reports. This investigation compared the spatial and temporal gait characteristics of a sample of children with TS (N=8) with those of healthy controls (HC; N=8). All children were instructed to walk under two speed conditions: "preferred" and "fastest." Gait parameters were measured using an electronic walkway. Spatial and temporal gait parameters were compared using a two-way (group)×(conditions) repeated measures ANOVA. The preliminary results suggested that similar to HC children, children with TS were capable of regulating temporal characteristics of gait based on walking speed. They also exhibited subtle gait anomalies such as irregular step length, as evidenced by significant differences in step length differential (p=0.003), detectable despite the small sample size. These findings warrant further investigation into the gait control of children with TS.
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Affiliation(s)
- Wen-Yu Liu
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Kwei-Shan, Tao-Yuan 33302, Taiwan, ROC
| | - Pei-Hsuan Lin
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Kwei-Shan, Tao-Yuan 33302, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital - Taoyuan Branch, 123, Din-Ghu Rd., Kwei-Shan, Tao-Yuan 33378, Taiwan, ROC
| | - Hen-Yu Lien
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Kwei-Shan, Tao-Yuan 33302, Taiwan, ROC
| | - Huei-Shyong Wang
- College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Kwei-Shan, Tao-Yuan 33302, Taiwan, ROC; Division of Pediatric Neurology, Chang Gung Children's Hospital, 5 Fu-Hsing Street, Kwei-Shan, Tao-Yuan 33305, Taiwan, ROC.
| | - Alice May-Kuen Wong
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Kwei-Shan, Tao-Yuan 33302, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital - Taoyuan Branch, 123, Din-Ghu Rd., Kwei-Shan, Tao-Yuan 33378, Taiwan, ROC; College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Kwei-Shan, Tao-Yuan 33302, Taiwan, ROC
| | - Simon Fuk-Tan Tang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital - Taoyuan Branch, 123, Din-Ghu Rd., Kwei-Shan, Tao-Yuan 33378, Taiwan, ROC; College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Kwei-Shan, Tao-Yuan 33302, Taiwan, ROC
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Abstract
The basal ganglia were originally thought to be associated purely with motor control. However, dysfunction and pathology of different regions and circuits are now known to give rise to many clinical manifestations beyond the association of basal ganglia dysfunction with movement disorders. Moreover, disorders that were thought to be caused by dysfunction of the basal ganglia only, such as Parkinson's disease and Huntington's disease, have diverse abnormalities distributed not only in the brain but also in the peripheral and autonomic nervous systems; this knowledge poses new questions and challenges. We discuss advances and the unanswered questions, and ways in which progress might be made.
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Affiliation(s)
- Jose A Obeso
- Movement Disorders Laboratory, Department of Neurology and Neuroscience Area, Clínica Universitaria and Medical School, and CIMA, University of Navarra, Pamplona, Spain; Centro de Investigación en Redes sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
| | - Maria C Rodriguez-Oroz
- Centro de Investigación en Redes sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Neurology, University Hospital Donostia and Neuroscience Unit BioDonostia Research Institute, San Sebastian, Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Maria Stamelou
- Movement Disorders Clinic, Second Department of Neurology, Attiko Hospital, University of Athens, Greece; Sobell Department of Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Kailash P Bhatia
- Sobell Department of Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, UK
| | - David J Burn
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Brandt VC, Niessen E, Ganos C, Kahl U, Bäumer T, Münchau A. Altered synaptic plasticity in Tourette's syndrome and its relationship to motor skill learning. PLoS One 2014; 9:e98417. [PMID: 24878665 PMCID: PMC4039486 DOI: 10.1371/journal.pone.0098417] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/02/2014] [Indexed: 11/25/2022] Open
Abstract
Gilles de la Tourette syndrome is a neuropsychiatric disorder characterized by motor and phonic tics that can be considered motor responses to preceding inner urges. It has been shown that Tourette patients have inferior performance in some motor learning tasks and reduced synaptic plasticity induced by transcranial magnetic stimulation. However, it has not been investigated whether altered synaptic plasticity is directly linked to impaired motor skill acquisition in Tourette patients. In this study, cortical plasticity was assessed by measuring motor-evoked potentials before and after paired associative stimulation in 14 Tourette patients (13 male; age 18–39) and 15 healthy controls (12 male; age 18–33). Tic and urge severity were assessed using the Yale Global Tic Severity Scale and the Premonitory Urges for Tics Scale. Motor learning was assessed 45 minutes after inducing synaptic plasticity and 9 months later, using the rotary pursuit task. On average, long-term potentiation-like effects in response to the paired associative stimulation were present in healthy controls but not in patients. In Tourette patients, long-term potentiation-like effects were associated with more and long-term depression-like effects with less severe urges and tics. While motor learning did not differ between patients and healthy controls 45 minutes after inducing synaptic plasticity, the learning curve of the healthy controls started at a significantly higher level than the Tourette patients' 9 months later. Induced synaptic plasticity correlated positively with motor skills in healthy controls 9 months later. The present study confirms previously found long-term improvement in motor performance after paired associative stimulation in healthy controls but not in Tourette patients. Tourette patients did not show long-term potentiation in response to PAS and also showed reduced levels of motor skill consolidation after 9 months compared to healthy controls. Moreover, synaptic plasticity appears to be related to symptom severity.
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Affiliation(s)
- Valerie Cathérine Brandt
- Institute of Neurogenetics, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
- Department of Neurology, University Clinic Hamburg-Eppendorf, Hamburg, Hamburg, Germany
- * E-mail:
| | - Eva Niessen
- Institute of Neuroscience & Medicine, Research Centre Jülich, Jülich, Nordrhein-Westfalen, Germany
| | - Christos Ganos
- Institute of Neurogenetics, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
- Department of Neurology, University Clinic Hamburg-Eppendorf, Hamburg, Hamburg, Germany
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, United Kingdom
| | - Ursula Kahl
- Department of Neurology, University Clinic Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Tobias Bäumer
- Institute of Neurogenetics, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
| | - Alexander Münchau
- Institute of Neurogenetics, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
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Zauber SE, Ahn S, Worth RM, Rubchinsky LL. Oscillatory neural activity of anteromedial globus pallidus internus in Tourette syndrome. Clin Neurophysiol 2014; 125:1923-4. [PMID: 24484872 DOI: 10.1016/j.clinph.2014.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/11/2013] [Accepted: 01/03/2014] [Indexed: 11/18/2022]
Affiliation(s)
- S Elizabeth Zauber
- Department of Neurology, Indiana University School of Medicine, 355 W 16th St., Suite 4700, Indianapolis, IN 46202, USA.
| | - Sungwoo Ahn
- Department of Mathematical Sciences and Center for Mathematical Biosciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Robert M Worth
- Department of Mathematical Sciences and Center for Mathematical Biosciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA; Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leonid L Rubchinsky
- Department of Mathematical Sciences and Center for Mathematical Biosciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA; Stark Neurosciences Research Institute, Indiana University School of Medicine, 402 N. Blackford St., Indianapolis, IN 46202, USA.
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Cui YH, Zheng Y, Jin Z, He Y, Chen X, Yu LP. [Relationship between tic symptom severity and amplitude of low frequency fluctuation of resting-state functional magnetic resonance imaging of Tourette syndrome]. Zhonghua Er Ke Za Zhi 2013; 51:448-452. [PMID: 24120064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the relationship between tic symptom severity and amplitude of low frequency fluctuation (ALFF) brain functioning of the first-episode Tourette syndrome through resting-state functional magnetic resonance imaging (fMRI). METHOD Sixteen subjects were all recruited from the outpatient department of pediatrics, Beijing Anding Hospital, Capital Medical University and were all first-episode Tourette syndrome patients [male: 13, female: 3; age: 6-16 years; mean age: (11.00 ± 2.92) years]; mean education time: (5.06 ± 2.86) years; course: 14-104 months; mean (48.44 ± 25.00) months; scores of YGTSS at baseline: tic severity score: 37.88 ± 5.39; global damage score: 25.63 ± 12.63. All the subjects experienced resting-state fMRI scans and ALFF were calculated in three frequency ranges: 0.01-0.1 Hz, 0.01-0.027 Hz and 0.027-0.073 Hz. First-episode Tourette syndrome patients and 16 gender, age, and education-matched normal controls experienced resting-state fMRI scans. Correlation analysis was performed in between the amplitude of low frequency fluctuation (ALFF) and the severity of tic symptom. P < 0.05 and k value ≥ 10 were considered to be of significance. RESULT In tic symptom patients, tic severity (total tic scores of YGTSS) was positively correlated with the ALFF values in the orbital part of left superior frontal gyrus (0.01-0.1 Hz:r = 0.83,0.027-0.073 Hz:r = 0.91, P < 0.05, respectively), right middle frontal gyrus (0.01-0.027 Hz:r = 0.85,0.027-0.073 Hz:r = 0.57, P < 0.05, respectively ) and orbital part of left middle frontal gyrus (0.01-0.027 Hz:r = 0.64, P < 0.05). Tic severity was negatively correlated with the ALFF values in the right calcarine fissure and surrounding cortex (0.01-0.1 Hz:r = -0.65,0.01-0.027 Hz:r = -0.69, P < 0.05, respectively ) and the left calcarine fissure and surrounding cortex (0.027-0.073 Hz:r = -0.81, P < 0.05). CONCLUSION Tic symptom severity of the first-episode Tourette syndrome is associated with abnormal brain activity patterns of specific brain areas.
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Affiliation(s)
- Yong-hua Cui
- Department of Pediatrics, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
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Liu X, Wang X, Li L, Wang H, Jiao X. Influence of mesenchymal stem cell transplantation on stereotypic behavior and dopamine levels in rats with Tourette syndrome. PLoS One 2013; 8:e62198. [PMID: 23638003 PMCID: PMC3637366 DOI: 10.1371/journal.pone.0062198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/18/2013] [Indexed: 01/06/2023] Open
Abstract
Context Tourette syndrome (TS) is a heterogeneous neuropsychiatric disorder. Chronic motor and phonic tics are central symptoms in TS patients. For some patients, tics are intractable to any traditional treatment and cause lifelong impairment and life-threatening symptoms. New therapies should be developed to address symptoms and overt manifestations of TS. Transplantation of neurogenic stem cells might be a viable approach in TS treatment. Objective We used mesenchymal stem cell (MSC) transplantation to treat TS. We discuss the mechanism of action, as well as the efficiency of this approach, in treating TS. Settings and Design An autoimmune TS animal model was adopted in the present study. Forty-eight Wistar rats were randomly allocated to the control group and the 2 experimental groups, namely, TS rats+vehicle and TS rats+MSC. MSCs were co-cultured with 5-bromodeoxyuridine (BrdU) for 24 h for labeling prior to grafting. Methods Stereotypic behaviors were recorded at 1, 7, 14, and 28 days after transplantation. Dopamine (DA) content in the striatum of rats in the 3 groups was measured using a high-performance liquid chromatography column equipped with an electrochemical detector (HPLC-ECD) on day 28 after transplantation. Statistical analysis Statistical analysis was performed by repeated measurements analysis of variance to evaluate stereotypic behavior counts at different time points. Results TS rats exhibited higher stereotypic behavioral counts compared with the control group. One week after transplantation, TS rats with MSC grafts exhibited significantly decreased stereotypic behavior. Rats with MSC grafts also showed reduced levels of DA in the striatum when compared with TS rats, which were exposed only to the vehicle. Conclusions Intrastriatal transplantation of MSCs can provide relief from the stereotypic behavior of TS. Our results indicate that this approach may have potential for developing therapies against TS. The mechanism(s) of the observed effect may be related to the suppression of DA system by decreasing the content of DA in TS rats.
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Affiliation(s)
- Xiumei Liu
- Department of Pediatrics, Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Xueming Wang
- Department of Pediatrics, Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Lixia Li
- Department of Pediatrics, Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
- * E-mail:
| | - Haiyan Wang
- Department of Pediatrics, Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Xiaoling Jiao
- Department of Pediatrics, Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Vidailhet M, Lehéricy S. [MRI in patients with dystonias and Tourette syndrome]. Bull Acad Natl Med 2013; 197:847-859. [PMID: 25518154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recent developments in magnetic resonance imaging have provided further insights into the pathophysiology of movement disorders including dystonias and Tourette syndrome. Both structural and functional abnormalities have been described in dystonic patients, with a number of genotype-phenotype correlations. Interactions between the cerebello-thalamo-cortical and basal ganglia-cortex networks play a role in the penetrance and expression of dystonia. In Tourette syndrome, motor symptoms and behavioral disorders correlate with structural changes in limbic, motor and associative fronto-striato-parietal circuits of the brain. Both disorders may be related to subtle developmental abnormalities. Compensatory mechanisms may have either a positive or a negative effect (adaptive reactions or faulty activity).
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Swerdlow NR. Update: studies of prepulse inhibition of startle, with particular relevance to the pathophysiology or treatment of Tourette Syndrome. Neurosci Biobehav Rev 2012; 37:1150-6. [PMID: 23017868 DOI: 10.1016/j.neubiorev.2012.09.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/28/2012] [Accepted: 09/05/2012] [Indexed: 11/19/2022]
Abstract
Prepulse inhibition of the startle reflex (PPI) is an operational measure of sensorimotor gating, in which the motor response to an abrupt, intense stimulus is inhibited by a weak lead stimulus. PPI is reduced in several brain disorders, including Tourette Syndrome (TS); it is regulated by forebrain circuitry, including portions of the basal ganglia implicated in the pathophysiology of TS, and is also heritable and under strong genetic control. PPI has been the focus of numerous translational models, because it is expressed by most mammalian species, with remarkable conservation of response characteristics and underlying neural circuitry between rodents and primates. Several of these models have recently explored causative factors in TS - from genes to specific basal ganglia perturbations - as well as potential TS therapeutics, including novel pharmacological and neurosurgical interventions. With the focus on Comprehensive Behavioral Interventions for Tics (CBIT) in the evolving treatment model for TS, future studies might apply PPI as a predictive measure for CBIT response, or for identifying medications that might augment CBIT efficacy. In the end, a measure based on a simple pontine-based reflex will have limitations in its ability to explicate any complex behavioral phenotype.
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Affiliation(s)
- Neal R Swerdlow
- Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0804, USA.
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Maling N, Hashemiyoon R, Foote KD, Okun MS, Sanchez JC. Increased thalamic gamma band activity correlates with symptom relief following deep brain stimulation in humans with Tourette's syndrome. PLoS One 2012; 7:e44215. [PMID: 22970181 PMCID: PMC3435399 DOI: 10.1371/journal.pone.0044215] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 08/03/2012] [Indexed: 12/04/2022] Open
Abstract
Tourette syndrome (TS) is an idiopathic, childhood-onset neuropsychiatric disorder, which is marked by persistent multiple motor and phonic tics. The disorder is highly disruptive and in some cases completely debilitating. For those with severe, treatment-refractory TS, deep brain stimulation (DBS) has emerged as a possible option, although its mechanism of action is not fully understood. We performed a longitudinal study of the effects of DBS on TS symptomatology while concomitantly examining neurophysiological dynamics. We present the first report of the clinical correlation between the presence of gamma band activity and decreased tic severity. Local field potential recordings from five subjects implanted in the centromedian nucleus (CM) of the thalamus revealed a temporal correlation between the power of gamma band activity and the clinical metrics of symptomatology as measured by the Yale Global Tic Severity Scale and the Modified Rush Tic Rating Scale. Additional studies utilizing short-term stimulation also produced increases in gamma power. Our results suggest that modulation of gamma band activity in both long-term and short-term DBS of the CM is a key factor in mitigating the pathophysiology associated with TS.
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Affiliation(s)
- Nicholas Maling
- Department of Neuroscience, University of Florida, Gainesville, Florida, United States of America
| | - Rowshanak Hashemiyoon
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida, United States of America
| | - Kelly D. Foote
- Department of Neurosurgery, University of Florida, Gainesville, Florida, United States of America
- Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
| | - Michael S. Okun
- Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
- Department of Neurology, University of Florida, Gainesville, Florida, United States of America
| | - Justin C. Sanchez
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida, United States of America
- Neuroscience Program, University of Miami, Miami, Florida, United States of America
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, United States of America
- * E-mail:
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Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG, Chang S, Liu H, Dziura J, Walkup JT, Scahill L. Randomized trial of behavior therapy for adults with Tourette syndrome. Arch Gen Psychiatry 2012; 69:795-803. [PMID: 22868933 PMCID: PMC3772729 DOI: 10.1001/archgenpsychiatry.2011.1528] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decrease by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. OBJECTIVE To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. DESIGN A randomized controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. SETTING Three outpatient research clinics. PATIENTS Patients (N = 122; 78 males; age range, 16-69 years) with Tourette syndrome or chronic tic disorder were recruited between December 27, 2005, and May 21, 2009. INTERVENTIONS Patients received 8 sessions of comprehensive behavioral intervention for tics or 8 sessions of supportive treatment for 10 weeks. Patients with a positive response were given 3 monthly booster sessions. MAIN OUTCOME MEASURES Total tic score on the Yale Global Tic Severity Scale and the Clinical Global Impression-Improvement scale rated by a clinician masked to treatment assignment. RESULTS Behavior therapy was associated with a significantly greater mean (SD) decrease on the Yale Global Tic Severity Scale (24.0 [6.47] to 17.8 [7.32]) from baseline to end point compared with the control treatment (21.8 [6.59] to 19.3 [7.40]) (P < .001; effect size = 0.57). Twenty-four of 63 patients (38.1%) were rated as much improved or very much improved on the Clinical Global Impression-Improvement scale compared with 4 of 63 (6.4%) in the control group (P < .001). Attrition was 13.9%, with no difference across groups. Patients receiving behavior therapy who were available for assessment at 6 months after treatment showed continued benefit. CONCLUSION Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00231985.
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Affiliation(s)
- Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, Boston, 02114, USA.
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50
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Abstract
BACKGROUND Self-injurious behaviour (SIB) is a devastating problem observed in individuals with various neurodevelopmental disorders, including specific genetic syndromes as well as idiopathic intellectual and developmental disability. Although an increased prevalence of SIB has been documented in specific genetic mutations, little is known about the neurobiological basis of SIB. This makes vulnerability assessment and pharmacological treatment incredibly challenging. METHOD Here we review evidence that SIB and other repetitive, invariant behaviours, such as stereotypy, compulsions and tics, share many phenotypic similarities, are often co-morbidly expressed and have common inducing conditions. This argues for shared or overlapping pathophysiology. As much more is known about the neurobiology of these related disorders, this should make the neurobiology of SIB a more tractable problem. RESULTS Stereotypy, compulsions and tics are diagnostic for disorders that have received focused neurobiological investigation (autism, obsessive compulsive disorder, Tourette syndrome, respectively). In addition, animal models of these repetitive behaviours have been well characterised. Collectively, these studies have found that cortical basal ganglia circuitry dysfunction mediates repetitive behaviour. Moreover, these studies provide more detailed information and potentially testable hypotheses about specific aspects of the circuitry that may be operative in SIB. CONCLUSIONS We can use available information from clinical and animal models to make more precise hypotheses regarding the particular pathophysiology driving SIB. The results of testing such hypotheses should generate pharmacological strategies that may prove efficacious in reducing SIB.
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Affiliation(s)
- A M Muehlmann
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA.
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