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Gkotsoulias DG, Rullmann M, Schmitt S, Bujanow A, Zientek F, Messerschmidt K, Pampel A, Büttner AP, Schildan A, Sabri O, Müller-Vahl K, Barthel H, Möller HE. Abnormalities of iron homeostasis and the dopaminergic system in Tourette syndrome revealed by 7T MRI and PET. Brain Commun 2025; 7:fcaf104. [PMID: 40177529 PMCID: PMC11961303 DOI: 10.1093/braincomms/fcaf104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 02/20/2025] [Accepted: 03/07/2025] [Indexed: 04/05/2025] Open
Abstract
While the implication of a dysfunctional dopaminergic system in Tourette syndrome (TS) is well established, the underlying pathophysiological mechanisms remain unclear. Apart from neurotransmitters, disturbed iron homeostasis and iron regulatory mechanisms are also suspected. Iron is a trace element of fundamental biological importance and is involved in the synthesis and metabolism of dopamine and its receptors and transporters. The goal of the current pre-registered, multi-modal, cross-sectional study was to investigate the relationship between potential iron homeostasis imbalances and dopaminergic system disturbances in patients with TS. Susceptibility-sensitive MRI at 7 Tesla was used to obtain surrogate measures for local brain iron in 25 patients with TS (age 30 ± 9 years, 6 female) and 40 matched control subjects. Additionally, dopamine D1 receptor availability was investigated with [11C]SCH23390 PET in a subgroup of 20 patients and 20 controls. Significantly reduced sub-cortical magnetic susceptibility, indicating reduced iron levels, was observed in TS patients in the caudate, pallidum, sub-thalamic nucleus, thalamus, red nucleus and substantia nigra. These reductions were accompanied by significant reductions of the [11C]SCH23390 binding potential indicating reduced availability of D1 receptors in the dorsal striatum. The D1 receptor abnormality correlated with tic severity. These results point to alterations of intra-synaptic dopamine release and reduced striatal D1 receptor binding, supporting the notion of disruption in multiple functional elements of the dopaminergic system. Such dopaminergic abnormalities appear to be associated with disturbances in iron homeostasis.
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Affiliation(s)
| | - Michael Rullmann
- Department of Nuclear Medicine, Leipzig University Medical Center, Leipzig 04103, Germany
| | - Simon Schmitt
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover 30625, Germany
| | - Anna Bujanow
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig 04103, Germany
| | - Franziska Zientek
- Department of Nuclear Medicine, Leipzig University Medical Center, Leipzig 04103, Germany
| | | | - André Pampel
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig 04103, Germany
| | | | - Andreas Schildan
- Department of Nuclear Medicine, Leipzig University Medical Center, Leipzig 04103, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, Leipzig University Medical Center, Leipzig 04103, Germany
| | - Kirsten Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover 30625, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University Medical Center, Leipzig 04103, Germany
| | - Harald E Möller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig 04103, Germany
- Felix Bloch Institute for Solid State Physics, Leipzig University, Leipzig 04103, Germany
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Stern ER, Collins KA, Bragdon LB, Eng GK, Recchia N, Coffey BJ, Leibu E, Murrough JW, Tobe RH, Iosifescu DV, Burdick KE, Goodman WK. Randomized Controlled Trial of the Effects of High-Dose Ondansetron on Clinical Symptoms and Brain Connectivity in Obsessive-Compulsive and Tic Disorders. Am J Psychiatry 2025; 182:285-296. [PMID: 39876680 DOI: 10.1176/appi.ajp.20240294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Abstract
OBJECTIVE Sensory phenomena (SP) are aversive sensations driving repetitive behaviors in obsessive-compulsive disorder (OCD) and Tourette's disorder that are not well addressed by standard treatments. SP are related to the functioning of an interoceptive-sensorimotor circuit that may be modulated by the 5-HT3 receptor antagonist ondansetron. The present study employed an experimental medicine approach to test the effects of 4 weeks of high-dose ondansetron compared to placebo on SP severity and brain connectivity in a cohort of individuals with OCD and/or Tourette's disorder. METHODS Of 51 participants who completed the study, 27 were assigned to receive 24 mg/day of ondansetron and 24 to receive placebo. Analyses examined changes in SP severity and, for participants with OCD, overall OCD severity from baseline to final visit. Functional MRI data were collected at both visits for analysis of intrinsic functional connectivity metrics characterizing global correlation (reflecting area "hubness") and local correlation (reflecting near-neighbor coherence). RESULTS There were no significant differences between ondansetron and placebo in the reduction of SP or overall OCD severity in the full sample. In a subsample of participants with OCD taking concomitant serotonin reuptake inhibitors (SRIs), ondansetron was associated with a significant decrease in overall OCD severity and global connectivity of the medial sensorimotor cortex compared with placebo. Longitudinal reductions in SP severity were related to decreases in right sensorimotor hubness in both groups, and to brainstem local coherence only in participants taking ondansetron. CONCLUSIONS There was no effect of high-dose ondansetron on SP. However, when used as an augmentation to SRIs, ondansetron reduced overall OCD severity, which may be related to changes in the "hubness" of the sensorimotor cortex. Ondansetron's ability to modulate brainstem connectivity may underlie its variable effectiveness in reducing SP.
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Affiliation(s)
- Emily R Stern
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Katherine A Collins
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Laura B Bragdon
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Goi Khia Eng
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Nicolette Recchia
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Barbara J Coffey
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Evan Leibu
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - James W Murrough
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Russell H Tobe
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Dan V Iosifescu
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Katherine E Burdick
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Wayne K Goodman
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
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Wilson LA, Scarfo J, Jones ME, Rehm IC. The relationship between sensory phenomena and interoception across the obsessive-compulsive spectrum: a systematic review. BMC Psychiatry 2025; 25:162. [PMID: 39994601 PMCID: PMC11849306 DOI: 10.1186/s12888-024-06441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 12/23/2024] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND Uncomfortable sensations preceding repetitive behaviours, known as sensory phenomena, have been documented across the obsessive-compulsive spectrum. Indirect evidence suggests altered interoception may play a role in these shared experiences of sensory phenomena; however, research explicitly measuring this relationship is limited. The current systematic review aimed to establish the nature of sensory phenomena and interoception in obsessive-compulsive and related disorders (OCRDs) and tic disorders as potential maintaining factors of these disorders. METHODS PsycINFO, PubMed, and Scopus databases were searched from 2007 to April 2024, yielding 65 studies. RESULTS While the majority of studies presented low risk of bias, significant overlap and ambiguity characterised the measurement and conceptualisation of sensory phenomena and interoception. Overall, higher sensory phenomena was associated with greater symptom severity in several obsessive-compulsive spectrum disorders. Obsessive-compulsive disorder and tic disorder samples were characterised by lower interoceptive accuracy, with mixed findings on interoceptive sensibility. Some limited research emerged suggesting altered interoceptive abilities may be associated with greater sensory phenomena in obsessive-compulsive disorder and tic disorders. CONCLUSIONS Sensory phenomena are experienced across the obsessive-compulsive spectrum. Future research should explore interoceptive abilities across the OCRDs, and build upon evidence supporting a relationship between sensory phenomena and interoception in OCD and tic disorders. TRIAL REGISTRATION CRD42023422817.
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Affiliation(s)
- Lizzie A Wilson
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Road, Footscray, VIC, 3011, Australia
| | - Jessica Scarfo
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Road, Footscray, VIC, 3011, Australia
| | - Mikayla E Jones
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Road, Footscray, VIC, 3011, Australia
| | - Imogen C Rehm
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Road, Footscray, VIC, 3011, Australia.
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Green B, Waters A, Jimenez-Shahed J. Pain in Tourette Syndrome: A Comprehensive Review. J Child Adolesc Psychopharmacol 2025; 35:23-36. [PMID: 39558767 DOI: 10.1089/cap.2024.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2024]
Abstract
Objectives: Recent survey data suggest that a high proportion of patients with Tourette syndrome (TS) experience pain, yet pain features in TS have not been previously investigated in a systematic manner. This article reviews the current understanding and impact of pain in TS as well as identifies possible areas for emphasis for future research on pain in TS. Methods: Using a comprehensive search strategy in two relevant research databases (PubMed and Scopus), we searched for relevant peer-reviewed, primary research articles, and review articles. Search terms used were Tourette syndrome, tic disorder, pain, pain management, sensory, and sensory gating. Results: A total of 116 pertinent articles were identified. Pain is reported by 47%-60% of individuals with TS and may relate to different aspects of tic phenomenology or other causes. Pain is more prevalent among TS patients than in the general population and negatively impacts quality of life. To standardize future research efforts, we propose the following classification: tic-related immediate pain, tic-related delayed injury/pain, suppression-related pain, premonitory urge-related pain, and associated primary pain syndromes. Altered sensory gating and interoceptive processing abnormalities are possible mechanisms contributing to pain in TS but warrant further study. Despite pain prevalence, most TS clinical rating scales and outcome measures used in therapeutic studies do not incorporate sufficient information regarding pain. Therapies known to improve pain in non-TS conditions that are also reported to improve tics have not been investigated for their effects on pain among TS patients. Conclusion: TS can be associated with a chronic pain syndrome that negatively affects quality of life. Future research using a systematic framework is needed to better understand pain cause(s) and prevalence, develop appropriate assessment methods, establish outcome measures, and understand mechanisms of pain in TS. Such investigations are likely to lead to therapeutic options for this troublesome symptom.
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Affiliation(s)
- Bryan Green
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Allison Waters
- Psychiatry and Neuroscience, Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joohi Jimenez-Shahed
- Neurology and Neurosurgery, Medical Director, Movement Disorders Neuromodulation & Brain Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Wohlgemuth JB, Watson KH, Gill KD, Isaacs DA. Premonitory urge in tic disorders - a scoping review. Front Psychiatry 2025; 16:1504442. [PMID: 39950174 PMCID: PMC11821575 DOI: 10.3389/fpsyt.2025.1504442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 01/06/2025] [Indexed: 02/16/2025] Open
Abstract
Introduction Premonitory urges are uncomfortable bodily sensations preceding tics. They are highly prevalent, frequently bothersome, and increasingly recognized as a central phenotypic feature in tic disorder populations. This scoping review aimed to systematically consolidate published knowledge and identify knowledge gaps regarding premonitory urges in primary tic disorders. Methods Search strategies were deployed in five databases and five topic-relevant journals. Two independent reviewers screened all candidate abstracts against predefined inclusion criteria. One hundred and fifty-five articles were included in the scoping review. The same two reviewers independently extracted and consolidated pertinent data from included articles. Results Multiple methods for assessing premonitory urge were identified, each with strengths and weaknesses. The subjective quality of premonitory urges varies between individuals, with increased prevalence of a "not just right" urge quality in individuals with comorbid obsessive-compulsive disorder. Awareness of premonitory urge appears to arise several years after tic-onset, yet many individuals perceive their tics as voluntary responses to premonitory urges. Premonitory urges and tics are temporally coupled in real time, but premonitory urge severity and tic severity, as assessed by clinical scales, are not consistently associated. The mechanistic and developmental relationship between premonitory urges and tics remains unclear. Data are limited on premonitory urge response to treatment, but several promising interventions were identified. The insula and supplementary motor area are the neuroanatomical structures most strongly implicated in emergence of the premonitory urge. Discussion Knowledge of the clinical characteristics, measurement, and neural mechanisms of premonitory urge has advanced considerably in recent years, but important knowledge gaps remain in each of these domains. Addressing these knowledge gaps will be key to developing effective interventions for premonitory urge. Systematic Review Registration Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/WT43Z.
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Affiliation(s)
- John B. Wohlgemuth
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Kelly H. Watson
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kayce D. Gill
- Annette and Irwin Eskind Family Biomedical Library and Learning Center, Vanderbilt University, Nashville, TN, United States
| | - David A. Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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Forlim CG, Brandt V, Jakubovski E, Ganos C, Kühn S, Müller‐Vahl K. Symptom Network Analysis in a Large Sample of Children and Adults with a Chronic Tic Disorder. Mov Disord Clin Pract 2024; 11:1232-1240. [PMID: 39054607 PMCID: PMC11489602 DOI: 10.1002/mdc3.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/06/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Chronic tic disorders (CTD) are multifaceted disorders characterized by multiple motor and/or vocal tics. They are often associated with complex tics including echophenomena, paliphenomena, and coprophenomena as well as psychiatric comorbidities such as attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). OBJECTIVES Our goal was to uncover the inter-relational structure of CTD and comorbid symptoms in children and adults and to understand changes in symptom structure across development. METHODS We used network and graph analyses to uncover the structure of association of symptoms in childhood/adolescence (n = 529) and adulthood (n = 503) and how this structure might change from childhood to adulthood, pinpointing core symptoms as a main target for interventions. RESULTS The analysis yielded core symptom networks in young and adult patients with CTD including complex tics and tic-related phenomena as well as touching people and objects. Core symptoms in childhood also included ADHD symptoms, whereas core symptoms in adults included symptoms of OCD instead. Interestingly, self-injurious behavior did not play a core role in the young CTD network, but became one of the central symptoms in adults with CDT. In addition, we found strong connections between complex motor and vocal tics as well as echolalia and echopraxia. CONCLUSIONS Next to other complex tics, echophenomena, paliphenomena, and coprophenomena can be regarded core symptoms of CTD. ADHD symptoms are closely related to CTD in childhood, whereas symptoms of OCD and self-injurious behavior are closely associated with CTD in adults. Our results suggest that a differentiation between motor and vocal tics is somewhat arbitrary.
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Affiliation(s)
- Caroline Garcia Forlim
- Neuronal Plasticity Working Group, Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Center for Environmental NeuroscienceMax Planck Institute for Human DevelopmentBerlinGermany
| | - Valerie Brandt
- School of Psychology, Centre for Innovation in Mental HealthUniversity of SouthamptonSouthamptonUK
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Christos Ganos
- Movement Disorder Clinic, Edmond J. Safra Program in Parkinson's Disease, Division of NeurologyUniversity of Toronto, Toronto Western HospitalTorontoOntarioCanada
| | - Simone Kühn
- Neuronal Plasticity Working Group, Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Center for Environmental NeuroscienceMax Planck Institute for Human DevelopmentBerlinGermany
| | - Kirsten Müller‐Vahl
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
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Parvizi-Wayne D, Severs L. When the interoceptive and conceptual clash: The case of oppositional phenomenal self-modelling in Tourette syndrome. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024; 24:660-680. [PMID: 38777988 PMCID: PMC11233343 DOI: 10.3758/s13415-024-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
Tourette syndrome (TS) has been associated with a rich set of symptoms that are said to be uncomfortable, unwilled, and effortful to manage. Furthermore, tics, the canonical characteristic of TS, are multifaceted, and their onset and maintenance is complex. A formal account that integrates these features of TS symptomatology within a plausible theoretical framework is currently absent from the field. In this paper, we assess the explanatory power of hierarchical generative modelling in accounting for TS symptomatology from the perspective of active inference. We propose a fourfold analysis of sensory, motor, and cognitive phenomena associated with TS. In Section 1, we characterise tics as a form of action aimed at sensory attenuation. In Section 2, we introduce the notion of epistemic ticcing and describe such behaviour as the search for evidence that there is an agent (i.e., self) at the heart of the generative hierarchy. In Section 3, we characterise both epistemic (sensation-free) and nonepistemic (sensational) tics as habitual behaviour. Finally, in Section 4, we propose that ticcing behaviour involves an inevitable conflict between distinguishable aspects of selfhood; namely, between the minimal phenomenal sense of self-which is putatively underwritten by interoceptive inference-and the explicit preferences that constitute the individual's conceptual sense of self. In sum, we aim to provide an empirically informed analysis of TS symptomatology under active inference, revealing a continuity between covert and overt features of the condition.
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Affiliation(s)
- D Parvizi-Wayne
- Department of Psychology, Royal Holloway University of London, London, UK.
| | - L Severs
- Centre for the Philosophy of Science, Faculty of Sciences, University of Lisbon, Lisbon, Portugal
- Ruhr-Universität Bochum, Institute of Philosophy II, Bochum, Germany
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8
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Zouki JJ, Eapen V, Efron D, Maxwell A, Corp DT, Silk TJ. Functional brain networks associated with the urge for action: Implications for pathological urge. Neurosci Biobehav Rev 2024; 163:105779. [PMID: 38936563 DOI: 10.1016/j.neubiorev.2024.105779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 05/26/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
Tics in Tourette syndrome (TS) are often preceded by sensory urges that drive the motor and vocal symptoms. Many everyday physiological behaviors are associated with sensory phenomena experienced as an urge for action, which may provide insight into the neural correlates of this pathological urge to tic that remains elusive. This study aimed to identify a brain network common to distinct physiological behaviors in healthy individuals, and in turn, examine whether this network converges with a network we previously localized in TS, using novel 'coordinate network mapping' methods. Systematic searches were conducted to identify functional neuroimaging studies reporting correlates of the urge to micturate, swallow, blink, or cough. Using activation likelihood estimation meta-analysis, we identified an 'urge network' common to these physiological behaviors, involving the bilateral insula/claustrum/inferior frontal gyrus/supplementary motor area, mid-/anterior- cingulate cortex (ACC), right postcentral gyrus, and left thalamus/precentral gyrus. Similarity between the urge and TS networks was identified in the bilateral insula, ACC, and left thalamus/claustrum. The potential role of the insula/ACC as nodes in the network for bodily representations of the urge to tic are discussed.
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Affiliation(s)
- Jade-Jocelyne Zouki
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC 3220, Australia.
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, UNSW School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Daryl Efron
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3010, Australia; Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Amanda Maxwell
- Discipline of Psychiatry and Mental Health, UNSW School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Daniel T Corp
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC 3220, Australia; Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, FI-20014, Finland
| | - Timothy J Silk
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC 3220, Australia; Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
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9
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Orth L, Meeh J, Leiding D, Habel U, Neuner I, Sarkheil P. Aberrant Functional Connectivity of the Salience Network in Adult Patients with Tic Disorders: A Resting-State fMRI Study. eNeuro 2024; 11:ENEURO.0223-23.2024. [PMID: 38744491 PMCID: PMC11167695 DOI: 10.1523/eneuro.0223-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 05/16/2024] Open
Abstract
Tic disorders (TD) are characterized by the presence of motor and/or vocal tics. Common neurophysiological frameworks suggest dysregulations of the cortico-striatal-thalamo-cortical (CSTC) brain circuit that controls movement execution. Besides common tics, there are other "non-tic" symptoms that are primarily related to sensory perception, sensorimotor integration, attention, and social cognition. The existence of these symptoms, the sensory tic triggers, and the modifying effect of attention and cognitive control mechanisms on tics may indicate the salience network's (SN) involvement in the neurophysiology of TD. Resting-state functional MRI measurements were performed in 26 participants with TD and 25 healthy controls (HC). The group differences in resting-state functional connectivity patterns were measured based on seed-to-voxel connectivity analyses. Compared to HC, patients with TD exhibited altered connectivity between the core regions of the SN (insula, anterior cingulate cortex, and temporoparietal junction) and sensory, associative, and motor-related cortices. Furthermore, connectivity changes were observed in relation to the severity of tics in the TD group. The SN, particularly the insula, is likely to be an important site of dysregulation in TD. Our results provide evidence for large-scale neural deviations in TD beyond the CSTC pathologies. These findings may be relevant for developing treatment targets.
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Affiliation(s)
- Linda Orth
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
| | - Johanna Meeh
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany
| | - Delia Leiding
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich, 52428 Jülich, Germany
| | - Pegah Sarkheil
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany
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Wellen BCM, Ramanujam K, Lavelle M, Capriotti MR, Butner J, Euler MJ, Himle MB. A Test of the Behavioral Model of Tic Disorders Using a Dynamical Systems Framework. Behav Ther 2024; 55:513-527. [PMID: 38670665 DOI: 10.1016/j.beth.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/01/2023] [Accepted: 08/15/2023] [Indexed: 04/28/2024]
Abstract
Tic disorders are a class of neurodevelopmental disorders characterized by involuntary motor and/or vocal tics. It has been hypothesized that tics function to reduce aversive premonitory urges (i.e., negative reinforcement) and that suppression-based behavioral interventions such as habit reversal training (HRT) and exposure and response prevention (ERP) disrupt this process and facilitate urge reduction through habituation. However, previous findings regarding the negative reinforcement hypothesis and the effect of suppression on the urge-tic relationship have been inconsistent. The present study applied a dynamical systems framework and within-subject time-series autoregressive models to examine the temporal dynamics of urges and tics and assess whether their relationship changes over time. Eleven adults with tic disorders provided continuous urge ratings during separate conditions in which they were instructed to tic freely or to suppress tics. During the free-to-tic conditions, there was considerable heterogeneity across participants in whether and how the urge-tic relationship followed a pattern consistent with the automatic negative reinforcement hypothesis. Further, little evidence for within-session habituation was seen; tic suppression did not result in a reduction in premonitory urges for most participants. Analysis of broader urge change metrics did show significant disruption to the urge pattern during suppression, which has implications for the current biobehavioral model of tics.
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11
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Aktan D, Depierreux F. How to face the hemifacial spasm: challenges and misconceptions. Acta Neurol Belg 2024; 124:17-23. [PMID: 37498482 DOI: 10.1007/s13760-023-02342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
Hemifacial spasm (HFS) is characterised by intermittent, brief or sustained, repetitive contractions of the muscles innervated by one facial nerve. It is one of the most frequent movement disorders affecting the face. However common and allegedly straightforward to diagnose, it might reveal as a challenge for clinicians in various situations. Indeed, it often needs prior exclusion of many other movement disorders affecting the face, with frequent phenomenological overlaps with blepharospasm, post-facial palsy, facial motor tics, etc. The clinical diagnosis shall be supported by modern brain imaging techniques, and sometimes electromyography, as some particular aetiologies may require specific treatment. Primary forms are associated with vascular compression of the ipsilateral seventh cranial nerve, whereas secondary forms can be caused by any injury occurring on the facial nerve course. This article proposes a global and organised approach to the diagnosis, and the ensuing therapeutic options, as many practitioners still use some inefficient medications when they encounter a case of facial spasm.
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Affiliation(s)
- David Aktan
- Neurology Department, University Hospital of Liège, CHU Liege, Avenue Hippocrate-B35, 4000, Liège, Belgium.
| | - Frédérique Depierreux
- Neurology Department, University Hospital of Liège, CHU Liege, Avenue Hippocrate-B35, 4000, Liège, Belgium
- Movement Disorder Unit, Neurology Department, CHU Liège, Liège, Belgium
- GIGA-CRC in vivo imaging, University of Liège, Liège, Belgium
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12
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Quoilin C, Chaise F, Duque J, de Timary P. Relationship between transcranial magnetic stimulation markers of motor control and clinical recovery in obsessive compulsive disorder/Gilles de la Tourette syndrome: a proof of concept case study. Front Psychiatry 2024; 15:1307344. [PMID: 38304284 PMCID: PMC10832049 DOI: 10.3389/fpsyt.2024.1307344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Abstract
Background Obsessive compulsive disorder (OCD) and Gilles de la Tourette syndrome (GTS) are neurodevelopmental disorders characterized by difficulties in controlling intrusive thoughts (obsessions) and undesired actions (tics), respectively. Both conditions have been associated with abnormal inhibition but a tangible deficit of inhibitory control abilities is controversial in GTS. Methods Here, we examined a 25 years-old male patient with severe OCD symptoms and a mild form of GTS, where impairments in motor control were central. Transcranial magnetic stimulation (TMS) was applied over the primary motor cortex (M1) to elicit motor-evoked potentials (MEPs) during four experimental sessions, allowing us to assess the excitability of motor intracortical circuitry at rest as well as the degree of MEP suppression during action preparation, a phenomenon thought to regulate movement initiation. Results When tested for the first time, the patient presented a decent level of MEP suppression during action preparation, but he exhibited a lack of intracortical inhibition at rest, as evidenced by reduced short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI). Interestingly, the patient's symptomatology drastically improved over the course of the sessions (reduced obsessions and tics), coinciding with feedback given on his good motor control abilities. These changes were reflected in the TMS measurements, with a significant strengthening of intracortical inhibition (SICI and LICI more pronounced than previously) and a more selective tuning of MEPs during action preparation; MEPs became even more suppressed, or selectively facilitated depending on the behavioral condition in which they we probed. Conclusion This study highlights the importance of better understanding motor inhibitory mechanisms in neurodevelopmental disorders and suggests a biofeedback approach as a potential novel treatment.
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Affiliation(s)
- Caroline Quoilin
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Fostine Chaise
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Julie Duque
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Philippe de Timary
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Department of Adult Psychiatry, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Che G, Ren W, McGuire JF, Li P, Zhao Z, Tian J, Zhang J, Zhang Y. Clinical evaluation of premonitory urges in children and adolescents using the Chinese version of Individualized Premonitory Urge for Tics Scale. Front Psychiatry 2023; 14:1224825. [PMID: 38034925 PMCID: PMC10687167 DOI: 10.3389/fpsyt.2023.1224825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023] Open
Abstract
Background Premonitory urges (PUs) have been the focus of recent efforts to assess the severity and develop interventions for tic disorders (TD). We aimed to investigate the PUs in TD and its comorbidities from multiple dimensions, using the Chinese version of the Premonitory Urge for Tics Scale (C-PUTS) and the Chinese version of the Individualized Premonitory Urge for Tics Scale (C-IPUTS), in order to provide perspectives for the diagnosis and management of TD in children and adolescents. Methods A total of 123 cases were included in the study. The IPUTS was translated, back-translated, culturally adjusted, and pre-investigated to determine the items of the C-IPUTS. The reliability and validity of the C-IPUTS scale were evaluated by a questionnaire survey on children and adolescents with TD at the Developmental Pediatrics Department of the Second Hospital of Jilin University. Meanwhile, the C-PUTS, which had been evaluated and used in China, Yale Global Tic Severity Scale (YGTSS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Depression Self-Rating Scale (DSRS), Screen for Childhood Anxiety-Related Disorders (SCARED), Achenbach Child Behavior Checklist (CBCL), and Swanson, Nolan and Pelham, Version IV (SNAP-IV), were used to assess the association of PUs with tics and comorbidities of TD. Results All dimensions of the C-IPUTS demonstrated good reliability and validity. Our findings suggested that PUs in children and adolescents in China occurred primarily at the head/face and neck/throat. The different dimensions of the C-IPUTS (number, frequency, and intensity) and C-PUTS were positively correlated with the YGTSS total score, while the C-PUTS was positively correlated with the Y-BOCS, SCARED, DSRS, and SNAP-IV scale total scores. The three dimensions of the C-IPUTS demonstrated correlations with anxiety severity and obsessive-compulsive symptoms. Conclusion The C-IPUTS can be used to assess PUs reliably and effectively and provide further information for the C-PUTS from various dimensions in a Chinese setting. PUs relate to obsessive-compulsive symptoms, anxiety, attention deficit hyperactivity, and behavioral problems in children and adolescents with TDs. Accordingly, PUs evaluation using the C-IPUTS combined with the PUTS might provide useful information for future therapies for TDs to achieve greater tic reduction.
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Affiliation(s)
- Guanghua Che
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
- Pediatrics Centre, The Second Hospital of Jilin University, Changchun, China
| | - Wenjing Ren
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Joseph F. McGuire
- Center for Obsessive-Compulsive Disorder (OCD), Anxiety, and Related Disorders for Children, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ping Li
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Zhiruo Zhao
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Jing Tian
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Jinyuan Zhang
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Yue Zhang
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
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Maxwell A, Zouki JJ, Eapen V. Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation. Front Pediatr 2023; 11:1265123. [PMID: 38034832 PMCID: PMC10687404 DOI: 10.3389/fped.2023.1265123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction The onset of the COVID-19 pandemic saw a global surge in functional tic-like behaviors (FTLBs). FTLBs are unique from primary tic disorders. They are thought to manifest through a complex interplay between environmental and personal factors, including the stress-arousal system, and are characterized by their sudden and explosive onset. Accordingly, common interventions for tic disorders show limited efficacy in this population. We present an Integrated Cognitive Behavioral Intervention for Functional Tics (I-CBiT) that uses an urge acceptance model to manage tics and related stress and anxiety. Methods We describe the treatment outcomes of eight young people presenting with new and sudden onset FTLBs who underwent I-CBiT, which integrates traditional behavioral tic interventions with third-wave cognitive behavioral therapies. All cases completed the three-phase intervention involving core components of psychoeducation, exposure and response prevention with urge acceptance, sensory grounding strategies, and cognitive behavioral intervention targeting the stress-arousal system. Tic severity and impairment were assessed prior to treatment and at completion. Results All cases showed a significant reduction in tic severity post I-CBiT and an improvement in overall daily living function. These cases highlight the role of urge acceptance in managing both tic urges and the underlying stress-arousal system to bring about long-term change. Conclusion We demonstrated the efficacy of I-CBiT for managing FTLBs. Our findings illustrate the importance of treating underlying stress and anxiety in this population and, therefore, a need for greater interaction between multidisciplinary services in managing FTLBs to comprehensively cover the varied symptom presentations linked to thoughts, emotions, bodily sensations, and stress responses.
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Affiliation(s)
- Amanda Maxwell
- Discipline of Psychiatry and Mental Health, UNSW School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Jade-Jocelyne Zouki
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, UNSW School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
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15
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van de Griendt JMTM, van den Berg NME, Verdellen CWJ, Cath DC, Verbraak MJPM. Working Mechanisms of Exposure and Response Prevention in the Treatment of Tourette Syndrome and Tic Disorders Revisited: No Evidence for within-Session Habituation to Premonitory Urges. J Clin Med 2023; 12:7087. [PMID: 38002700 PMCID: PMC10672020 DOI: 10.3390/jcm12227087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Exposure and response prevention (ERP) has been shown to be an effective treatment for Tourette syndrome (TS) and chronic tic disorders (CTD). ERP is based on voluntary tic suppression in combination with prolonged exposure to premonitory urges preceding tics. A prevailing hypothesis of the working mechanism underlying ERP in tics is habituation to the premonitory urges as a result of prolonged exposure. However, results so far are equivocal. This study aims to further explore the relation between urges and ERP in tics, by investigating the course of premonitory urges during ERP sessions. METHODS Using a data-driven approach, within-session habituation to premonitory urge intensity was investigated. In total, 29 TS patients rated urge intensity at seven timepoints during ten 1 h ERP sessions. RESULTS/CONCLUSIONS Latent growth modeling showed an increase in urge intensity during the first 15 min of each session followed by a plateau in the remaining 45 min of the session. This does not support the idea of within-session habituation to premonitory urges as a working mechanism of ERP. Other potential underlying working mechanisms are discussed and should be tested in future research.
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Affiliation(s)
| | - Nelleke M. E. van den Berg
- Department of Psychology, Erasmus University Rotterdam, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands;
| | - Cara W. J. Verdellen
- PsyQ Nijmegen, Parnassia Group, Sint Annastraat 263, 6525 GR Nijmegen, The Netherlands;
| | - Daniëlle C. Cath
- Department of Psychiatry, University Medical Center Groningen, Rijksuniversiteit Groningen, 9700 AD Groningen, The Netherlands;
- GGZ Drenthe, Dennenweg 9, 9404 LA Assen, The Netherlands
| | - Marc J. P. M. Verbraak
- Behavioural Science Institute, Radboud University Nijmegen, Thomas van Aquinostraat 4, 6525 GD Nijmegen, The Netherlands;
- Pro Persona, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
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16
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Brandt V, Otte JH, Fremer C, Jakubovski E, Müller-Vahl K. Non-just-right experiences are more closely related to OCD than tics in Tourette patients. Sci Rep 2023; 13:19627. [PMID: 37949933 PMCID: PMC10638287 DOI: 10.1038/s41598-023-37658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/25/2023] [Indexed: 11/12/2023] Open
Abstract
Complex tics and obsessive or compulsive behaviour can be difficult to differentiate diagnostically. The majority of adult patients with Tourette syndrome report experiencing premonitory urges before tics. Some of these experiences have been linked to non-just-right experiences (NJRE), which are frequently reported by patients with obsessive-compulsive disorder or behaviours (OCD/OCB). We aimed to assess whether NJRE are more closely related to tics and tic-associated premonitory urges or whether they are more closely associated with OCD. A total of N = 111 patients (mean age = 34.77 + /-12.93; N = 37 female) with a confirmed diagnosis of Tourette syndrome completed the premonitory urges for tic disorders scale (PUTS), the revised non-just-right experiences scale (NJRE-QR), and questionnaires regarding their tic severity, and comorbid OCD/OCB. A multi-trait-multi-methods matrix was calculated to examine associations amongst scales measuring tic-related and OCB-related phenomena. The PUTS correlated overall higher with tic questionnaires than with OCD/OCB questionnaires. The NJRE correlated higher with OCD symptoms than with tic severity. The results indicate that non-just-right experiences are more closely associated with comorbid OCB than with tics in patients with Tourette syndrome.
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Affiliation(s)
- Valerie Brandt
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany.
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK.
| | - Jan-Hendrik Otte
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Carolin Fremer
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany.
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Khoodoruth MAS, Ahammad F, Khan YS, Mohammad F. The shared genetic risk factors between Tourette syndrome and obsessive-compulsive disorder. Front Neurol 2023; 14:1283572. [PMID: 37905190 PMCID: PMC10613519 DOI: 10.3389/fneur.2023.1283572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Tourette syndrome (TS) and obsessive-compulsive disorder (OCD) are two neuropsychiatric disorders that frequently co-occur. Previous evidence suggests a shared genetic diathesis underlying the comorbidity of TS and OCD. This review aims to comprehensively summarize the current literature on the genetic factors linked with TS and its comorbidities, with a focus on OCD. Family studies, linkage analysis, cytogenetic studies, and genome-wide association studies (GWAS) have played a pivotal role in identifying common and rare genetic variants connected with TS and OCD. Although the genetic framework of TS and OCD is complex and multifactorial, several susceptibility loci and candidate genes have been identified that might play a crucial role in the pathogenesis of both disorders. Additionally, post-infectious environmental elements have also been proposed to contribute to the development of TS-OCD, although the dynamics between genetic and environmental factors is not yet fully understood. International collaborations and studies with well-defined phenotypes will be crucial in the future to further elucidate the genetic basis of TS and OCD and to develop targeted therapeutic strategies for individuals suffering from these debilitating conditions.
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Affiliation(s)
- Mohamed Adil Shah Khoodoruth
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Child and Adolescent Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Foysal Ahammad
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Yasser Saeed Khan
- Child and Adolescent Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Farhan Mohammad
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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18
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Rae CL, Raykov P, Ambridge EM, Colling LJ, Gould van Praag CD, Bouyagoub S, Polanski L, Larsson DEO, Critchley HD. Elevated representational similarity of voluntary action and inhibition in Tourette syndrome. Brain Commun 2023; 5:fcad224. [PMID: 37705680 PMCID: PMC10497185 DOI: 10.1093/braincomms/fcad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/07/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Many people with Tourette syndrome are able to volitionally suppress tics, under certain circumstances. To understand better the neural mechanisms that underlie this ability, we used functional magnetic resonance neuroimaging to track regional brain activity during performance of an intentional inhibition task. On some trials, Tourette syndrome and comparison participants internally chose to make or withhold a motor action (a button press), while on other trials, they followed 'Go' and 'NoGo' instructions to make or withhold the same action. Using representational similarity analysis, a functional magnetic resonance neuroimaging multivariate pattern analysis technique, we assessed how Tourette syndrome and comparison participants differed in neural activity when choosing to make or to withhold an action, relative to externally cued responses on Go and NoGo trials. Analyses were pre-registered, and the data and code are publicly available. We considered similarity of action representations within regions implicated as critical to motor action release or inhibition and to symptom expression in Tourette syndrome, namely the pre-supplementary motor area, inferior frontal gyrus, insula, caudate nucleus and primary motor cortex. Strikingly, in the Tourette syndrome compared to the comparison group, neural activity within the pre-supplementary motor area displayed greater representational similarity across all action types. Within the pre-supplementary motor area, there was lower response-specific differentiation of activity relating to action and inhibition plans and to internally chosen and externally cued actions, implicating the region as a functional nexus in the symptomatology of Tourette syndrome. Correspondingly, patients with Tourette syndrome may experience volitional tic suppression as an effortful and tiring process because, at the top of the putative motor decision hierarchy, activity within the population of neurons facilitating action is overly similar to activity within the population of neurons promoting inhibition. However, not all pre-supplementary motor area group differences survived correction for multiple comparisons. Group differences in representational similarity were also present in the primary motor cortex. Here, representations of internally chosen and externally cued inhibition were more differentiated in the Tourette syndrome group than in the comparison group, potentially a consequence of a weaker voluntary capacity earlier in the motor hierarchy to suppress actions proactively. Tic severity and premonitory sensations correlated with primary motor cortex and caudate nucleus representational similarity, but these effects did not survive correction for multiple comparisons. In summary, more rigid pre-supplementary motor area neural coding across action categories may constitute a central feature of Tourette syndrome, which can account for patients' experience of 'unvoluntary' tics and effortful tic suppression.
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Affiliation(s)
- Charlotte L Rae
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - Petar Raykov
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | | | | | | | - Samira Bouyagoub
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton BN1 9RY, UK
| | - Liliana Polanski
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin 14195, Germany
| | - Dennis E O Larsson
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton BN1 9RY, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton BN1 9RY, UK
- Sussex Partnership NHS Foundation Trust, Worthing BN3 7HZ, UK
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19
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Baizabal-Carvallo JF, Alonso-Juarez M, Jankovic J. Contrasting features between Tourette syndrome and secondary tic disorders. J Neural Transm (Vienna) 2023; 130:931-936. [PMID: 37117738 PMCID: PMC10144877 DOI: 10.1007/s00702-023-02642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/25/2023] [Indexed: 04/30/2023]
Abstract
Tics are rapid, recurrent, non-rhythmic movements or emitted sounds. Tics are the hallmark of Tourette syndrome (TS); however, a number of other disorders may be associated with tics, so-called secondary tic disorders (STD). We assessed clinical history and performed blinded evaluations of video-recordings from patients with TS and STD in order to identify features that may differentiate tics associated with TS vs STD. There were 156 patients with TS and 38 with STD, 21 of whom had functional (psychogenic) tics. Patients with TS were more frequently male and had a younger age at onset. Tics in TS tend to involve muscles in the cranial-cervical area more often and have greater severity and complexity than those in patients with STD. Similar findings were observed when contrasting patients with TS with patients with functional tics only. Simple phonic tics showed the greatest diagnostic accuracy for TS, compared with STD, but marked overlap in the types of tics and comorbidities was observed between patients with TS and STD. Patients with TS were more likely males, had a younger age at onset, phonic tics and motor tics affecting predominantly the head and neck area, and had a greater complexity and severity of tics than those with STD. When these features are absent a consideration should be given to the possibility of a tic disorder other than TS.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
- Department of Sciences and Engineering, University of Guanajuato, Ave León 428, Jardines del Moral, C.P. 37320, León, Guanajuato, Mexico.
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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20
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Schütteler C, Gerlach AL. [Metacognitions and interoceptive sensibility in the perception of premonitory urges in tic disorders across the lifespan]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 51:275-282. [PMID: 36398570 DOI: 10.1024/1422-4917/a000910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Metacognitions and interoceptive sensibility in the perception of premonitory urges in tic disorders across the lifespan Abstract. Objective: Depending on contextual factors, the prevalence of premonitory urges (PU) in patients with tic disorders (TD) increases with age and varies both intra- and interindividually. In youth, PUs correlate with metacognitions. In both youth and adults, interoceptive sensibility is altered compared to healthy controls. We examined the relationship between PUs, tics, metacognitions, and interoceptive sensibility across the lifespan regarding tic severity. Method: In an online survey, 53 participants reported their PUs on the Premonitory Urge for Tics Scale (PUTS) and tic severity on the Symptom Checklist for Tic Disorders (SBB-TIC). We assessed interoceptive sensibility via the Body Perception Questionnaire (BPQ-A) and metacognitions regarding tics with the Belief About Tics Scale (BATS). Results: Adults scored higher on the PUTS than youth. In youth, interoceptive sensibility increased with age; interoceptive sensibility correlated with PUTS. Metacognitions and interoceptive sensibility explained a significant amount of variance in premonitory urges, even after controlling for tic severity and age. Conclusions: The presumed cause of age-dependent development of PUs in youth lies in their neurophysiological maturing processes. However, negative metacognitions and interoceptive abilities also play an important role in the development and maintenance of PU and might be of therapeutic use in the treatment of TD.
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Affiliation(s)
- Christina Schütteler
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
| | - Alexander L Gerlach
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
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21
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Brandt V, Essing J, Jakubovski E, Müller‐Vahl K. Premonitory Urge and Tic Severity, Comorbidities, and Quality of Life in Chronic Tic Disorders. Mov Disord Clin Pract 2023; 10:922-932. [PMID: 37332633 PMCID: PMC10272904 DOI: 10.1002/mdc3.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Tics are intimately associated with premonitory urges (PU) but knowledge about urges is still limited, with small sample sizes often limiting the generalizability of findings. OBJECTIVES This study addressed the following open questions: (1) is tic severity associated with urge severity, (2) how common is relief, (3) which comorbidities are associated with urges, (4) are urges, tics, and comorbidities associated with lower quality of life, and (5) can complex and simple, motor and vocal tics be differentiated based on PU? METHODS N = 291 patients who reported a confirmed diagnosis of chronic primary tic disorder (age = 18-65, 24% female) filled out an online survey assessing demographic data, comorbid conditions, location, quality and intensity of PU, as well as quality of life. Every tic was recorded, and whether the patient experienced a PU, the frequency, intensity, and quality of that urge. RESULTS PU and tic severity were significantly associated, and 85% of urge-related tics were followed by relief. A diagnosis of attention deficit/hyperactivity disorder (ADHD) or depression, female gender, and older age increased the likelihood of experiencing PU, while more obsessive compulsive (OCD) symptoms and younger age were associated with higher urge intensities. PU, complex vocal tics, ADHD, OCD, anxiety, and depression were related to lower quality of life. Motor and vocal, complex and simple tics did not differ regarding PU intensity, frequency, and quality, or relief. CONCLUSIONS The results shed light on the relationship between PU, tics, comorbidities, age, gender, and quality of life in tic disorders.
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Affiliation(s)
- Valerie Brandt
- School of Psychology, Centre for Innovation in Mental healthUniversity of SouthamptonSouthamptonUK
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Jana Essing
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Kirsten Müller‐Vahl
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
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22
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Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
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Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
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23
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Kimura K, Murase N, Nagao Y, Nozaki M, Fukumizu M, Kita Y, Hayashi M, Hoshino K. Pre-movement gating of somatosensory evoked potentials in tourette syndrome. Brain Dev 2023; 45:324-331. [PMID: 36878743 DOI: 10.1016/j.braindev.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/29/2023] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Tourette syndrome (TS) is a neurobehavioral disorder characterized by motor and vocal tics. Simple tics are purposeless involuntary movements that spontaneously resolve during middle adolescence. Complex tics appear to be semi-voluntary movements that may become intractable when associated with obsessive-compulsive disorder (OCD). Sensory tics or urges preceded by tics suggest sensorimotor processing impairment in TS. We aimed to clarify its pathophysiology by exploring the pre-movement gating (attenuation) of somatosensory evoked potentials (SEPs). METHODS We examined 42 patients (aged 9-48 years), 4 of whom underwent follow-up assessment, along with 19 healthy controls. We defined patients with only simple tics as TS-S and patients with complex tics as TS-C. Pre-movement gating of SEPs was assessed using a previously described method. Frontal N30 (FrN30) amplitudes were compared between pre-movement and resting states. The gating ratio of pre-movement/resting amplitude of the FrN30 component was assessed: the larger the ratio, the less the gating. RESULTS The gating ratio for TS-C patients was larger than that of TS-S patients and healthy controls, but a statistical difference between TS-S and TS-C appeared after 15 years and over (p < 0.001). There were no significant differences in the gating ratio between TS-S patients and healthy controls. The gating ratio was related to the severity of OCD (p < 0.05). CONCLUSION Sensorimotor processing was preserved for simple tics but impaired in complex tics, specifically after middle adolescence. Our study supports an age-dependent dysfunction of both motor and non-motor cortico-striato-thalamo-cortical circuits in complex tics. SEP gating seems promising as a tool for assessing age-dependent sensorimotor disintegration in TS.
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Affiliation(s)
- Kazue Kimura
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan.
| | - Nagako Murase
- Department of Neurology, National Hospital Organization, Nara Medical Center, Nara, Japan
| | - Yuri Nagao
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Maki Nozaki
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Michio Fukumizu
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Yosuke Kita
- Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan; Cognitive Brain Research Unit (CBRU), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Kyoko Hoshino
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
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24
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Schütteler C, Woitecki K, Döpfner M, Gerlach AL. Interoception and Premonitory Urges in Children and Adolescents With Tic Disorders. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e8185. [PMID: 37065000 PMCID: PMC10103159 DOI: 10.32872/cpe.8185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 10/25/2022] [Indexed: 04/03/2023] Open
Abstract
Background Compared to healthy controls (HCs), adult Tic Disorder (TD) patients exhibit a lower interoceptive accuracy (IAcc) in heartbeat perception. Since the lower IAcc is not evident in children, the age at which tics develop, but in adults only (Pile et al., 2018, https://doi.org/10.1007/s10803-018-3608-8), lower IAcc may reflect a pathological mechanism relevant with regard to tics, premonitory urges (PUs) or the resulting impairment. Although tics are a motor phenomenon, up to date, IAcc has been assessed only with a heartbeat-counting task. This study aims at comparing cardiac and muscular IAcc using two different paradigms and investigates how IAcc is related to premonitory urges in youth. Method Interoceptive measures (heartbeat-counting task, muscle tension paradigm) of 28 youth with TD were compared to 23 control participants and related to self-rated premonitory urges and tic symptoms. Results TD patients did not differ from HCs in any IAcc measures. However, within TD patients, IAcc explained additional variance in PUs when controlling for tic severity. Muscular IAcc in TD patients is related to urges and tics, but the direction of this association is unclear. IAcc is lower in TD patients than in HCs, indicating imprecise sensory input which is more easily overcome by priors within the predictive coding framework. Conclusions Muscle tension feedback tasks could extend interoceptive trainings aimed at improving IAcc to improve accuracy of urge perception (more precise sensory input) to foster the ability to control tics via HRT. Longitudinal studies could provide further insights in causal relationships between IAcc, premonitory urges and tics.
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Affiliation(s)
- Christina Schütteler
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander L. Gerlach
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
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25
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Schütteler C, Gerlach AL. Die Bedeutung des Vorgefühls bei Tic-Störungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Funktion des Vorgefühls in der Pathogenese und Aufrechterhaltung von Tic-Störungen (TS) wird in den letzten Jahren verstärkt erforscht. Die mögliche funktionelle Bedeutung der Vorgefühle wird aber noch nicht ausreichend verstanden. Methode: Im vorliegenden Review wird der Kenntnisstand zu Vorgefühlen entlang eines integrativen funktionalen Störungsmodells zusammengefasst. Ergebnisse: Im Vergleich zum Jugendalter nehmen Tic-Symptome bei Tic-Störungen im Erwachsenenalter ab, während immer mehr Betroffene ein Vorgefühl berichten. Hierbei kann zwischen einem allgemeinen Vorgefühl (trait) und dem Drang, Tics auszuführen (state) unterschieden werden. Das Vorgefühl als trait ist abhängig von der Interozeptionsfähigkeit. An den Drang, Tics auszuführen, kann habituiert werden, moderiert von Aufmerksamkeits- und Attributionsprozessen. Durch das Auflösen des Vorgefühl-Tic-Reizreaktionsmusters reduzieren sich die Tic-Symptome. Schlussfolgerung: Für weitere Erkenntnisse in Bezug auf die Bedeutung von Vorgefühl und den Drang, Tics auszuführen, sollten zukünftige Forschungsansätze Drang und allgemeine Vorgefühle in therapeutischen Interventionsstudien berücksichtigen, weitere Interozeptionsparadigmen einbeziehen und die Entwicklung von allgemeinem Vorgefühl und Drang über die Lebensspanne hinweg untersuchen.
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Affiliation(s)
- Christina Schütteler
- Institut für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
| | - Alexander L. Gerlach
- Institut für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
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26
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Beste C. Overcoming the phenomenological Perpetuum mobile in clinical cognitive neuroscience for the benefit of replicability in research and the societal view on mental disorders. Front Hum Neurosci 2022; 16:1054714. [DOI: 10.3389/fnhum.2022.1054714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Cognitive neuroscience comes in many facets, and a particularly large branch of research is conducted in individuals with mental health problems. This article outlines why it is important that cognitive neuroscientists re-shape their role in mental health research and re-define directions of research for the next decades. At present, cognitive neuroscience research in mental health is too firmly rooted in categorial diagnostic definitions of mental health conditions. It is discussed why this hampers a mechanistic understanding of brain functions underlying mental health problems and why this is a problem for replicability in research. A possible solution to these problems is presented. This solution affects the strategy of research questions to be asked, how current trends to increase replicability in research can or cannot be applied in the mental health field and how data are analyzed. Of note, these aspects are not only relevant for the scientific process, but affect the societal view on mental disorders and the position of affected individuals as members of society, as well as the debate on the inclusion of so-called WEIRD and non-WEIRD people in studies. Accordingly, societal and science political aspects of re-defining the role of cognitive neuroscientists in mental health research are elaborated that will be important to shape cognitive neuroscience in mental health for the next decades.
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27
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van der Veen S, Caviness JN, Dreissen YE, Ganos C, Ibrahim A, Koelman JH, Stefani A, Tijssen MA. Myoclonus and other jerky movement disorders. Clin Neurophysiol Pract 2022; 7:285-316. [PMID: 36324989 PMCID: PMC9619152 DOI: 10.1016/j.cnp.2022.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Myoclonus and other jerky movements form a large heterogeneous group of disorders. Clinical neurophysiology studies can have an important contribution to support diagnosis but also to gain insight in the pathophysiology of different kind of jerks. This review focuses on myoclonus, tics, startle disorders, restless legs syndrome, and periodic leg movements during sleep. Myoclonus is defined as brief, shock-like movements, and subtypes can be classified based the anatomical origin. Both the clinical phenotype and the neurophysiological tests support this classification: cortical, cortical-subcortical, subcortical/non-segmental, segmental, peripheral, and functional jerks. The most important techniques used are polymyography and the combination of electromyography-electroencephalography focused on jerk-locked back-averaging, cortico-muscular coherence, and the Bereitschaftspotential. Clinically, the differential diagnosis of myoclonus includes tics, and this diagnosis is mainly based on the history with premonitory urges and the ability to suppress the tic. Electrophysiological tests are mainly applied in a research setting and include the Bereitschaftspotential, local field potentials, transcranial magnetic stimulation, and pre-pulse inhibition. Jerks due to a startling stimulus form the group of startle syndromes. This group includes disorders with an exaggerated startle reflex, such as hyperekplexia and stiff person syndrome, but also neuropsychiatric and stimulus-induced disorders. For these disorders polymyography combined with a startling stimulus can be useful to determine the pattern of muscle activation and thus the diagnosis. Assessment of symptoms in restless legs syndrome and periodic leg movements during sleep can be performed with different validated scoring criteria with the help of electromyography.
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Affiliation(s)
- Sterre van der Veen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - John N. Caviness
- Department of Neurology, Mayo Clinic Arizona, Movement Neurophysiology Laboratory, Scottsdale, AZ, USA
| | - Yasmine E.M. Dreissen
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christos Ganos
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes H.T.M. Koelman
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Corresponding author at: Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands.
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28
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Forcadell E, Garcia-Delgar B, Nicolau R, Pérez-Vigil A, Cordovilla C, Lázaro L, Ibáñez L, Mir P, Madruga-Garrido M, Correa-Vela M, Morer A. Tic disorders and premonitory urges: validation of the Spanish-language version of the Premonitory Urge for Tics Scale in children and adolescents. NEUROLOGÍA (ENGLISH EDITION) 2022:S2173-5808(22)00071-2. [PMID: 35820636 DOI: 10.1016/j.nrleng.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/19/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Most people with persistent tics report an unpleasant sensation (premonitory urge) before the tic. In recent years, interest in these sensory phenomena has increased due to their important role in behavioural therapy. However, instruments for assessing these sensations remain scarce. Among the available instruments, the Premonitory Urge for Tics Scale (PUTS) is the most widely used. METHODS We examined the psychometric properties and factor structure of the Spanish-language version of the PUTS in a sample of 72 children and adolescents with Tourette syndrome or persistent tic disorders. We analysed data from the total sample and by age group (children up to 10 years old and children/adolescents over 10). RESULTS The PUTS presented good internal consistency and moderate correlations between items on the scale (except for item 1). Divergent validity was good, test-retest reliability was adequate, and a bifactorial structure was identified (one dimension related to mental phenomena reported in obsessive-compulsive disorder, and another related to the quality and frequency of premonitory urges). These results were replicated in both age groups, with lower divergent validity and test-retest reliability in the younger group. CONCLUSIONS The Spanish-language version of the PUTS is a valid, reliable tool for assessing premonitory urges in both children and adolescents, especially after the age of 10.
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Affiliation(s)
- E Forcadell
- Servicio de Psiquiatría y Psicológica Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, Spain.
| | - B Garcia-Delgar
- Servicio de Psiquiatría y Psicológica Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, Spain
| | - R Nicolau
- Servicio de Psiquiatría y Psicológica Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, Spain
| | - A Pérez-Vigil
- Servicio de Psiquiatría y Psicológica Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, Spain
| | - C Cordovilla
- Servicio de Psiquiatría y Psicológica Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, Spain
| | - L Lázaro
- Servicio de Psiquiatría y Psicológica Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L Ibáñez
- Family Health Centers at NYU Langone, New York, USA
| | - P Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Madruga-Garrido
- Sección de Neuropediatría, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Correa-Vela
- Sección de Neurología Pediátrica, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - A Morer
- Servicio de Psiquiatría y Psicológica Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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McCann B, Lam M, Shiohama T, Ijner P, Takahashi E, Levman J. Magnetic Resonance Imaging Demonstrates Gyral Abnormalities in Tourette Syndrome. Int J Dev Neurosci 2022; 82:539-547. [PMID: 35775746 DOI: 10.1002/jdn.10209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022] Open
Abstract
Tourette syndrome (TS) is a neurological disorder characterized by involuntary and repetitive movements known as tics. A retrospective analysis of magnetic resonance imaging (MRI) scans from 39 children and adolescents with TS was performed and subsequently compared to MRI scans from 834 neurotypical controls. The purpose of this study was to identify any differences in the regions of motor circuitry in TS to further our understanding of their disturbances in motor control (i.e., motor tics). Measures of volume, cortical thickness, surface area, and surface curvature for specific motor regions were derived from each MRI scan. The results revealed increased surface curvature in the opercular part of the inferior frontal gyrus and the triangular part of the inferior frontal gyrus in the TS group compared to the neurotypical control group. These novel findings offer some of the first evidence for surface curvature differences in motor circuitry regions in TS, which may be associated with known motor and vocal tics.
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Affiliation(s)
- Bernadette McCann
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada
| | - Melanie Lam
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada
| | - Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Prahar Ijner
- Department of Computer Science, St. Francis Xavier University, Antigonish, NS, Canada
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Department of Pediatrics, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Massachusetts Institute of Technology, Charlestown, MA, USA
| | - Jacob Levman
- Department of Computer Science, St. Francis Xavier University, Antigonish, NS, Canada.,Nova Scotia Health Authority - Research, Innovation and Discovery, Center for Clinical Research, Halifax, NS, Canada
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30
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Dystonic motor and phonic tics in Tourette syndrome. J Neurol 2022; 269:5312-5318. [PMID: 35567613 DOI: 10.1007/s00415-022-11174-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Dystonic tics differ from clonic tics by their slower and more sustained nature. Dystonic tics are often present in patients with Tourette syndrome (TS) and other tic-disorders. However, their phenomenology and impact on overall impairment have not been extensively studied. MATERIALS AND METHODS We assessed clinical history and tic duration in video-recordings from patients with TS evaluated at our movement disorders clinic. Dystonic tics were defined as those lasting ≥ 1000 ms (ms). RESULTS Of the total of 201 patients with TS, there were 156 with video-recordings suitable for tic duration analysis, of their tics, 57 (36.5%) of whom had dystonic motor tics, including 9 (5.7%) with dystonic phonic tics. Dystonic motor tics had a duration range between 1033 and 15,000 ms and dystonic phonic tics between 1132 and 17,766 ms. Patients with dystonic tics were older 24.4 vs. 16.5 years (P = 0.005) and had an older age at onset 12.9 vs. 7.2 years (P < 0.001), than patients without dystonic tics. The bivariate analysis showed an association between the presence of dystonic tics, greater tic severity and wider body distribution. The multivariate regression analysis showed a statistical association with older age at evaluation (P = 0.001), greater tic severity on video-recordings (P = 0.001) and co-occurrence with complex motor tics (P = 0.020). The presence of dystonic tics increased the risk for being considered for deep brain stimulation therapy, odds ratio: 15.7 (P = 0.002). CONCLUSION Dystonic tics, observed in about a third of patients with TS, are associated with increased severity of TS.
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Arbuzova P, Guo S, Koß C, Kurvits L, Faivre N, Kühn AA, Filevich E, Ganos C. No evidence of impaired visual and tactile metacognition in adults with tourette disorder. Parkinsonism Relat Disord 2022; 97:29-33. [PMID: 35294915 DOI: 10.1016/j.parkreldis.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Premonitory urges in Tourette disorder are often linked to altered somatosensory processing, which might include deficits in metacognition. We explored tactile and visual metacognitive ability in people with Tourette disorder and healthy control participants. METHODS Patients with Tourrete disorder and healthy control participants completed a tactile and a visual metacognitive task. On each trial, participants did a forced choice discrimination and then rated their confidence in their decision. To quantify metacognitive ability, we used m-ratio - a bias-free measure that allows for comparisons across modalities. Correlations between severity of tics and premonitory urges with tactile metacognitive sensitivity were also performed. RESULTS Metacognitive ability in both tactile and visual domains was comparable between adults with Tourette disorder and healthy controls. We also found no evidence for correlations between tactile metacognitive ability and severity of premonitory urges or tic severity. CONCLUSIONS Tactile and visual metacognition is not impaired in adults with Tourette disorder. These results question the role of altered tactile metacognition in pathophysiology of tic disorders.
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Affiliation(s)
- Polina Arbuzova
- Department of Psychology & Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Bernstein Center for Computational Neurosciences Berlin, Berlin, Germany.
| | - Siqi Guo
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Koß
- Department of Psychology, Humboldt-Universität zu Berlin, Bernstein Center for Computational Neurosciences Berlin, Berlin, Germany
| | - Lille Kurvits
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nathan Faivre
- Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elisa Filevich
- Department of Psychology & Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Bernstein Center for Computational Neurosciences Berlin, Berlin, Germany
| | - Christos Ganos
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Eapen V, Usherwood T. Assessing tics in children. BMJ 2022; 376:e069346. [PMID: 35241477 DOI: 10.1136/bmj-2021-069346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Valsamma Eapen
- University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Tim Usherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
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He JL, Mikkelsen M, Huddleston DA, Crocetti D, Cecil KM, Singer HS, Edden RA, Gilbert DL, Mostofsky SH, Puts NA. Frequency and Intensity of Premonitory Urges-to-Tic in Tourette Syndrome Is Associated With Supplementary Motor Area GABA+ Levels. Mov Disord 2022; 37:563-573. [PMID: 34854494 PMCID: PMC9014425 DOI: 10.1002/mds.28868] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Individuals with Tourette syndrome (TS) often report that they express tics as a means of alleviating the experience of unpleasant sensations. These sensations are perceived as an urge to act and are referred to as premonitory urges. Premonitory urges have been the focus of recent efforts to develop interventions to reduce tic expression in those with TS. OBJECTIVE The aim of this study was to examine the contribution of brain γ-aminobutyric acid (GABA) and glutamate levels of the right primary sensorimotor cortex (SM1), supplementary motor area (SMA), and insular cortex (insula) to tic and urge severity in children with TS. METHODS Edited magnetic resonance spectroscopy was used to assess GABA+ (GABA + macromolecules) and Glx (glutamate + glutamine) of the right SM1, SMA, and insula in 68 children with TS (MAge = 10.59, SDAge = 1.33) and 41 typically developing control subjects (MAge = 10.26, SDAge = 2.21). We first compared GABA+ and Glx levels of these brain regions between groups. We then explored the association between regional GABA+ and Glx levels with urge and tic severity. RESULTS GABA+ and Glx of the right SM1, SMA, and insula were comparable between the children with TS and typically developing control subjects. In children with TS, lower levels of SMA GABA+ were associated with more severe and more frequent premonitory urges. Neither GABA+ nor Glx levels were associated with tic severity. CONCLUSIONS These results broadly support the role of GABAergic neurotransmission within the SMA in the experience of premonitory urges in children with TS. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jason L. He
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Mark Mikkelsen
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - David A. Huddleston
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Kim M. Cecil
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Harvey S. Singer
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland, USA,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Donald L. Gilbert
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Stewart H. Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicolaas A.J. Puts
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom,MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom,Correspondence to: Dr. Nicolaas Puts, Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AB, London, United Kingdom;
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Enhanced habit formation in Tourette patients explained by shortcut modulation in a hierarchical cortico-basal ganglia model. Brain Struct Funct 2022; 227:1031-1050. [PMID: 35113242 PMCID: PMC8930794 DOI: 10.1007/s00429-021-02446-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/15/2021] [Indexed: 12/28/2022]
Abstract
Devaluation protocols reveal that Tourette patients show an increased propensity to habitual behaviors as they continue to respond to devalued outcomes in a cognitive stimulus-response-outcome association task. We use a neuro-computational model of hierarchically organized cortico-basal ganglia-thalamo-cortical loops to shed more light on habit formation and its alteration in Tourette patients. In our model, habitual behavior emerges from cortico-thalamic shortcut connections, where enhanced habit formation can be linked to faster plasticity in the shortcut or to a stronger feedback from the shortcut to the basal ganglia. We explore two major hypotheses of Tourette pathophysiology-local striatal disinhibition and increased dopaminergic modulation of striatal medium spiny neurons-as causes for altered shortcut activation. Both model changes altered shortcut functioning and resulted in higher rates of responses towards devalued outcomes, similar to what is observed in Tourette patients. We recommend future experimental neuroscientific studies to locate shortcuts between cortico-basal ganglia-thalamo-cortical loops in the human brain and study their potential role in health and disease.
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Essing J, Jakubovski E, Psathakis N, Cevirme SN, Leckman JF, Müller-Vahl KR. Premonitory Urges Reconsidered: Urge Location Corresponds to Tic Location in Patients With Primary Tic Disorders. J Mov Disord 2022; 15:43-52. [PMID: 35124958 PMCID: PMC8820883 DOI: 10.14802/jmd.21045] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Objective In patients with Tourette syndrome and other primary tic disorders (PTDs), tics are typically preceded by premonitory urges (PUs). To date, only a few studies have investigated the location and frequency of PUs, and contrary to clinical experience, the results suggest that PUs are not located in the same anatomic region as the tics. This study aimed to further explore PU location and frequency in detail, differentiating the kind and complexity of the corresponding tics, in a large sample of patients with PTD. Methods A total of 291 adult (≥ 18 years) patients with a confirmed diagnosis of chronic PTD were included. The study was conducted online, assement included tics and the general characterization of PUs and a sophisticated body drawing for locating PUs. Results We found that PUs were located in the same body area as, or in direct proximity to, the corresponding tic. Most frequently, PUs were located in the face and at the head (62.1%). Compared with simple tics, complex (motor and vocal) tics were more often preceded by a PU; but there was no difference in PU frequency observed between motor tics and vocal tics. PUs were more often experienced at the front than at the back of the body (73% vs. 27%), while there was no difference between the right and left sides (41.6% vs. 41.3%). Conclusion The strong association between PU and tic location further supports the hypothesis that PUs represent the core of PTD. Accordingly, future therapies should focus on treating PUs to achieve greater tic reduction.
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Affiliation(s)
- Jana Essing
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Nikolas Psathakis
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Sinan N Cevirme
- Center of Experimental Medicine, Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
- Corresponding author: Kirsten R Müller-Vahl, MD Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany / Tel: +49- 511-5323551 / Fax: +49-511-5323187 / E-mail:
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36
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Martindale JM, Mink JW. The Rise of Functional Tic-Like Behaviors: What Do the COVID-19 Pandemic and Social Media Have to Do With It? A Narrative Review. Front Pediatr 2022; 10:863919. [PMID: 35899132 PMCID: PMC9309505 DOI: 10.3389/fped.2022.863919] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There has been a rise in explosive onset of tic-like behaviors during the COVID-19 pandemic. Historically, this is an uncommon phenomenology of functional movement disorders across all ages. Both the psychological burden of the pandemic and social media usage have been implicated in the rise of these tic-like behaviors. METHODS This paper provides a narrative review of the literature on chronic tic disorders, functional tics, and mass functional illness with particular focus on the key distinguishing features, role of social media, and the role of COVID-19. RESULTS The COVID-19 pandemic has profoundly affected the mental health of many individuals, including children, adolescents, and their caregivers. Implementation of lockdowns, lifestyle disruptions, school closures, and social distancing have driven a surge in social media and digital technology use. The combination of predisposing factors, the psychological burden of the COVID-19 pandemic, and social media are implicated in the rise and spread of tic-like behaviors; which may represent a modern-day form of mass functional illness. While many of the features overlap with functional tics, there are emerging distinctive features that are important to recognize. A more encompassing term, Functional Tic-Like Behaviors, is used to better reflect multiple contributing factors. CONCLUSION Knowledge of these differences is essential to mitigate downstream health effects and poor outcomes.
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Affiliation(s)
- Jaclyn M Martindale
- Department of Neurology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
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Abstract
AIM Tonic tics (TTs) are a part of a clinical picture of Gilles de la Tourette syndrome (GTS) and manifest themselves as sustained and isometric contraction of a muscle group devoid of the movement effect or accompanied by only slight visible motion. The aim of this study was to evaluate the prevalence and phenomenology of TTs, and to assess the clinical associations of TTs with tic severity and comorbidities in patients with GTS. METHODS We performed a one-time registration study in a cohort of 241 consecutive outpatients with GTS aged 5 to 50 years (188 males, 153 patients under the age of 18 years). All patients were personally interviewed and examined. RESULTS TTs occurred in 85.2% of adults and 63.9% of children and adolescents. Most frequently reported types of TTs were tensing of the abdomen (58.7%), neck (52.7%), and upper limbs (50.3%). Multivariate statistical analysis showed a significant correlation between TTs and the total number of simple tics, total number of complex tics, and age at evaluation. In the group of children and adolescents, an additional significant variable was the duration of GTS. In the group of adults, significant parameters were total number of simple tics, total number of complex tics, peak tic severity ever experienced, premonitory urges, and the presence of dystonic tics. CONCLUSION TTs belong to the tic spectrum, common and early symptoms of GTS, are associated with overall a greater number of tics which are more severe, and with more comorbidities.
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Affiliation(s)
- Justyna Kaczyńska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Janik
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland,Address for correspondence Piotr Janik, MD, PhD Department of Neurology, Medical University of WarsawBanacha 1a, 02-097 WarsawPoland
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Bragdon LB, Eng GK, Belanger A, Collins KA, Stern ER. Interoception and Obsessive-Compulsive Disorder: A Review of Current Evidence and Future Directions. Front Psychiatry 2021; 12:686482. [PMID: 34512412 PMCID: PMC8424053 DOI: 10.3389/fpsyt.2021.686482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023] Open
Abstract
Disrupted interoceptive processes are present in a range of psychiatric conditions, and there is a small but growing body of research on the role of interoception in obsessive-compulsive disorder (OCD). In this review, we outline dimensions of interoception and review current literature on the processing of internal bodily sensations within OCD. Investigations in OCD utilizing objective measures of interoception are limited and results mixed, however, the subjective experience of internal bodily sensations appears to be atypical and relate to specific patterns of symptom dimensions. Further, neuroimaging investigations suggest that interoception is related to core features of OCD, particularly sensory phenomena and disgust. Interoception is discussed in the context of treatment by presenting an overview of existing interventions and suggesting how modifications aimed at better targeting interoceptive processes could serve to optimize outcomes. Interoception represents a promising direction for multi-method research in OCD, which we expect, will prove useful for improving current interventions and identifying new treatment targets.
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Affiliation(s)
- Laura B. Bragdon
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Goi Khia Eng
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Amanda Belanger
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Katherine A. Collins
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily R. Stern
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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Schubert L, Verrel J, Behm A, Bäumer T, Beste C, Münchau A. Inter-individual differences in urge-tic associations in Tourette syndrome. Cortex 2021; 143:80-91. [PMID: 34391084 DOI: 10.1016/j.cortex.2021.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/26/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Premonitory urges are a cardinal feature in Tourette syndrome (GTS) and are commonly viewed as a driving force of tics. However, inter-individual differences in experimentally measured urges, tics and urge-tic associations, as well as possible relations to clinical characteristics and abnormal perception-action processing recently demonstrated in these patients have not been investigated in detail. Here, we analyze the temporal associations between urges and tics in 21 adult patients with GTS including inter-individual differences and the relation of such associations with clinical measures and experimentally tested perception-action coupling. At the group level, our results confirm known positive associations between subjective urges and tics, with increased tic frequency and tic intensity during periods of elevated urge. Inter-individual differences in the associations between urges and tics were, however, substantial. While most participants (57-66 % depending on the specific measure) showed positive associations as expected, several participants did not, and two even had negative associations with tic occurrence and intensity being reduced at times of increased urges. Subjective urge levels and tic occurrence correlated with corresponding clinical scores, providing converging evidence. Measures of the strength of urge-tic associations did not correlate with clinical measures nor the strength of perception-action coupling. Taken together, urge-tic associations in GTS are complex and heterogenous, casting doubt on the notion that tics are primarily driven by urges.
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Affiliation(s)
- Lina Schubert
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Amelie Behm
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany.
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Somatosensory perception-action binding in Tourette syndrome. Sci Rep 2021; 11:13388. [PMID: 34183712 PMCID: PMC8238990 DOI: 10.1038/s41598-021-92761-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
It is a common phenomenon that somatosensory sensations can trigger actions to alleviate experienced tension. Such “urges” are particularly relevant in patients with Gilles de la Tourette (GTS) syndrome since they often precede tics, the cardinal feature of this common neurodevelopmental disorder. Altered sensorimotor integration processes in GTS as well as evidence for increased binding of stimulus- and response-related features (“hyper-binding”) in the visual domain suggest enhanced perception–action binding also in the somatosensory modality. In the current study, the Theory of Event Coding (TEC) was used as an overarching cognitive framework to examine somatosensory-motor binding. For this purpose, a somatosensory-motor version of a task measuring stimulus–response binding (S-R task) was tested using electro-tactile stimuli. Contrary to the main hypothesis, there were no group differences in binding effects between GTS patients and healthy controls in the somatosensory-motor paradigm. Behavioral data did not indicate differences in binding between examined groups. These data can be interpreted such that a compensatory “downregulation” of increased somatosensory stimulus saliency, e.g., due to the occurrence of somatosensory urges and hypersensitivity to external stimuli, results in reduced binding with associated motor output, which brings binding to a “normal” level. Therefore, “hyper-binding” in GTS seems to be modality-specific.
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Bhagwat AA, Deogaonkar M, Deopujari CE. Microsurgery and Neuromodulation for Facial Spasms. Neurol India 2021; 68:S196-S201. [PMID: 33318350 DOI: 10.4103/0028-3886.302455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Facial spasms are of various types. Hemifacial spasm (HFS) is characterized by unilateral tonic-clonic contractions of facial muscles, following a specific pattern of disease progression. It has well-delineated clinical, radiological and electrophysiological features. We have conducted an extensive review of existing literature on the subject, as regards etiopathogenesis, clinical features, investigations and management options for facial spasms. Primary Hemifacial spasm (HFS) may be treated using pharmacotherapy, botulinum toxin injections or microvascular decompression surgery. Microvascular decompression has the potential to reverse the pathological changes of the disease and has proved to be the most successful of all treatment options. Other facial spasms are exceedingly difficult to treat and may need neuromodulation as an option. The following article attempts to review the clinical features and therapeutic approaches to managing patients with facial spasms.
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Affiliation(s)
- Aniruddha A Bhagwat
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Milind Deogaonkar
- Department of Neurosurgery, University of West Virginia, Medical Centre Drive, Morgantown WV, USA
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42
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Ueda K, Black KJ. A Comprehensive Review of Tic Disorders in Children. J Clin Med 2021; 10:2479. [PMID: 34204991 PMCID: PMC8199885 DOI: 10.3390/jcm10112479] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/13/2023] Open
Abstract
Tics are characterized by sudden, rapid, recurrent, nonrhythmic movement or vocalization, and are the most common movement disorders in children. Their onset is usually in childhood and tics often will diminish within one year. However, some of the tics can persist and cause various problems such as social embarrassment, physical discomfort, or emotional impairments, which could interfere with daily activities and school performance. Furthermore, tic disorders are frequently associated with comorbid neuropsychiatric symptoms, which can become more problematic than tic symptoms. Unfortunately, misunderstanding and misconceptions of tic disorders still exist among the general population. Understanding tic disorders and their comorbidities is important to deliver appropriate care to patients with tics. Several studies have been conducted to elucidate the clinical course, epidemiology, and pathophysiology of tics, but they are still not well understood. This article aims to provide an overview about tics and tic disorders, and recent findings on tic disorders including history, definition, diagnosis, epidemiology, etiology, diagnostic approach, comorbidities, treatment and management, and differential diagnosis.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Kevin J. Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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Rae CL, Parkinson J, Betka S, Gouldvan Praag CD, Bouyagoub S, Polyanska L, Larsson DEO, Harrison NA, Garfinkel SN, Critchley HD. Amplified engagement of prefrontal cortex during control of voluntary action in Tourette syndrome. Brain Commun 2021; 2:fcaa199. [PMID: 33409490 PMCID: PMC7772099 DOI: 10.1093/braincomms/fcaa199] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Tourette syndrome is characterized by ‘unvoluntary’ tics, which are compulsive, yet often temporarily suppressible. The inferior frontal gyrus is implicated in motor control, including inhibition of pre-potent actions through influences on downstream subcortical and motor regions. Although tic suppression in Tourette syndrome also engages the inferior frontal gyrus, it is unclear whether such prefrontal control of action is also dysfunctional: Tic suppression studies do not permit comparison with control groups, and neuroimaging studies of motor inhibition can be confounded by the concurrent expression or suppression of tics. Here, patients with Tourette syndrome were directly compared to control participants when performing an intentional inhibition task during functional MRI. Tic expression was recorded throughout for removal from statistical models. Participants were instructed to make a button press in response to Go cues, withhold responses to NoGo cues, and decide whether to press or withhold to ‘Choose’ cues. Overall performance was similar between groups, for both intentional inhibition rates (% Choose-Go) and reactive NoGo inhibition commission errors. A subliminal face prime elicited no additional effects on intentional or reactive inhibition. Across participants, the task activated prefrontal and motor cortices and subcortical nuclei, including pre-supplementary motor area, inferior frontal gyrus, insula, caudate nucleus, thalamus and primary motor cortex. In Tourette syndrome, activity was elevated in the inferior frontal gyrus, insula and basal ganglia, most notably within the right inferior frontal gyrus during voluntary action and inhibition (Choose-Go and Choose-NoGo), and reactive inhibition (NoGo-correct). Anatomically, the locus of this inferior frontal gyrus hyperactivation during control of voluntary action matched that previously reported for tic suppression. In Tourette syndrome, activity within the caudate nucleus was also enhanced during both intentional (Choose-NoGo) and reactive (NoGo-correct) inhibition. Strikingly, despite the absence of overt motor behaviour, primary motor cortex activity increased in patients with Tourette syndrome but decreased in controls during both reactive and intentional inhibition. Additionally, severity of premonitory sensations scaled with functional connectivity of the pre-supplementary motor area to the caudate nucleus, globus pallidus and thalamus when choosing to respond (Choose-Go). Together, these results suggest that patients with Tourette syndrome use equivalent prefrontal mechanisms to suppress tics and withhold non-tic actions, but require greater inferior frontal gyrus engagement than controls to overcome motor drive from hyperactive downstream regions, notably primary motor cortex. Moreover, premonitory sensations may cue midline motor regions to generate tics through interactions with the basal ganglia.
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Affiliation(s)
- Charlotte L Rae
- School of Psychology, University of Sussex, Sussex BN1 9QH, UK
| | - Jim Parkinson
- School of Psychology, University of Sussex, Sussex BN1 9QH, UK
| | - Sophie Betka
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | | | - Samira Bouyagoub
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | - Liliana Polyanska
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | | | - Neil A Harrison
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, Sussex, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Sussex, UK
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Cen SS, Yu J, Wang Q, Deeb W, Wang KL, Shukla AW, Malaty I, Ramirez-Zamora A, Zhang JG, Hu W, Meng FG. Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview. Front Neurol 2021; 11:573576. [PMID: 33391146 PMCID: PMC7775481 DOI: 10.3389/fneur.2020.573576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.
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Affiliation(s)
- Shan-Shan Cen
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jun Yu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wissam Deeb
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Kai-Liang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aparna Wagle Shukla
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Irene Malaty
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Hu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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Forcadell E, Garcia-Delgar B, Nicolau R, Pérez-Vigil A, Cordovilla C, Lázaro L, Ibáñez L, Mir P, Madruga-Garrido M, Correa-Vela M, Morer A. Tic disorders and premonitory urges: validation of the Spanish-language version of the Premonitory Urge for Tics Scale in children and adolescents. Neurologia 2020; 38:S0213-4853(20)30427-8. [PMID: 33317967 DOI: 10.1016/j.nrl.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Most people with persistent tics report an unpleasant sensation (premonitory urge) before the tic. In recent years, interest in these sensory phenomena has increased due to their important role in behavioural therapy. However, instruments for assessing these sensations remain scarce. Among the available instruments, the Premonitory Urge for Tics Scale (PUTS) is the most widely used. METHODS We examined the psychometric properties and factor structure of the Spanish-language version of the PUTS in a sample of 72 children and adolescents with Tourette syndrome or persistent tic disorders. We analysed data from the total sample and by age group (children up to 10 years old and children/adolescents over 10). RESULTS The PUTS presented good internal consistency and moderate correlations between items on the scale (except for item one). Divergent validity was good, test-retest reliability was adequate, and a bifactorial structure was identified (one dimension related to mental phenomena reported in obsessive-compulsive disorder, and another related to the quality and frequency of premonitory urges). These results were replicated in both age groups, with lower divergent validity and test-retest reliability in the younger group. CONCLUSIONS The Spanish-language version of the PUTS is a valid, reliable tool for assessing premonitory urges in both children and adolescents, especially after the age of 10.
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Affiliation(s)
- E Forcadell
- Servicio de Psiquiatría y Psicología Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, España.
| | - B Garcia-Delgar
- Servicio de Psiquiatría y Psicología Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, España
| | - R Nicolau
- Servicio de Psiquiatría y Psicología Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, España
| | - A Pérez-Vigil
- Servicio de Psiquiatría y Psicología Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, España
| | - C Cordovilla
- Servicio de Psiquiatría y Psicología Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, España
| | - L Lázaro
- Servicio de Psiquiatría y Psicología Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, España; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - L Ibáñez
- Family Health Centers at NYU Langone, Nueva York, Estados Unidos de América
| | - P Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Madruga-Garrido
- Sección de Neuropediatría, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Correa-Vela
- Sección de Neurología Pediátrica, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, España
| | - A Morer
- Servicio de Psiquiatría y Psicología Clínica Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic Universitari, Barcelona, España; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, España
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Kleimaker A, Kleimaker M, Bäumer T, Beste C, Münchau A. Gilles de la Tourette Syndrome-A Disorder of Action-Perception Integration. Front Neurol 2020; 11:597898. [PMID: 33324336 PMCID: PMC7726237 DOI: 10.3389/fneur.2020.597898] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022] Open
Abstract
Gilles de la Tourette syndrome is a multifaceted and complex neuropsychiatric disorder. Given that tics as motor phenomena are the defining and cardinal feature of Tourette syndrome, it has long been conceptualized as a motor/movement disorder. However, considering premonitory urges preceding tics, hypersensitivity to external stimuli and abnormalities in sensorimotor integration perceptual processes also seem to be relevant in the pathophysiology of Tourette syndrome. In addition, tic expression depends on attention and tics can, at least partly and transiently, be controlled, so that cognitive processes need to be considered as well. Against this background, explanatory concepts should encompass not only the motor phenomenon tic but also perceptual and cognitive processes. Representing a comprehensive theory of the processing of perceptions and actions paying particular attention to their interdependency and the role of cognitive control, the Theory of Event Coding seems to be a suitable conceptual framework for the understanding of Tourette syndrome. In fact, recent data suggests that addressing the relation between actions (i.e., tics) and perceptions (i.e., sensory phenomena like premonitory urges) in the context of event coding allows to gaining relevant insights into perception-action coding in Tourette syndrome indicating that perception action binding is abnormally strong in this disorder.
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Affiliation(s)
- Alexander Kleimaker
- Center of Brain, Behavior and Metabolism, Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Maximilian Kleimaker
- Center of Brain, Behavior and Metabolism, Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Bäumer
- Center of Brain, Behavior and Metabolism, Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Alexander Münchau
- Center of Brain, Behavior and Metabolism, Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
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Badenoch J, Searle T, Watson I, Cavanna AE. Sensory symptoms in body-focused repetitive behaviors, restless legs syndrome, and Tourette syndrome: An overlap? Neurosci Biobehav Rev 2020; 119:320-332. [PMID: 33086129 DOI: 10.1016/j.neubiorev.2020.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/25/2022]
Abstract
Tourette syndrome (TS) is a neurodevelopmental condition characterized by multiple tics. Sensory symptoms play a key role in the clinical phenomenology and pathophysiology of TS, as most patients report premonitory urges driving tic expression. Interestingly, sensory symptoms have also been reported in other conditions characterized by repeated behaviors. This review explores the nature of sensory symptoms reported by patients with body focused repetitive behaviors (BFRBs, especially trichotillomania and skin picking disorder) and restless legs syndrome (RLS) in comparison to TS. A sense of mounting inner tension and reinforcement mechanisms driven by gratification and relief on expression of the tic or repetitive behavior appear to be implicated across all conditions. Subjective urges can be temporarily suppressed by patients with TS and selected BFRBs, whereas patients with RLS tend to report dysesthesia more frequently than a suppressible urge to move. The observed similarities in the phenomenology of sensory symptoms across these conditions raise the possibility of a comparable underlying pathophysiology. Preliminary findings suggest an overlap of neural pathways encompassing the insula, basal ganglia (putamen), and posterior cingulate cortex.
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Affiliation(s)
- James Badenoch
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom
| | - Tamara Searle
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom
| | - Iona Watson
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom; University College London and Institute of Neurology, London, United Kingdom.
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48
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Yan J, Yu L, Wen F, Wang F, Liu J, Cui Y, Li Y. The severity of obsessive-compulsive symptoms in Tourette syndrome and its relationship with premonitory urges: a meta-analysis. Expert Rev Neurother 2020; 20:1197-1205. [PMID: 32954857 DOI: 10.1080/14737175.2020.1826932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Nearly half of the patients with Tourette Syndrome (TS) present with comorbid Obsessive-Compulsive Symptoms (OCS) and premonitory urges (PUs). However, inconsistent results have been found in the correlation between PUs and OCS in patients with TS. METHODS A meta-analysis was applied to identify the severity of OCS and its correlation with PUs in TS patients. Subgroup and meta-regression analyses were used to identify potential heterogeneity. RESULTS A total of 13 studies, including 576 patients, were enrolled in this study. The pooled correlation coefficient (r) was 0.29 (95% confidence interval: 0.18, 0.38) and heterogeneity (I2) of pooled r was 40% based on a fixed-effect model. The mean level of OCS based on the assessment of Children's Yale-Brown Obsessive-Compulsive Symptom Scale/Yale-Brown Obsessive-Compulsive Symptom Scale was 14.99 (95% CI: 11.41, 18.57) by a random effect model. Results of meta-regression analysis demonstrated that the severity of tic symptoms based on the assessment of the Yale Global Tic Severity Scale was the predictor of severity of OCS (p = 0.018). CONCLUSION There was a mild positive correlation between the PUs and OCS in patients with TS. The severity of OCS in TS patients was mild to moderate and positively predicted by the severity of tic symptoms.
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Affiliation(s)
- Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Liping Yu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Fang Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Jingran Liu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
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Sigurdsson HP, Jackson SR, Kim S, Dyke K, Jackson GM. A feasibility study for somatomotor cortical mapping in Tourette syndrome using neuronavigated transcranial magnetic stimulation. Cortex 2020; 129:175-187. [DOI: 10.1016/j.cortex.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/06/2020] [Accepted: 04/21/2020] [Indexed: 01/20/2023]
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Naro A, Billeri L, Colucci VP, Le Cause M, De Domenico C, Ciatto L, Bramanti P, Bramanti A, Calabrò RS. Brain functional connectivity in chronic tic disorders and Gilles de la Tourette syndrome. Prog Neurobiol 2020; 194:101884. [PMID: 32659317 DOI: 10.1016/j.pneurobio.2020.101884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/27/2020] [Accepted: 07/07/2020] [Indexed: 01/23/2023]
Abstract
The pathophysiology of chronic tic disorder (cTD) and Gilles de la Tourette syndrome (GTS) is characterized by the dysfunction of both motor and non - motor cortico - striatal - thalamo - cortical (CSTC) circuitries, which leads to tic release and comorbids. A role of fronto - parietal network (FPN) connectivity breakdown has been postulated for tic pathogenesis, given that the FPN entertain connections with limbic, paralimbic, and CSTC networks. Our study was aimed at characterizing the FPN functional connectivity in cTD and GTS in order to assess the role of its deterioration in tic severity and the degree of comorbids. We recorded scalp EEG during resting state in patients with cTD and GTS. The eLORETA current source densities were analyzed, and the lagged phase synchronization (LPS) was calculated to estimate nonlinear functional connectivity between cortical areas. We found that the FPN functional connectivity in delta band was more detrimental in more severe GTS patients. Also, the sensorimotor functional connectivity in beta2 band was stronger in more severe cTD and GTS patients. FPN functional connectivity deterioration correlated with comorbids presence and severity in patients with GTS. Our data suggest that a FPN disconnection may contribute to the motoric symptomatology and comorbid severity in GTS, whereas sensorimotor disconnection may contribute to tic severity in cTD and GTS. Although preliminary, our study points out a differently disturbed brain connectivity between patients with cTD and GTS. This may serve as diagnostic marker and potentially interesting base to develop pharmacological and noninvasive neuromodulation trials aimed at reducing tic symptomatology.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | | | - Laura Ciatto
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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