Neural correlates of behavior therapy for Tourette's disorder

Thilo Deckersbach; Tina Chou; Jennifer C Britton; Lindsay E Carlson; Hannah E Reese; Jedidiah Siev; Lawrence Scahill; John C Piacentini; Douglas W Woods; John T Walkup; Alan L Peterson; Darin D Dougherty; Sabine Wilhelm

doi:10.1016/j.pscychresns.2014.09.003

Neural correlates of behavior therapy for Tourette's disorder

Psychiatry Res. 2014 Dec 30;224(3):269-74. doi: 10.1016/j.pscychresns.2014.09.003. Epub 2014 Sep 16.

Authors

Affiliations

¹ Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
² Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Harvard University, Cambridge, MA, USA.
³ University of Miami, Coral Gables, FL, USA.
⁴ Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁵ Nova Southeastern University, Fort-Lauderdale-Davie, FL, USA.
⁶ Emory University, Atlanta, GA, USA.
⁷ UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
⁸ Texas A&M University, College Station, TX, USA.
⁹ Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA.
¹⁰ University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.

Abstract

Tourette's disorder, also called Tourette syndrome (TS), is characterized by motor and vocal tics that can cause significant impairment in daily functioning. Tics are believed to be due to failed inhibition of both associative and motor cortico-striato-thalamo-cortical pathways. Comprehensive Behavioral Intervention for Tics (CBIT), which is an extension of Habit Reversal Therapy (HRT), teaches patients to become more aware of sensations that reliably precede tics (premonitory urges) and to initiate competing movements that inhibit the occurrence of tics. In this study, we used functional magnetic resonance imaging (fMRI) to investigate the neural changes associated with CBIT treatment in subjects with TS. Eight subjects with TS were matched with eight healthy controls in gender, education, age, and handedness. Subjects completed the Visuospatial Priming (VSP) task, a measure of response inhibition, during fMRI scanning before and after CBIT treatment (or waiting period for controls). For TS subjects, we found a significant decrease in striatal (putamen) activation from pre- to post-treatment. Change in VSP task-related activation from pre- to post-treatment in Brodmann's area 47 (the inferior frontal gyrus) was negatively correlated with changes in tic severity. CBIT may promote normalization of aberrant cortico-striato-thalamo-cortical associative and motor pathways in individuals with TS.

Keywords: Behavior therapy; Habit reversal; Neuroimaging; Tourette׳s disorder.

Publication types

Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Behavior Therapy / methods*
Cerebrum / physiopathology*
Frontal Lobe / physiopathology
Humans
Inhibition, Psychological*
Magnetic Resonance Imaging
Male
Neural Pathways / physiopathology*
Putamen / physiopathology
Tourette Syndrome / physiopathology*
Tourette Syndrome / therapy*
Treatment Outcome
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding