Brain Areas Coactivating with Motor Cortex During Chronic Motor Tics and Intentional Movements

doi:10.1016/j.biopsych.2008.11.012

Biological Psychiatry

Volume 65, Issue 7, 1 April 2009, Pages 594-599

https://doi.org/10.1016/j.biopsych.2008.11.012 Get rights and content

Background

Chronic tic disorders are characterized by motor tics that are often preceded by premonitory urges to tic. Functional neuroimaging studies have documented brain activity patterns prior to and during tics, but these studies have not examined whether the activation patterns differ from those seen in normal control subjects performing similar acts.

Methods

A novel method was used to compare brain patterns during tics and intentional movements. First, the part of motor cortex specific to each patient's tic movement was identified. The brain areas activating prior to, during, and after that part of motor cortex during tics were then identified by temporally cross-correlating the time course of the localized motor region with activity in other brain areas. Given that motor cortex was active during tic execution, this yielded information regarding the brain areas active prior to, during, and after the movements. The spatiotemporal pattern of coactivation with motor cortex during tics was contrasted with that seen in healthy control subjects during intentional tic-like movements.

Results

Data from 16 adult subjects with tic disorders and 16 matched control subjects, who performed intentional movements similar to the patients' tics, revealed nearly identical patterns of cross-correlation to motor cortex throughout the brain in the two groups. However, the supplementary motor area showed a significantly broader profile of cross-correlation to motor cortex during tics than during intentional movements.

Conclusions

These findings highlight the importance of the supplementary motor area in tic generation and may point toward novel intervention strategies for individuals suffering with severe tics.

Section snippets

Human Subjects

Sixteen individuals (13 men) with active tic disorders between 18 and 56 years of age were recruited. Only individuals who reported they could execute their tics without moving their heads and whose repertoire of tics was dominated by one or two specific movements were included. Diagnoses, tic locations, and pertinent medication profiles are presented in Table 1. Thirteen of the 16 patients experienced a bilateral movement as their most frequent tic, thus limiting our ability to investigate

Results

The maps of cross-correlations to motor cortex during tics revealed activity throughout the motor circuit (Supplement 2). Positive correlations with motor cortex were apparent in primary and secondary motor cortex, SMA, somatosensory cortex, superior temporal gyrus, dorsal anterior cingulate cortex, inferior parietal lobule, cerebellum, orbitofrontal cortex, insula, claustrum, substantia nigra, lenticular nuclei, thalami, and red nuclei. Negative correlations were present in ventral anterior

Discussion

Cross-correlations with the time course of motor cortex during tics revealed a progression of activity through motor circuitry. The pattern of neural activity during intentional movements in control subjects was very similar to that obtained during tics. This underscores the importance of collecting control data to differentiate brain activity specific to tics from brain activity generally associated with movement.

Region of interest analyses revealed differences between patients and control

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Archival ReportBrain Areas Coactivating with Motor Cortex During Chronic Motor Tics and Intentional Movements

Background

Methods

Results

Conclusions

Section snippets

Human Subjects

Results

Discussion

Neuroimage

Neuroimage

Lancet

Clin Neurophysiol

Clin Neurophysiol

The functional neuroanatomy of Tourette's syndrome: An FDG-PET studyI. Regional changes in cerebral glucose metabolism differentiating patients and controls

Neuropsychopharmacology

Structural and functional studies of Gilles de la Tourette syndrome

Rev Neurol

The metabolic anatomy of Tourette's syndrome

Neurology

Asymmetry of basal ganglia perfusion in Tourette's syndrome shown by technetium-99m-HMPAO SPECT

J Nucl Med

[123I] B-CIT SPECT imaging of striatal dopamine transporter binding in Tourette's disorder

Am J Psychiatry

Brain perfusion abnormalities in Gilles de la Tourette's syndrome

Br J Psychiatry

Abnormal cerebral activation associated with a motor task in Tourette syndrome

AJNR Am J Neuroradiol

A functional neuroanatomy of tics in Tourette Syndrome

Arch Gen Psychiatry

Sensory experiences of Gilles de la Tourette syndrome

Arch Gen Psychiatry

Archival Report
Brain Areas Coactivating with Motor Cortex During Chronic Motor Tics and Intentional Movements

[¹²³I] B-CIT SPECT imaging of striatal dopamine transporter binding in Tourette's disorder