Summary: Real-time fMRI neurofeedback could be a potential new treatment for Tourette syndrome.
Characterized by repetitive movements or vocalizations known as tics, Tourette Syndrome is a neurodevelopmental disorder that plagues many adolescents. A study conducted by Yale researchers has trained adolescents with Tourette Syndrome to control their tics through an imaging technique that allows patients to monitor the function of their own brain in real time.
This study is published in Biological Psychiatry.
The study utilized real-time functional magnetic resonance imaging neurofeedback (rt-fMRI-NF), which is a relatively new technique with great potential for treating neuropsychiatric disorders, according to Michelle Hampson, senior author and associate professor in the Department of Radiology and Biomedical Imaging. “It is a non-invasive, neuroscience-based intervention for training human brain function towards healthier patterns,” Hampson said.
Although researchers have explored the clinical utility of this technique in treating conditions from depression to Parkinson’s disease, this study marks the first time that it has been tested as a clinical intervention for Tourette Syndrome.
The study enrolled individuals with Tourette Syndrome ages 11 to 19 years who displayed a certain frequency of tics as measured by the Yale Global Tic Severity Scale. Subjects were tasked with alternately raising and lowering activity in the supplementary motor area, a brain region associated with tics in Tourette Syndrome, which was displayed to them as a real-time graph during the brain imaging scans. The researchers found a significant reduction of tics in subjects during the training, which exceeded symptom improvements in a control condition (the control condition was designed to induce similar placebo and motivation effects but did not involve real neurofeedback), suggesting that the neurofeedback may be helpful for treating Tourette symptoms.
“Currently available treatments for tics in Tourette Syndrome include behavior therapy and pharmaceuticals, but not everyone responds. This is the first study of its kind showing that rt-fMRI-NF has potential as a treatment for Tourette Syndrome,” said Denis Sukhodolsky, co-author and associate professor in the Yale Child Study Center. This was an early stage study with a small sample size, but the promising results should encourage further research, said the investigators.
Other study authors are Christopher Walsh, William N. Koller, Jeffrey Eilbott, Mariela Rance, Robert K. Fulbright, Zhiying Zhao, Michael H. Bloch, Robert King, James F. Leckman, Dustin Scheinost, and Brian Pittman.
Funding: This study was supported by the National Institutes of Health. The design of the intervention was informed by studies funded by the Tourette Syndrome Association and the Dana Foundation.
Noah Vaca – Yale
The image is credited to Yale.
Original Research: Closed access
“Randomized, sham-controlled trial of real-time fMRI neurofeedback for tics in adolescents with Tourette Syndrome”. Michelle Hampson et al.
Biological Psychiatry. doi:10.1016/j.biopsych.2019.07.035
Randomized, sham-controlled trial of real-time fMRI neurofeedback for tics in adolescents with Tourette Syndrome
Activity in the supplementary motor area (SMA) has been associated with tics in Tourette Syndrome (TS). The aim of this study was to test a novel intervention – real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback from SMA – for reduction of tics in adolescents with TS.
Twenty-one adolescents with TS were enrolled in a double-blind, randomized, sham-controlled, crossover study involving two sessions of neurofeedback from their SMA. The primary outcome measure of tic severity was the Yale Global Tic Symptom Severity Scale (YGTSS) administered by an independent evaluator before and after each arm. The secondary outcome was control over the SMA assessed in neuroimaging scans where subjects were cued to increase/decrease activity in SMA without receiving feedback.
All 21 subjects completed both arms of the study and all assessments. Participants had significantly greater reduction of tics on the YGTSS scale after neurofeedback as compared to sham (p<0.05). Mean Total YGTSS score decreased from 25.2+4.6 at baseline to 19.9+5.7 at endpoint in neurofeedback and from 24.8+8.1 to 23.3+8.5 in sham. The 3.8-point difference is clinically meaningful and corresponds to an effect size of 0.59. However, there were no differences in changes on the secondary measure of control over the SMA. Conclusions
This first randomized controlled trial of rt-fMRI neurofeedback in adolescents with TS suggests that this neurofeedback intervention may be helpful for improving tic symptoms. However, no effects were found in terms of change in control over the SMA, the hypothesized mechanism of action.