Deckersbach Thilo, Chou Tina, Britton Jennifer C, Carlson Lindsay E, Reese Hannah E, Siev Jedidiah, Scahill Lawrence, Piacentini John C, Woods Douglas W, Walkup John T, Peterson Alan L, Dougherty Darin D, Wilhelm Sabine
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Harvard University, Cambridge, MA, USA.
Psychiatry Res. 2014 Dec 30;224(3):269-74. doi: 10.1016/j.pscychresns.2014.09.003. Epub 2014 Sep 16.
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.
抽动秽语障碍，也称为抽动秽语综合征（TS），其特征是运动性和发声性抽动，可导致日常功能严重受损。抽动被认为是由于联合和运动皮质-纹状体-丘脑-皮质通路的抑制失败所致。抽动综合行为干预（CBIT）是习惯逆转疗法（HRT）的延伸，它教导患者更加意识到抽动之前可靠出现的感觉（先兆冲动），并启动抑制抽动发生的竞争性动作。在本研究中，我们使用功能磁共振成像（fMRI）来研究与CBIT治疗相关的TS患者的神经变化。八名TS患者在性别、教育程度、年龄和利手方面与八名健康对照匹配。受试者在CBIT治疗前和治疗后（或对照组的等待期）的fMRI扫描期间完成视觉空间启动（VSP）任务，这是一种反应抑制的测量方法。对于TS患者，我们发现从治疗前到治疗后纹状体（壳核）激活显著降低。布罗德曼区47（额下回）中从治疗前到治疗后与VSP任务相关的激活变化与抽动严重程度的变化呈负相关。CBIT可能促进TS患者异常的皮质-纹状体-丘脑-皮质联合和运动通路正常化。
