Tourette Syndrome Neurodevelopmental Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Neuroimage Clin. 2020;26:102198. doi: 10.1016/j.nicl.2020.102198. Epub 2020 Jan 25.
Tourette syndrome (TS) is commonly comorbid with obsessive-compulsive disorder (OCD) and many phenomenological similarities exist between tics and obsessive-compulsive symptoms (OCS). Therefore, due to the clinical importance of comorbid OCD, the goal of this study was to investigate the neural substrates of OCS in TS using functional magnetic resonance imaging.
Forty patients with TS and 20 healthy controls underwent functional magnetic resonance imaging while viewing blocks of OCS-provoking pictures relating to washing, checking and symmetry symptoms, as well as generally disgusting and neutral scenes. Statistical comparisons were made between patients with moderate/severe OCS, absent/mild OCS and healthy controls. As well, within the entire TS patient group, significant associations with clinical measures were assessed for each of the provocation conditions.
Group differences in the insula, sensorimotor cortex, supramarginal gyrus and visual processing regions were common among the checking, washing and disgust conditions. In the patient group, negative associations between OCS severity and activity in the supramarginal gyrus, inferior frontal gyrus, sensorimotor cortex, precuneus and visual processing regions were common among the provocation conditions. Tic severity was only associated with activity in the anterior cingulate cortex for the symmetry condition.
Our findings implicate areas previously reported to be involved in OCD, as well as areas not typically implicated in OCD, suggesting that the neurobiological profile of TS+OCD is intermediate to pure TS and pure OCD.
妥瑞氏症（TS）通常与强迫症（OCD）共病，且抽动和强迫症状（OCS）之间存在许多现象学上的相似之处。因此，由于共病 OCD 的临床重要性，本研究的目的是使用功能磁共振成像研究 TS 中 OCS 的神经基础。
40 名 TS 患者和 20 名健康对照者接受了功能磁共振成像检查，同时观看了与洗涤、检查和对称症状相关的 OCS 诱发图片、一般令人厌恶和中性场景的图片。对中度/重度 OCS、无/轻度 OCS 和健康对照组患者进行了统计比较。此外，在整个 TS 患者组中，对每种诱发条件与临床指标的显著相关性进行了评估。
在检查、洗涤和厌恶条件下，岛叶、感觉运动皮层、缘上回和视觉处理区域的组间差异是共同的。在患者组中，OCS 严重程度与缘上回、下额前回、感觉运动皮层、楔前叶和视觉处理区域的活动之间存在负相关，在所有诱发条件下均存在这种情况。对于对称条件，抽搐严重程度仅与前扣带皮层的活动有关。
我们的研究结果提示了以前报道与 OCD 相关的区域，以及通常不涉及 OCD 的区域，表明 TS+OCD 的神经生物学特征介于单纯 TS 和单纯 OCD 之间。
