抽动障碍患儿 tic 严重程度的生物标志物：经颅磁刺激测量的运动皮层抑制。
Biomarkers of tic severity in children with Tourette syndrome: Motor cortex inhibition measured with transcranial magnetic stimulation.
机构信息
Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA.
Division of Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
出版信息
Dev Med Child Neurol. 2023 Oct;65(10):1321-1331. doi: 10.1111/dmcn.15578. Epub 2023 Mar 20.
AIM
To compare transcranial magnetic stimulation (TMS)-derived measures of primary motor cortex (M1) physiology between children with and without Tourette syndrome, and to dimensionally analyze TMS measures with Tourette syndrome-related symptom severity.
METHOD
We used a cross-sectional experimental design. Sixty 8- to 12-year-old children participated (30 with Tourette syndrome: three females, mean age 10 years 10 months, standard deviation [SD] 1 year 3 months; 30 typically developing children: seven females, mean age 10 years 7 months, SD 1 year 3 months). In the group with Tourette syndrome, 15 (one female, mean age 10 years 11 months, SD 1 year 3 months) had comorbid attention-deficit/hyperactivity disorder (ADHD), rated with the Conners, Third Edition and the parent-reported ADHD rating scales. Tic severity was rated with the Yale Global Tic Severity Scale and urge severity with the Individualized Premonitory Urge for Tics Scale. M1 short-interval cortical inhibition (SICI) and intracortical facilitation were compared between diagnostic groups and, within the group with Tourette syndrome, correlated with symptom severity using linear mixed-effects models for repeated measures.
RESULTS
Accounting for ADHD, we found no difference in SICI or intracortical facilitation in those with Tourette syndrome versus typically developing children (p > 0.1). In the group with Tourette syndrome, reduced M1 SICI predicted greater total (p = 0.012) and global (p = 0.002) tic severity. There were no associations with urge severity (p > 0.5).
INTERPRETATION
Reduced M1 SICI is robustly associated with increased tic, but not urge, severity.
WHAT THIS PAPER ADDS
Increased tic severity is associated with reduced motor cortex short-interval cortical inhibition (SICI). Children with Tourette syndrome with increased urge severity also show increased tic severity. However, reduced motor cortex SICI is associated with tic, but not urge, severity.
目的
比较伴有和不伴有妥瑞氏综合征（Tourette syndrome，TS）的儿童的经颅磁刺激（transcranial magnetic stimulation，TMS）源性初级运动皮层（M1）生理学测量值，并对 TMS 测量值与 TS 相关症状严重程度进行维度分析。
方法
我们采用了横断面实验设计。共有 60 名 8 至 12 岁的儿童参与了此项研究（30 名患有妥瑞氏综合征的儿童：3 名女性，平均年龄 10 岁 10 个月，标准差[SD]为 1 年 3 个月；30 名正常发育的儿童：7 名女性，平均年龄 10 岁 7 个月，SD 为 1 年 3 个月）。在妥瑞氏综合征组中，有 15 名（1 名女性，平均年龄 10 岁 11 个月，SD 为 1 年 3 个月）患有注意力缺陷多动障碍（attention-deficit/hyperactivity disorder，ADHD），使用康纳氏第三版（Conners，Third Edition）和父母报告的 ADHD 评定量表进行评定。用耶鲁总体 tic 严重程度量表（Yale Global Tic Severity Scale）和个体冲动 tic 前预感量表（Individualized Premonitory Urge for Tics Scale）评定 tic 严重程度和冲动严重程度。比较诊断组之间的 M1 短潜伏期皮质抑制（short-interval cortical inhibition，SICI）和皮质内易化，并在妥瑞氏综合征组内，使用重复测量线性混合效应模型，将 M1 SICI 与症状严重程度进行相关性分析。
结果
在考虑到 ADHD 后，我们发现妥瑞氏综合征组与正常发育组之间的 SICI 或皮质内易化无差异（p>0.1）。在妥瑞氏综合征组中，M1 SICI 降低与总 tic 严重程度（p=0.012）和总体 tic 严重程度（p=0.002）呈正相关。但与冲动严重程度无关（p>0.5）。
结论
M1 SICI 降低与 tic 严重程度增加显著相关，但与冲动严重程度无关。
本研究的重要发现
增加的 tic 严重程度与降低的运动皮层短潜伏期皮质抑制（short-interval cortical inhibition，SICI）有关。伴有增加冲动严重程度的妥瑞氏综合征儿童也表现出 tic 严重程度增加。然而，降低的运动皮层 SICI 与 tic 严重程度有关，与冲动严重程度无关。
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