Department of Neurology, Rostock University Medical Center, Rostock, Germany.
Department of Psychiatry, Neurology, Psychosomatics, and Psychotherapy in Childhood and Adolescence, Rostock University Medical Center, Rostock, Germany.
J Psychiatr Res. 2024 Aug;176:18-22. doi: 10.1016/j.jpsychires.2024.05.058. Epub 2024 May 30.
Functional neuroimaging studies demonstrate disinhibition of the cortico-striatal-thalamo-cortical circuit. However, structural imaging studies revealed conflicting results, some suggesting smaller volumes of the caudate nucleus (CN) in children with Gilles de la Tourette syndrome (TS). Here we wanted to find out whether transcranial sonography (TCS) detects alterations of raphe nuclei, substantia nigra, lenticular nucleus (LN), or CN in children with Tic disorder or TS (TIC/TS).The study included 25 treatment-naive children (age: 12.2 ± 2.5 years) with a DSM-V based diagnosis of Tic disorder or TS (10 subjects), without other psychiatric or neurologic diagnosis, and 25 healthy controls (age: 12.17 ± 2.57 years), matched for age and sex. Parental rating of behavioral, emotional abnormalities, somatic complaints and social competencies of the participants were assessed using the Child Behavior Check List (CBCL/4-18R). TCS of deep brain structures was conducted through the preauricular acoustic bone windows using a 2.5-MHz phased-array ultrasound system. Fisher's exact test and Mann-Whitney-U test were used for comparisons between TIC/TS patients and healthy volunteers. The number of participants with hyperechogenic area of left CN in the TIC/TS sample was increased, compared to the healthy control group. TIC/TS patients with hyperechogenic CN showed an increased occurrence of thought- and obsessive-compulsive problems. This TCS study revealed pathologic structural changes in CN, its higher occurrence in TIC/TS compared to healthy controls and the relation to comorbidity of thought problems. Further research should focus on the molecular cause of these alterations, probably the disturbed iron metabolism.
功能神经影像学研究表明皮质-纹状体-丘脑-皮质回路的抑制作用。然而，结构影像学研究结果却存在矛盾，一些研究表明，图雷特综合征（TS）患儿的尾状核体积较小。在这里，我们想了解经颅超声（TCS）是否能检测到抽动障碍或 TS（TIC/TS）患儿的中缝核、黑质、豆状核（LN）或尾状核改变。该研究纳入了 25 名未经治疗的儿童（年龄：12.2±2.5 岁），这些儿童均符合 DSM-V 标准的抽动障碍或 TS 诊断（10 名受试者），没有其他精神或神经诊断，同时还纳入了 25 名健康对照者（年龄：12.17±2.57 岁），在年龄和性别上与患者相匹配。采用儿童行为检查表（CBCL/4-18R）对参与者的行为、情绪异常、躯体抱怨和社会能力进行了父母评定。通过经耳前骨窗用 2.5MHz 相控阵超声系统对深部脑结构进行了 TCS。采用 Fisher 确切检验和 Mann-Whitney-U 检验对 TIC/TS 患者和健康志愿者进行了比较。与健康对照组相比，TIC/TS 样本中左侧 CN 高回声区的参与者数量增加。CN 高回声的 TIC/TS 患者出现思维和强迫性问题的发生率增加。这项 TCS 研究揭示了 CN 的病理性结构变化，与健康对照组相比，TIC/TS 患者中更常见，并且与思维问题的共病有关。进一步的研究应集中于这些改变的分子原因，可能是铁代谢紊乱。
