A functional neuroanatomy of tics in Tourette syndrome.
BACKGROUND
Tics are involuntary, brief, stereotyped motor and vocal behaviors often associated with irresistible urges. They are a defining symptom of the classic neuropsychiatric disorder, Tourette syndrome (TS), and constitute an example of disordered human volition. The neural correlates of tics are not well understood and have not been imaged selectively.


METHODS
Event-related [(15)O]H(2)O positron emission tomography techniques combined with time-synchronized audio and videotaping were used to determine the duration of, frequency of, and radiotracer input during tics in each of 72 scans from 6 patients with TS. This permitted a voxel-by-voxel correlational analysis within Statistical Parametric Mapping of patterns of neural activity associated with the tics.


RESULTS
Brain regions in which activity was significantly correlated with tic occurrence in the group included medial and lateral premotor cortices, anterior cingulate cortex, dorsolateral-rostral prefrontal cortex, inferior parietal cortex, putamen, and caudate, as well as primary motor cortex, the Broca's area, superior temporal gyrus, insula, and claustrum. In an individual patient with prominent coprolalia, such vocal tics were associated with activity in prerolandic and postrolandic language regions, insula, caudate, thalamus, and cerebellum, while activity in sensorimotor cortex was noted with motor tics.


CONCLUSIONS
Aberrant activity in the interrelated sensorimotor, language, executive, and paralimbic circuits identified in this study may account for the initiation and execution of diverse motor and vocal behaviors that characterize tics in TS, as well as for the urges that often accompany them. Arch Gen Psychiatry. 2000;57:741-748
Stern
E
E
Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Room 1304, Weill Medical College of Cornell University, 525 E 68th St, New York, NY 10021, USA.
Silbersweig
D A
DA
Chee
K Y
KY
Holmes
A
A
Robertson
M M
MM
Trimble
M
M
Frith
C D
CD
Frackowiak
R S
RS
Dolan
R J
RJ
D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology; D010104:Oxygen Radioisotopes; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology; D012720:Severity of Illness Index; D013060:Speech / Q000502:physiology; D013238:Stereotaxic Techniques; D019956:Stereotypic Movement Disorder / Q000175:diagnosis / Q000503:physiopathology; D013637:Tape Recording / Q000706:statistics & numerical data; D020323:Tics / Q000503:physiopathology*; D014055:Tomography, Emission-Computed / Q000706:statistics & numerical data; D005879:Tourette Syndrome / Q000175:diagnosis / Q000503:physiopathology*
D010104:Oxygen Radioisotopes